Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy

Intravitreal conbercept for chronic central serous chorioretinopathy with occult CNV: a retrospective clinical study based on multimodal ophthalmic imaging

Purpose

This study aimed to evaluate the therapeutic efficacy and safety of intravitreal conbercept in patients with chronic central serous chorioretinopathy (cCSC) complicated by occult choroidal neovascularization (CNV), and to explore its potential in improving visual function and various ophthalmic parameters.

Methods

This retrospective, longitudinal, comparative study included 50 patients diagnosed with cCSC and occult CNV. Patients underwent intravitreal conbercept injections and were monitored over a six-month period. Comprehensive ophthalmic evaluation included best-corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF) status, subfoveal choroidal thickness (SFCT), and optical coherence tomography angiography (OCTA). OCTA parameters such as foveal avascular zone (FAZ) area and CNV lesion characteristics were analyzed pre- and post-treatment. Patients were categorized based on changes in CNV lesion size to identify prognostic factors influencing treatment response.

Results

Significant improvements were observed in mean BCVA from baseline (0.78 ± 0.50 vs. 0.32 ± 0.31, p < 0.01) in all 50 eyes of the patients, except for one eye. Additionally, there were significant improvements in CMT, SRF status, SFCT, FAZ area, and CNV lesion size post-treatment (p < 0.05). Pearson correlation analysis indicated a positive correlation between baseline BCVA and CMT (r = 0.3615, p = 0.0116). Changes in BCVA post-treatment correlated with alterations in CMT, SRF diameter, and CNV lesion size. Patients with a favorable treatment response had significantly lower baseline CMT (312.17 ± 57.39 vs. 428.86 ± 114.54, p < 0.05) and CNV vessel diameter (17.46 ± 2.72 vs. 24.84 ± 4.02, p < 0.01) compared to those with unfavorable responses.

Conclusion

Intravitreal conbercept injection was found to be safe and effective in improving BCVA and various ophthalmic parameters in patients with cCSC complicated by occult CNV, with no significant adverse effects observed during the study period. Baseline CMT, SRF diameter, CNV lesion size, and mean CNV vessel diameter were identified as valuable indicators for assessing treatment response and prognosis. These findings provide important insights for the clinical management and prognostic evaluation of cCSC patients with occult CNV, highlighting the utility of multimodal imaging in assessing treatment outcomes.

Central serous chorioretinopathy: An evidence-based treatment guideline

Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.

Comparison of Intravitreal Bevacizumab and Aflibercept Injections for Central Serous Chorioretinopathy

Purpose: We examined differences in the treatment effects of intravitreal bevacizumab injections and intravitreal aflibercept injections in patients with central serous chorioretinopathy. Methods: This retrospective analysis included 51 eyes of 49 patients who received intravitreal anti-vascular endothelial growth factor agent injections after initial diagnosis with central serous chorioretinopathy. The patients were divided into two groups: one received an intravitreal bevacizumab injection, and another one received an intravitreal aflibercept injection. Patients with no reaction to treatment or a worsened condition, received repeat treatment with the same therapy. After treatment, patients were monitored for >3 months. Data were collected regarding best- corrected visual acuity (BCVA), subfoveal choroidal thickness, injection number, and treatment duration. Results: Both intravitreal bevacizumab injections and intravitreal aflibercept injections led to significant differences in BCVA (p < 0.0001, p = 0.001) and subfoveal choroidal thickness (p < 0.0001, p = 0.011), compared between before and after treatment. However, no differences between groups were observed in mean change of BCVA or subfoveal choroidal thickness. In addition, there were no differences between groups in injection number and treatment duration. Conclusions: In patients with central serous chorioretinopathy, both intravitreal bevacizumab injections and intravitreal aflibercept injections are effective treatment methods. There were no differences between the two medicines in terms of functional and anatomical recovery, or the injection number and treatment duration.

Macular microvascular changes in resolved central serous chorioretinopaty using spectral-domain optical coherence tomography angiography

PURPOSE

The purpose of this study was to evaluate microvascular changes in the retina and choriocapillaris in central serous chorioretinopathy (CSCR) patients with resolved serous detachment using optical coherence tomography angiography (OCTA).

METHOD

49 eyes of 46 patients with CSCR were included in the study. 32 eyes of 16 age-matched controls were included in the control group. Fundus photography, fluorescein angiography, spectral-domain optical coherence tomography and OCTA were used. Choriocapillaris (CC) flow area, foveal avascular zone (FAZ), parafoveal vascular density of superficial and deep capillary plexus of the acute and chronic CSCR groups were compared with the values of the control group. Contrary to previous studies, OCTA data were obtained at a time when there was no serous detachment. This was because we aimed at minimizing erroneous measurements that might arise due to serous detachment.

RESULTS

1- The acute CSCR patients (1.705±0.292mm²) were found to have lower choriocapillaris (CC) flow area compared to the control group (2.155±0.069mm²). (P<0.001). Lower CC flow area was found in the chronic CSCR patients (1.774±0.216mm²) compared to the control group (2.155±0.069mm²) (P<0.001). 2- Chronic CSCR patients (49.27%±3.84) had a lower parafoveal density in the superficial capillary plexus compared to the control group (52.25%±2.85) (P<0.05). 3- No statistically significant difference was found between the acute CSCR group (55.07%±6.29) and chronic CSCR group (52.65%±5.18) in terms of parafoveal density in the deep capillary plexus when individually compared to the control group (53.34%±2.7). 4-A positive correlation was found between the parafoveal density in the deep capillary plexus and central foveal thickness (CFT) in the chronic CSCR group (r=0.382) (P˂0.05) 5- No statistically significant difference was found in the FAZ of the acute CSCR group (0.258±0.054mm²) and chronic CSCR group (0.342±0.124mm²) when individually compared to the control group (0.311±0.1mm²). The largest mean FAZ area was found in the chronic CSCR group.

CONCLUSION

Our study showed that the pathogenesis of CSCR is characterized by choriocapillaris and retinal microvascular changes.