One year outcome and predictors of treatment outcome in central serous chorioretinopathy (CSCR): multimodal imaging based analysis

Abstract

Purpose : To evaluate treatment outcome of eyes with CSCR based on multimodal imaging based classification over one year of follow up.

Methods : Retrospective data of eyes diagnosed with CSCR and available history, visual acuity (VA) and multimodal imaging at baseline, 3 months, 6 months and 12 months and treatment details were included. Eyes with macular neovascularization, any other disease and inadequate follow up after treatment were excluded. Eyes were classified as per the multimodal imaging based classification of CSCR at baseline and every follow up into i) simple/ complex CSCR ii) primary episode/ recurrence/ resolved CSCR iii) persistent or not iv) outer retinal atrophy (ORA) present or not and v) fovea involved or not.

Results : Ninety-one eyes of 87 patients were classified into 50 eyes with simple CSCR and 41 eyes with complex CSCR. Complex CSCR cases had higher persistence, ORA and recurrent episodes (p=0.0005,0.0008,0.0008) while simple cases had higher central macular thickness (CMT)(p=0.02) at baseline. The most common choice of treatment was observation (58%) in simple CSCR and PDT (36.6%) in complex CSCR (p=0.02). In simple CSCR, logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA), subfoveal choroidal thickness (SCT) and CMT decreased (p=0.02,0.02,<0.0001) while persistence of subretinal fluid (SRF) and ORA increased (p< 0.0001,0.0002) over 12 months. In complex CSCR, CMT decreased (p=0.0009) and ORA (p=0.037) increased over follow up but the decrease in CMT over 12 months was more significant in simple CSCR compared to complex CSCR (p=0.002). In multivariate analysis, baseline BCVA (p<0.0001) was a significant predictor of final BCVA. Over a mean follow up of 21.7±16.8 months, none of the simple CSCR eyes converted to complex CSCR. Resolution of SRF, occurrence of ORA and recurrence during the follow up period was not significantly different between simple and complex CSCR (p=0.86,0.46,0.73).

Conclusions : Both visual and anatomical outcomes changed significantly in simplex CSCR group with observation being the most common treatment. PDT in complex CSCR helped to stabilize the vision. Baseline VA was significantly predictive of final visual outcome.

This is a 2021 ARVO Annual Meeting abstract.

 

Kaplan Meier curve demonstrating the probability of persistence of subretinal fluid is 36% with PDT, 59% with focal or micropulse laser and 60% with observation over 12 months.