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

Abstract

Purpose To analyze the short-term therapeutic efficacy of intravitreal injection of bevacizumab (IVB) for chronic central serous chorioretinopathy (CSC) according to the presence of choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA). Methods A retrospective chart review was perfomed on cases of CSC with CNV (Group 1: n = 31) and an age-matched cases of CSC without CNV (Group 2: n = 30). The response to IVB was evaluated by changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), choroidal thickness (CT), and pachyvessel diameter. Univariate and multivariate linear regression analyses were performed to identify factors associated with the visual outcome of chronic CSC with CNV after IVB. Results At baseline, the CT values differed significantly between Groups 1 and 2 (371.55 ± 67.09 vs. 417.33 ± 71.32 μm, p = 0.01). In Group 1, BCVA improved significantly (p < 0.001), and CMT (p < 0.001), CT (p = 0.001) and pachyvessel diameter (p = 0.045) decreased significantly, after IVB. In Group 2, only pachyvessel diameter (p = 0.001) was significantly smaller after IVB. Univariate analysis showed that the initial CT (B = 0.002, p = 0.026) and pachyvessel diameter (B = 0.002, p = 0.001) significantly affected visual outcome. In multivariate analysis, the initial pachyvessel diameter exhibited significant results (B = 0.002, p = 0.001). Conclusions IVB showed less effective short-term outcomes in chronic CSC patients without CNV than in patients with CNV. In chronic CSC with CNV, the short-term visual outcome after IVB was better in patients with a thinner choroid and smaller pachyvessels.

Nonhomogenous Hyperreflectivity in the Choriocapillaris Layer on Optical Coherence Tomography Angiography Implies Early Treatment with Anti-VEGF for Central Serous Chorioretinopathy

“…However, these previous studies did not analyze the patients according to the presence or absence of CNV on OCTA. Recently, Song et al [24] reported that anti-VEGF therapy showed more effective short-term outcomes in chronic CSCR patients with CNV than those without CNV classified by OCTA, and what they called CNV was similar to the visible CNV in our study (Fig. 3).…”

Bilateral multifocal and recurrent chorioretinopathy - case report

“…Other oral therapeutic options include: antioxidants, beta-blockers, carbonic anhydrase inhibitors, Rifampicin and Methotrexate, but due to the small sample size, their benefit could not be certified [17][18][19]. Intravitreal injections with anti-VEGF factor have been analyzed as a possible treatment option in people with chronic CSRC for their role in reducing choroidal hyperpermeability by suppressing nitric oxide production [2,3,20,21]. The current approach recommends the use of intraocular injections for treating clearly identified CNV [3].…”

The Uses of Photodynamic Therapy Versus Anti-vascular Endothelial Growth Factor in the Management of Acute Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis

“…CSC may cause SRF, mainly from exudative CNV activity. Hence, anti-VEGF treatment might be an effective therapeutic option [ 38 ]. Anti-VEGF antibodies have recently been employed in the management of acute CSC.…”

“…Anti-VEGF agents are known to affect choroidal circulation by reducing choroidal hyperpermeability and thickness through the suppression of nitric oxide production and constriction of pachychoroid vessel. Therefore, intravitreal injection of bevacizumab has been shown to be less effective in treating chronic CSCR patients without CNV than in those with CNV [ 38 ]. After being injected intravitreally, bevacizumab, a recombinant humanized full-length monoclonal antibody of VEGF, can pass through the retina and reach the RPE, choroid, and outer segments of photoreceptors.…”

“…However, the short-term visual outcomes with anti-VEGF were observed to be better in patients with a thinner choroid and smaller pachychoroid vessel after bevacizumab injection for chronic CSC with CNV. Therefore, conventional treatments like focal laser and PDT may be more appropriate for chronic CSC patients without CNV [ 38 ]. Song et al further emphasized that smaller pachychoroid arteries and thinner choroidal thickness at presentation in CNV patients were related to improved short-term visual results [ 38 ].…”