Choroidal imaging in patients with Cushing syndrome

Abstract

Aims: Glucocorticoid intake is a well-established risk factor for central serous chorioretinopathy that belongs to the pachychoroid spectrum disease (PSD). The study aimed to assess the prevalence of PSD and analyse the choroidal phenotype in patients with Cushing syndrome.

Methods: A cross-sectional study was performed in Ophtalmopôle hôpital Cochin, Paris, France, with a systematic evaluation of hospitalized patients with Cushing syndrome, between November 2017 and July 2018. 56 eyes from 28 Cushing syndrome patients and 56 eyes of 28 age and gender-matched, and close spherical equivalent healthy participants were included. All patients underwent a complete ophthalmic examination including Enhanced-Depth Imaging (EDI)-Optical Coherence Tomography (OCT). Measures of subfoveal, 1000 µm nasal and 1000 µm temporal choroidal thicknesses were realized, and the presence of choroidal pachyvessels was evaluated. Hormonal tests evaluated the corticotropic axis.

Results: The number of eyes with PSD was significantly higher in Cushing syndrome patients as compared to controls (21.4% versus 3.6%, p = 0.004). In Cushing patients' eyes, 17.9% had a pachychoroid pigment epitheliopathy (PPE) and 3.6% had a polypoidal choroidal vasculopathy. Pachyvessels were more common in Cushing syndrome patients than in healthy subjects (71.4% versus 42.9%, p = 0.002). Mean subfoveal choroidal thickness was 331 ± 110 µm in Cushing patients, with no statistical difference between the two groups. There was no correlation between choroidal thickness and urinary and salivary cortisol levels.

Conclusion: Patients with Cushing syndrome have a higher prevalence of PDS. An ophthalmologic specialized follow-up of these patients with EDI-OCT could detect chorioretinal abnormalities and adapt the surveillance of these patients.

Keywords: Cushing syndrome; choroid; optical coherence tomography; pachychoroid; pachychoroid pigment epitheliopathy.