Central serous chorioretinopathy complicated by neovascularization following panretinal photocoagulation for diabetic retinopathy

Abstract

AbstractPurpose: To report a case of chronic central serous chorioretinopathy (CSCR) complicated by neovascularization following panretinal photocoagulation (PRP) for a proliferative diabetic retinopathy (DR).Methods: A 51‐year‐old man, with a medical history of diabetes mellitus and chronic CSCR presented to our department for alteration of central vision of the left eye (LE) 6 months after bilateral PRP for proliferative DR. Complete ophthalmic examination with best corrected visual acuity (BCVA) measurement, fundus photography, fundus autofluorescence (FAF), swept source optical coherence tomography (SS‐OCT), swept source optical coherence tomography angiography (SS‐OCTA) and indocyanine green angiography (ICG‐A) were performed.Results: BCVA was 20/100 in the right eye (RE) and 20/400 in the LE. Anterior segment examination was unremarkable except for a cataract in the RE. Fundoscopic examination of the LE showed multiple areas of retinal pigment epithelium (RPE) alteration and a temporal pigment epithelium detachment (PED). FAF showed multiple hypoautofluorescent lesions associated with gravitational tracks. SS‐OCT revealed a serous retinal detachment, a flat irregular PED with a double layer sign overlying a thickened choroid and dilated choroidal vessels. Mid‐phase ICGA revealed 2 discrete areas of hyperfluorescence. SS‐OCTA confirmed the presence of 2 well‐defined choroidal neovascular membranes. The patient was diagnosed with Pachychoroid Neovasculopathy (PNV). After 2 intravitreal bevacizumab injections, SS‐OCT showed complete resolution of the subretinal fluid whereas SS‐OCTA visualized a mature “dead‐tree” shaped membrane.Conclusions: This is an unusual case of chronic CSCR progressing to PNV following PRP for RD. The disruption of an active RPE pump mechanism or release of endogenous stress hormones after PRP have been suggested by some authors as possible causes of this progression. Further studies are needed to elucidate the exact pathogenesis.