Response of neovascular central serous chorioretinopathy to an extended upload of anti-VEGF agents

Abstract

Purpose To determine the anatomical and functional outcomes of an extended 6-month intravitreal anti-vascular endothelial growth factor (anti-VEGF) upload in choroidal neovascularization (CNV) secondary to chronic central serous chorioretinopathy (CSCR). Methods A retrospective database analysis was performed applying the following inclusion criteria: (1) diagnosis of CSCR, (2) diagnosis of secondary CNV, and (3) treatment of at least six consecutive injections of anti-VEGF. Outcome measures included the change of central retinal subfield thickness, remodeling of the pigment epithelium detachments, and change in visual function. Results Twenty-one eyes of 21 patients were included. Mean patient age was 65 ± 8.3 years, and 35% of the patients (n = 8) were female. Mean disease duration before diagnosis of CNV was 48 ± 25.3 months. Mean central retinal thickness decreased from 346 ± 61 to 257 ± 57 μm (p < 0.01) after the sixth injection while mean visual acuity improved from 0.65 ± 0.35 to 0.49 ± 0.29 (logMAR; p < 0.01). Of note, an extended upload of six as opposed to three injections yielded an additional mean central retinal thickness reduction (280 ± 46 μm vs. 257 ± 57 μm, p = 0.038). Significant CNV remodeling was observed as a decrease in pigment epithelium detachment (PED) vertical (p = 0.021) and horizontal diameter (p = 0.024) as well as PED height (p < 0.01). Conclusion An extended anti-VEGF upload of six consecutive injections seems to be effective in inducing CNV remodeling and fluid resorption in CNV complicating chronic CSCR.

Comparison of Intraocular Cytokine Levels of Choroidal Neovascularization Secondary to Different Retinopathies

“…Our results demonstrated that in the nCSC group, only the level of VEGF increased; other proinflammatory cytokines remained unchanged, which supports the current view that the mechanism of neovascularization in pachychoroid disease differs greatly from that in AMD (23). The results also provide a theoretical basis for the treatment outcome reported by another study in which all patients with nCSC exhibited reduced pigment epithelial detachment thickness after 6 months of intravitreal anti-VEGF injection treatment (18). In the nAMD group, the levels of the inflammatory cytokines IL-10 and IP-10 both increased.…”

“…Choroidal vessel hyperpermeability and congestion were suggested to be the cause of CSC (17), which is a disease in the pachychoroid spectrum. Secondary CNV in CSC is also called pachychoroid neovasculopathy (18), which may also be affected by the dysregulation and hyperpermeability of the choroidal vessels (19). To our knowledge, although previous studies have shown that the VEGF level in CSC eyes without neovascularization was similar to those in normal human eyes (20,21), no research has investigated the VEGF level in the AH of patients with nCSC.…”

Short-term effect of anti-VEGF for chronic central serous chorioretinopathy according to the presence of choroidal neovascularization using optical coherence tomography angiography

“…Anti-VEGF treatment for chronic CSC with CNV is well-established [26]. Schworm et al [27] reported that extended (6-month) anti-VEGF therapy yielded CMT reduction and improved visual outcome in chronic CSC with CNV. Similarily, Matsumoto et al [28] reported that anti-VEGF therapy improved BCVA and CMT in pachychoroid neovasculopathy over a 2-year period.…”

Short-Term Outcomes of Cataract Surgery in Patients with a History of Central Serous Chorioretinopathy

“…Although these treatments have notable benefits, they also have limitations and do not guarantee a complete resolution of SRF. In addition, antivascular endothelial growth factor therapy is usually not effective, except in patients with neovascular CSC [ 30 , 31 ]. Currently, there is no gold standard method used to manage CSC.…”