Short-term effect of anti-VEGF for chronic central serous chorioretinopathy according to the presence of choroidal neovascularization using optical coherence tomography angiography

The Uses of Photodynamic Therapy Versus Anti-vascular Endothelial Growth Factor in the Management of Acute Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis

Central serous chorioretinopathy (CSCR) is an idiopathic chorioretinal disease characterized by localized serous detachment of the neurosensory retina at the macula. To date, there is no high-quality evidence of recent updates on treating acute CSCR, focusing on photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF). Hence, this review aims to conduct a comprehensive systematic review of the most recent therapeutic approaches for acute CSCR using the following electronic databases for a comprehensive and systematic literature review: MEDLINE, EMBASE, and Cochrane. In addition, we analyzed studies comparing PDT with placebo, anti-VEGF with placebo, or PDT with anti-VEGF in treating acute CSC eyes with no previous intervention. Seven studies were included, with a total of 292 eyes. The overall positive results were significantly higher among patients who received PDT compared to control groups (odds ratio [OR] = 7.96, 95% confidence interval [CI], 3.02 to 20.95, p < 0.001). The proportions of positive results were 81.0% and 97.1% among patients who received anti-VEGF and PDT, respectively, with no statistically significant differences between the groups. In addition, there were no significant differences between anti-VEGF and control groups. In contrast, PDT was significantly associated with lower recurrence odds than the control groups (OR = 0.12, 95% CI, 0.04 to 0.39, p = 0.042). According to our findings, PDT showed higher positive results than anti-VEGF in acute CSCR. In addition, PDT was significantly associated with a lower recurrence rate than the control group. However, the analysis needs to be confirmed and updated by large-scale, well-designed randomized clinical trials.

Non-homogenous hyperreflectivity in choriocapillaris layer on OCTA implies early treatment with anti-VEGF for central serous chorioretinopathy

Introduction: Optical coherence tomography angiography (OCTA) facilitates the detection of the choroidal neovascularization (CNV). This study explored the role of non-homogenous hyperreflectivity implying putative CNV in choriocapillaris layer on OCTA in central serous chorioretinopathy (CSCR). Methods: Thirteen eyes out of 12 patients with CSCR were examined with OCTA. The non-homogenous hyperreflectivity was compared with the histological morphology of experimental CNV. The effect of intravitreal anti-vascular endothelial growth factor (VEGF) was evaluated by analyzing the changes of central macular thickness (CMT) and the height of subretinal fluid (SRF). Results: Comparison of the non-homogenous hyperreflectivity on OCTA with the established CNV in two animal models strongly indicated these signals are putative CNV. During following-up, these non-homogenous hyperreflectivity in CSCR developed into visible CNV on OCTA. Moreover, anti-VEGF treatment was effective to reduce both the SRF and CMT in CSCR with non-homogeneous hyperreflectivity or secondary CNV within 2 months. Conclusion: This study suggested that the non-homogenous hyperreflectivity on OCTA could be served as a diagnostic biomarker for putative CNV in CSCR, implying early treatment with anti-VEGF.