Low IOP, High OPP Risk Factors for CSCR

Researchers in Italy recently hypothesized CSCR disease domains by IOP and scleral thickness, where the increase in risk proceeds in the opposite direction. Photo: Mohammad Rafieetary, OD. Click image to enlarge. In the eye, ocular perfusion pressure (OPP) is the driving force of blood flow in the choroidal vessels, and this depends positively on the systemic blood pressure and negatively on intraocular pressure (IOP). To define the possible involvement of IOP in central serous chorioretinopathy (CSCR), researchers in Italy evaluated the condition’s association with OPP and IOP as well as with anterior scleral thickness. The patients with CSCR had significantly higher blood pressure readings and significantly lower IOP values with respect to controls. The study also showed that patients with CSCR have significantly thicker sclera.This cross-sectional study, which was published in the American Journal of Ophthalmology, compared 80 patients with CSCR and 80 healthy controls.Patients with CSCR showed greater anterior scleral thickness (498µm vs. 455μm) and choroidal thickness (435µm vs. 321μm), higher blood pressure (systolic blood pressure: 130.6mm Hg vs. 124.8mm Hg; diastolic blood pressure: 82.8mm Hg vs. 77.0 mm Hg) and lower IOP (12.7mm Hg vs. 16.1mm Hg) than the controls, resulting in higher mean OPP (57.3mm Hg vs. 51.2mm Hg). ROC curve analysis revealed IOP as the strongest disease predictor (AUC=0.914), significantly superior to mean OPP (AUC=0.813) and anterior scleral thickness (AUC=0.737).Using best cut-offs (IOP ≤14mm Hg; anterior scleral thickness >454.5μm), the researchers identified two distinct CSCR subgroups: 13 eyes with low IOP and 12 with high anterior scleral thickness. Both groups displayed similar structural chorioretinal biomarkers and systemic hemodynamic findings.“The higher predictive value of the IOP indicates its autonomous role as a risk factor for CSCR,” the study authors wrote in their paper. “It could facilitate the pathogenesis of the disease both by interacting with hemodynamic factors in the OPP and by autonomously influencing the fluid exchanges in the ocular tissues.”The team speculated that when the tolerated limit of OPP is reached, with the contribution of a low IOP, a progressive choroidal vascular decompensation develops, manifesting with fluid diffusion from the choriocapillaris, especially in the macular region where the hemodynamic stress is greater for the abrupt entrance of short ciliary arteries in this district.With this perspective, pachychoroid and choroidal vein congestion could occur regardless of reduced venous outflow, given that, as the arterial input increases above the tolerability threshold, the blood volume in the choroidal veins increases due to their high compliance.“The IOP appears to define a model of the disease better than other parameters, suggesting a new paradigm for interpreting its pathology and offering new fields of investigation, as well as new therapeutic approaches for CSCR,” the researchers concluded. “Nevertheless, our results cannot be considered conclusive, and further research is required to understand fully the role of IOP and OPP in the pathogenesis of CSCR.”Click here for the journal source. Piccolino FC, Arrigo A, Forte P, et al. Intraocular pressure and ocular perfusion pressure in central serous chorioretinopathy. Am J Ophthalmol. August 22, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.