Choroidal neovascularization mimics in chronic central serous chorioretinopathy; an optical coherence tomography angiography study.

Abstract

Purpose :
The definitive diagnosis of choroidal neovascularization (CNV) in chronic central serous chorioretinopathy (CSC) is often challenging and depends on multi-modal imaging. Clinical features suggestive of CNV in CSC on optical coherence tomography (OCT), fluorescein angiography (FA) or indocyanine green angiography (ICGA) could also be found in chronic CSC, thereby accounting for potential misdiagnosis. OCT Angiography (OCTA) has been found to be of a great use in the detection of CNV. The aim of our study is to illustrate diagnostic features mimicking CNV in chronic CSC patients in which OCTA didn't show any evident CNV.

Methods :
This is a retrospective study of patients recruited from Moorfields Eye Hospital who had been diagnosed with CNV secondary to CSC between June 2008 and July 2019 and underwent OCTA at some stage during the follow up. All patient demographics and clinical data were collected. When available, all photographic data was evaluated for the different features mimicking CNV including the presence of intraretinal fluid (IRF), subretinal fluid (SRF), and subretinal hyperreflective material (SHRM). The retinal pigment epithelium (RPE) was assessed for the presence of any disruption, RPE melting and pigment epithelium detachment (PED).

Results :
A total of 129 patients had been presented with CNV secondary to CSC. Of those, 92 underwent OCTA, in 18 patients no evidence of CNV could be detected. Their mean age was 63.3 ± 13.5 years and the mean follow up period was 39.24±25.9 months. The mean choroidal thickness was 470.25, range (305-723). OCT demonstrated SRF in 16 eyes, IRF in 11 eyes, SHRM in six eyes and RPE disruption in 14 eyes. PED was detected in 16 eyes, all of them presenting with a hyporeflective sub RPE space. Fundus autofluorescence was evaluated in 15 eyes where in 11 eyes hypoautofluorescent areas could be seen corresponding to RPE melting on OCT. In 10 eyes late hyper fluorescence could be detected on FA and late hyperpermeability was evident on ICGA in 11 eyes. Sixteen eyes received anti-vascular endothelial growth factor, of these 10 eyes have persistent fluid (7 SRF, 8 IRF) at the last visit despite of treatment.

Conclusions :
Different features could mimic CNV diagnosis in chronic CSR. OCTA could give more insight for CNV evaluation and hence guiding retinologists to find right treatment decisions in those patients.

This is a 2020 ARVO Annual Meeting abstract.