Are There Any Choroidal Changes After Anti-VEGF Injections in Chronic Central Serous Chorioretinopathy with Naïve Macular Neovascularization?

Abstract

Purpose : The pathophysiology underlying macular neovascularization (MNV) secondary to central serous chorioretinopathy (CSC) has historically been hypothesized to occur due to choroidal vascular permeability, however this has become controversial in recent years. This study aimed to evaluate how choroidal thickness (CT) would change following anti-VEGF treatment in treatment-naive CSC patients with MNV.

Methods : 20 cases of treatment naïve MNV secondary to CSC from 2015 to 2019 were enrolled in this observational retrospective study. Subfoveal, nasal, and temporal CT were measured using Canon HS-100 Spectral Domain optical coherence tomography (OCT) (Tokyo, Japan) at presentation, after the first set of 3 anti-VEGF injections, and at final follow up. Secondary descriptive measures included subretinal fluid (SRF) and central macular thickness (CMT). Significant differences were evaluated using one-sided repeated measures ANOVA for all parameters, and a post-hoc level of statistical power was calculated with a minimum difference of 25 um.

Results : Mean time from diagnosis to first injection was 16 ± 14 days. There were no statistically significant differences found between mean CT at either of the three locations or time points (p > 0.05). Visual acuity remained stable (logMAR 0.51 ± 0.47 at presentation to 0.55 ± 0.54 at final follow-up) (P=0.336). SRF was the only parameter that improved significantly throughout follow-up. Compared to mean SRF at baseline (177 ± 116 um), mean SRF decreased by 82 um after the first injections, and by 14 um by final follow up (P=0.001).

Conclusions : No significant CT changes were found in chronic CSC patients treated for MNV with anti-VEGF, even with resolution of SRF. These results suggest that the mechanism underlying choroidal changes in these patients may be incompletely understood and likely separate to those found in other macular disorders. Recently, choroidal venous overload has been hypothesized to be a primary contributor to CSC pathophysiology, and, in addition to the possibility of long-standing fibrotic changes, these factors may act as barriers to CT response following anti-VEGF treatment.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1. Each row corresponds to OCT B-scans of a different case (A,D) at baseline, (B,E) after the first set of anti-VEGF injections and (C,F) at last follow-up, all showing decrease in SRF and no change in choroidal thickness.