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

Overview

Journal J Clin Med

Specialty General Medicine

Date 2020 Jun 25

PMID 32575806

Citations 6

Authors

Ahmed M Hagag

Shruti Chandra

Hagar Khalid

Ali Lamin

Pearse A Keane

Andrew J Lotery

Sobha Sivaprasad

Affiliations

Soon will be listed here.

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.

Citing Articles

Choroidal Response to Intravitreal Bevacizumab Injections in Treatment-Naïve Macular Neovascularization Secondary to Chronic Central Serous Chorioretinopathy.

Rabinovitch D, Shulman S, Goldenberg D, Wang L, Iyer P, Loewenstein A Biomedicines. 2025; 12(12.

PMID: 39767667 PMC: 11673265. DOI: 10.3390/biomedicines12122760.

Comparison of oral propranolol, oral rifampicin, and intravitreal anti-VEGF in central serous chorioretinopathy.

Sandeep K, Venugopal K, Javagal A, Acharya P, Sreelekshmi S, Narendra N Indian J Ophthalmol. 2023; 71(10):3381-3385.

PMID: 37787239 PMC: 10683675. DOI: 10.4103/IJO.IJO_169_23.

Multimodal Imaging Based Predictors for the Development of Choroidal Neovascularization in Patients with Central Serous Chorioretinopathy.

Caplash S, Surakiatchanukul T, Arora S, Maltsev D, Singh S, Sahoo N J Clin Med. 2023; 12(5).

PMID: 36902857 PMC: 10004102. DOI: 10.3390/jcm12052069.

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

Zhou X, Komuku Y, Araki T, Terasaki H, Miki A, Kuwayama S BMJ Open Ophthalmol. 2022; 7(1).

PMID: 35537029 PMC: 9016399. DOI: 10.1136/bmjophth-2022-000976.

Central Serous Chorioretinopathy Classification.

Vilela M, Mengue C Pharmaceuticals (Basel). 2021; 14(1).

PMID: 33396886 PMC: 7823356. DOI: 10.3390/ph14010026.

References

Fung A, Yannuzzi L, Freund K . Type 1 (sub-retinal pigment epithelial) neovascularization in central serous chorioretinopathy masquerading as neovascular age-related macular degeneration. Retina. 2012; 32(9):1829-37. DOI: 10.1097/IAE.0b013e3182680a66. View

Hwang H, Kim J, Kim K, Chae J, Kim D . FLAT IRREGULAR PIGMENT EPITHELIUM DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY: A Form of Pachychoroid Neovasculopathy?. Retina. 2019; 40(9):1724-1733. DOI: 10.1097/IAE.0000000000002662. View

Sheth J, Anantharaman G, Chandra S, Sivaprasad S . "Double-layer sign" on spectral domain optical coherence tomography in pachychoroid spectrum disease. Indian J Ophthalmol. 2018; 66(12):1796-1801. PMC: 6256905. DOI: 10.4103/ijo.IJO_377_18. View

Lim L, Mitchell P, Seddon J, Holz F, Wong T . Age-related macular degeneration. Lancet. 2012; 379(9827):1728-38. DOI: 10.1016/S0140-6736(12)60282-7. View

van Rijssen T, van Dijk E, Yzer S, Ohno-Matsui K, Keunen J, Schlingemann R . Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res. 2019; 73:100770. DOI: 10.1016/j.preteyeres.2019.07.003. View

Grossniklaus H, Green W . Choroidal neovascularization. Am J Ophthalmol. 2004; 137(3):496-503. DOI: 10.1016/j.ajo.2003.09.042. View

Teussink M, Breukink M, van Grinsven M, Hoyng C, Klevering B, Boon C . OCT Angiography Compared to Fluorescein and Indocyanine Green Angiography in Chronic Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci. 2015; 56(9):5229-37. DOI: 10.1167/iovs.15-17140. View

Cheung C, Lee W, Koizumi H, Dansingani K, Lai T, Freund K . Pachychoroid disease. Eye (Lond). 2018; 33(1):14-33. PMC: 6328576. DOI: 10.1038/s41433-018-0158-4. View

Liu T, Lin W, Zhou S, Meng X . Optical coherence tomography angiography of flat irregular pigment epithelial detachments in central serous chorioretinopathy. Br J Ophthalmol. 2020; 105(2):233-238. PMC: 7848048. DOI: 10.1136/bjophthalmol-2019-315318. View

10.

Gemenetzi M, De Salvo G, Lotery A . Central serous chorioretinopathy: an update on pathogenesis and treatment. Eye (Lond). 2010; 24(12):1743-56. DOI: 10.1038/eye.2010.130. View

11.

Klein M, Van Buskirk E, Friedman E, Gragoudas E, Chandra S . Experience with nontreatment of central serous choroidopathy. Arch Ophthalmol. 1974; 91(4):247-50. DOI: 10.1001/archopht.1974.03900060257001. View

12.

Shah V, Shah S, Mrejen S, Freund K . Subretinal hyperreflective exudation associated with neovascular age-related macular degeneration. Retina. 2014; 34(7):1281-8. DOI: 10.1097/IAE.0000000000000166. View

13.

Dansingani K, Balaratnasingam C, Klufas M, Sarraf D, Freund K . Optical Coherence Tomography Angiography of Shallow Irregular Pigment Epithelial Detachments In Pachychoroid Spectrum Disease. Am J Ophthalmol. 2015; 160(6):1243-1254.e2. DOI: 10.1016/j.ajo.2015.08.028. View

14.

Shi Y, Motulsky E, Goldhardt R, Zohar Y, Thulliez M, Feuer W . Predictive Value of the OCT Double-Layer Sign for Identifying Subclinical Neovascularization in Age-Related Macular Degeneration. Ophthalmol Retina. 2019; 3(3):211-219. DOI: 10.1016/j.oret.2018.10.012. View

15.

Loo R, Scott I, Flynn Jr H, Gass J, Murray T, Lewis M . Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina. 2002; 22(1):19-24. DOI: 10.1097/00006982-200202000-00004. View

16.

Amoaku W, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J . Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond). 2015; 29(10):1397-8. PMC: 5176328. DOI: 10.1038/eye.2015.159. View

17.

Hagag A, Gao S, Jia Y, Huang D . Optical coherence tomography angiography: Technical principles and clinical applications in ophthalmology. Taiwan J Ophthalmol. 2017; 7(3):115-129. PMC: 5617355. DOI: 10.4103/tjo.tjo_31_17. View

18.

Yoshida T, Ohno-Matsui K, Yasuzumi K, Kojima A, Shimada N, Futagami S . Myopic choroidal neovascularization: a 10-year follow-up. Ophthalmology. 2003; 110(7):1297-305. DOI: 10.1016/S0161-6420(03)00461-5. View

19.

Sahoo N, Govindhari V, Bedi R, Goud A, Singh R, Wu L . Subretinal hyperreflective material in central serous chorioretinopathy. Indian J Ophthalmol. 2019; 68(1):126-129. PMC: 6951218. DOI: 10.4103/ijo.IJO_265_19. View

20.

Lotery A, Sivaprasad S, OConnell A, Harris R, Culliford L, Ellis L . Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled trial. Lancet. 2020; 395(10220):294-303. DOI: 10.1016/S0140-6736(19)32981-2. View