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

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.

Risk factors and characteristics of central serous chorioretinopathy with later development of macular neovascularisation detected on OCT angiography: a retrospective multicentre observational study

“…A panel of experts recently recommended a new definition of macular neovascularisation (MNV) to replace the old term of choroidal neovascularisation 5. In recent research, CSC has been considered a part of the pachychoroid spectrum disease and may be complicated by the secondary formation of exudative MNV6 7; however, the mechanism of secondary MNV has not yet been determined. Some studies have found an increased prevalence of MNV after treatment with laser8 9 or photodynamic therapy (PDT)9 10 in CSC, which may be caused by rupture of the BM after laser therapy or choroidal ischaemia and excessive vascular endothelial growth factor (VEGF) production after PDT 9…”

Morphologic analysis of macular neovascularizations by OCT angiography—Technical limitations in the comparison of 3×3mm and 6×6mm images

“…Because optical coherence tomography (SD-OCT) is a non-invasive examination, it is particularly useful in cases of suspected MNV. An indication for a type 1 MNV can be shallow irregular retinal epithelium elevation (SIRE), for a type 2 MNV the subretinal hyperreflective material (SHRM) and for a type 3 MNV intraretinal edema with intraretinal hyperreflective material [4]. It is also suitable as a non-invasive monitoring of the disease course by assessing intraretinal and/or subretinal fluid, fibrosis, atrophy, and pigment epithelial detachments [5].…”

Current Pharmacological Treatment Options for Central Serous Chorioretinopathy: A Review

“…However, it is not completely understood whether those type 1 CNVs are really responsible for the exudation, or whether they might be considered a compensatory effect to a subtle and chronic hypossia secondary to a sick choroid. Recently, researchers showed that in patients with cCSC, CNV demonstrated by OCT angiography responded well to bevacizumab injections [ 79 ].…”