Choroidal neovascularization in central serous chorioretinopathy—a new clinical entity

Abstract

To describe the morphology of retinal and choroidal vessels in swept source optical coherence tomography angiography (SS-OCTA) in choroidal neovascularization (CNV) during the course of central serous chorioretinopathy (CSC). Additionally, to report intravitreal anti-VEGF (vascular endothelial growth factor) injection treatment results. A case series of patients diagnosed with chronic central serous chorioretinopathy. Fluorescein angiography, spectral domain optical coherence tomography, and SS-OCTA were performed. Analysis of retina and choroidal vasculature was performed. All patients received anti-VEGF therapy. The study demonstrated pathological vessels in the retina avascular zone and at the level of choriocapillaris during the course of choroidal neovascularization in central serous chorioretinopathy. These vessels are invisible in fluorescein angiography, as they are hidden by pooling of the dye. These vessels correspond to a slightly hyper-reflective elevation of retinal pigment epithelium visible in optical coherence tomography. Visual acuity and central retinal thickness decreased after anti-VEGF treatment. The vessels did not completely disappear despite anti-VEGF treatment. This study shows that SS-OCTA enables us to identify neovessels during the course of CSC. In diagnosing this entity, SS-OCTA appears superior to fluorescein angiography and might also enable us to decide on the best timing for anti-VEGF injections.