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Choroidal neovascularization in central serous chorioretinopathy—a new clinical entity

Choroidale Neovaskularisation bei zentraler seröser Chorioretinopathie – eine neue klinische Entität

  • Angio-OCT / Medical Retina
  • Published:
Spektrum der Augenheilkunde Aims and scope Submit manuscript

Summary

Purpose

To describe the morphology of retinal and choroidal vessels in swept source optical coherence tomography angiography (SS-OCTA) in choroidal neovascularization (CNV) during the course of central serous chorioretinopathy (CSC). Additionally, to report intravitreal anti-VEGF (vascular endothelial growth factor) injection treatment results.

Methods

A case series of patients diagnosed with chronic central serous chorioretinopathy. Fluorescein angiography, spectral domain optical coherence tomography, and SS-OCTA were performed. Analysis of retina and choroidal vasculature was performed. All patients received anti-VEGF therapy.

Results

The study demonstrated pathological vessels in the retina avascular zone and at the level of choriocapillaris during the course of choroidal neovascularization in central serous chorioretinopathy. These vessels are invisible in fluorescein angiography, as they are hidden by pooling of the dye. These vessels correspond to a slightly hyper-reflective elevation of retinal pigment epithelium visible in optical coherence tomography. Visual acuity and central retinal thickness decreased after anti-VEGF treatment. The vessels did not completely disappear despite anti-VEGF treatment.

Conclusion

This study shows that SS-OCTA enables us to identify neovessels during the course of CSC. In diagnosing this entity, SS-OCTA appears superior to fluorescein angiography and might also enable us to decide on the best timing for anti-VEGF injections.

Zusammenfassung

Zweck

Die Morphologie retinaler und choroidaler Gefäße wird mittels „swept-source“ optischer Kohärenztomographie-Angiographie (SS-OCTA) bei choroidaler Neovaskularisation (CNV) im Verlauf einer zentralen serösen Chorioretinopathie beschrieben (CSC). Des Weiteren wird über die Ergebnisse der Behandlung mit intravitrealen Anti-VEGF-Injektionen berichtet.

Methoden

Es handelt sich um eine Fallserie von Patienten, bei denen eine chronische zentrale seröse Chorioretinopathie diagnostiziert wurde. Eine Fluoreszenzangiograpie, eine Spectral-Domain-optische Kohärenztomographie sowie eine SS-OCTA wurden durchgeführt. Es erfolgte eine Analyse der retinalen und choroidalen Gefäße. Die Patienten waren für eine VEGF-Therapie geeignet.

Ergebnisse

Die Studie zeigte pathologische Gefäße in der avaskulären Zone der Netzhaut sowie den Grad der Choriokapillaren im Verlauf einer choroidalen Neovaskularisation bei zentraler seröser Chorioretinopathie. Diese Gefäße sind in der Fluoreszenzangiographie nicht sichtbar, da sie vom verteilten Farbstoff verdeckt werden. Diese Gefäße gehen mit einer leichten hyperreflektiven Erhöhung des Netzhautpigmentepithels einher, die in der optischen Kohärenztomographie zu sehen ist. Die Akuität des Visus und die zentrale Netzhautdicke verringerten sich nach der Anti-VEGF-Therapie. Die Gefäße verschwanden jedoch trotz der Anti-VEGF-Behandlung nicht vollständig.

Schlussfolgerung

Diese Studie zeigt, dass die SS-OCTA die Identifizierung von Neogefäßen im Verlauf einer CSC ermöglicht. Bei der Diagnostik dieser Entität scheint die SS-OCTA der Fluoreszenzangiographie überlegen zu sein und könnte uns dabei helfen, den besten Zeitpunkt für die Anti-VEGF-Injektionen zu finden.

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Authors and Affiliations

  1. Klinika Okulistyczna “Jasne Blonia”, ul.Rojna 90, 91-162, Lodz, Poland

    Zofia Michalewska MD, PhD, Karolina Dulczewska MD, PhD & Jerzy Nawrocki MD, PhD

Authors
  1. Zofia Michalewska MD, PhD
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  2. Karolina Dulczewska MD, PhD
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  3. Jerzy Nawrocki MD, PhD
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Corresponding author

Correspondence to Zofia Michalewska MD, PhD.

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Conflict of interest

Z. Michalewska and K. Dulczewska received honoraria from Topcon for lectures during the last year. J. Nawrocki has no financial interest to disclose.

Ethical standards

All procedures were in accordance with the ethical standards of the Institutional Ethics Committee and with the Helsinki Declaration of 1975, as revised in 2008. All patients signed an informed consent before inclusion in the study.

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Michalewska, Z., Dulczewska, K. & Nawrocki, J. Choroidal neovascularization in central serous chorioretinopathy—a new clinical entity. Spektrum Augenheilkd. 31, 251–256 (2017). https://doi.org/10.1007/s00717-017-0363-8

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  • DOI: https://doi.org/10.1007/s00717-017-0363-8

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