Multimodal Imaging in the Management of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy.

Ahmed M. Hagag,Sobha Sivaprasad,Pearse A. Keane,Ali Lamin,Andrew J. Lotery,Hagar Khalid,Shruti Chandra

doi:10.3390/jcm9061934

Abstract

The diagnosis and treatment of choroidal neovascularization (CNV) in eyes with chronic central serous chorioretinopathy (CSCR) can be challenging. The purpose of this study was to classify eyes with suspected CNV using multimodal imaging. The effect of intravitreal anti-vascular endothelial growth factor (VEGF) was assessed and compared to controls. This retrospective study included chronic CSCR patients with suspected secondary CNV who received intravitreal bevacizumab. Eyes were divided into “definite CNV” and “no CNV” based on optical coherence tomography angiography (OCTA). Eyes that did not undergo OCTA imaging were considered as “presumed CNV”. One-year outcome in visual acuity (VA) and central foveal thickness (CFT) were investigated and compared to non-treated control patients to assess the response to anti-VEGF. Logistic regression analysis was used to explore predictive biomarkers of CNV detection and improvement after anti-VEGF. Ninety-two eyes with chronic CSCR from 88 participants were included in this study. Sixty-one eyes received bevacizumab and 31 eyes were non-treated control subjects. The presence of subretinal hyperreflective material (SHRM) and shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) with sub-RPE hyperreflectivity on OCT was associated with a significantly increased risk of detecting CNV on OCTA. Intravitreal anti-VEGF caused significant functional and anatomical improvement in patients with neovascular CSCR as compared to non-treated eyes. In contrast, VA and CFT changes were not significantly different between treated and non-treated CSCR with no evidence of CNV on OCTA. No clinical or anatomical biomarkers were found to be associated with response to treatment. In conclusion, OCTA should be used to confirm the presence CNV in suspected chronic CSCR patients. Intravitreal anti-VEGF treatment resulted in a significantly better one-year outcome in patients with definitive OCTA evidence of CNV.

Highlights

Central serous chorioretinopathy (CSCR) is a chorioretinal disease typically characterized by serous subretinal detachment associated with retinal pigment epithelium (RPE) and/or choroidal abnormalities [1,2]
The response to intravitreal bevacizumab injections was retrospectively investigated over a one-year period in a cohort of chronic CSCR patients with suspected secondary choroidal neovascularization (CNV)
Our findings revealed significant functional and anatomical improvement in optical coherence tomography angiography (OCTA)-confirmed CNV secondary to CSCR after anti-vascular endothelial growth factor (VEGF) injections, as compared to control non-treated patients

Summary

Introduction

Central serous chorioretinopathy (CSCR) is a chorioretinal disease typically characterized by serous subretinal detachment associated with retinal pigment epithelium (RPE) and/or choroidal abnormalities [1,2]. It is the fourth most common acquired retinal disease with risk of visual impairment [3]. Patients with macula-involving acute CSCR usually present with blurred vision, metamorphopsia, relative central scotoma, or decreased contrast sensitivity due to accumulation of subretinal fluid (SRF) with/without focal pigment epithelial detachment (PED) evident on optical coherence tomography (OCT). Chronic CSCR, assumed to progress from acute CSCR, is likely to be an independent retinal pigment epitheliopathy secondary to choroidal abnormalities [6,7]

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