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Multimodal imaging in the management of choroidal neovascularization secondary to central serous chorioretinopathy

Multimodal imaging in the management of choroidal neovascularization secondary to central serous chorioretinopathy
Multimodal imaging in the management of choroidal neovascularization secondary to central serous chorioretinopathy
The diagnosis and treatment of choroidal neovascularization (CNV) in eyes with chronic central serous chorioretinopathy (CSCR) can be challenging. The purpose of this study was to classify eyes with suspected CNV using multimodal imaging. Effect of intravitreal anti vascular endothelial growth factor (VEGF) was assessed and compared to controls. This retrospective study included chronic CSCR patients with suspected secondary CNV who received intravitreal bevacizumab. Eyes were divided into “definite CNV” and “no CNV” based on optical coherence tomography angiography (OCTA). Eyes that did not undergo OCTA imaging were considered as “Presumed CNV”. One-year outcome in visual acuity (VA) and central foveal thickness (CFT) were investigated and compared to non-treated control patients to assess the response to anti-VEGF. Logistic regression analysis was used to explore predictive biomarkers of CNV detection and improvement after anti-VEGF. Ninety-two eyes with chronic CSCR from 88 participants were included in this study. Sixty-one eyes received bevacizumab and 31 eyes were non-treated control subjects. Presence of subretinal hyperreflective material (SHRM) and shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) with sub-RPE hyperreflectivity on OCT was associated with a significantly increased risk of detecting CNV on OCTA. Intravitreal anti-VEGF caused significant functional and anatomical improvement in patients with neovascular CSCR as compared to non-treated eyes. In contrast, VA and CFT changes were not significantly different between treated and non-treated CSCR with no evidence of CNV on OCTA. No clinical or anatomical biomarkers were found to be associated with response to treatment. In conclusion, OCTA should be used to confirm the presence CNV in suspected chronic CSCR patients. Intravitreal anti-VEGF treatment resulted in a significantly better 1-year outcome in patients with definitive OCTA evidence of CNV.
Hagag, Ahmed M.
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Chandra, Shruti
ff6b0484-2ac9-408d-be5b-2d62ddd300d2
Khalid, Hagar
c92a95ce-bc44-4902-9d5a-391ce087ff72
Lamin, Ali
63915b3a-52ce-4b62-8a43-e5da6a9ecae0
Keane, Pearse A.
66a42f80-e12e-4706-84b2-0096ce62f2b9
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Sivaprasad, Sobha
f2d2ba7d-03f8-48e2-9f2b-2bbe6ffd5213
Hagag, Ahmed M.
25260e22-2a8b-423b-a8ec-8304e2a83fc7
Chandra, Shruti
ff6b0484-2ac9-408d-be5b-2d62ddd300d2
Khalid, Hagar
c92a95ce-bc44-4902-9d5a-391ce087ff72
Lamin, Ali
63915b3a-52ce-4b62-8a43-e5da6a9ecae0
Keane, Pearse A.
66a42f80-e12e-4706-84b2-0096ce62f2b9
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Sivaprasad, Sobha
f2d2ba7d-03f8-48e2-9f2b-2bbe6ffd5213

Hagag, Ahmed M., Chandra, Shruti, Khalid, Hagar, Lamin, Ali, Keane, Pearse A., Lotery, Andrew and Sivaprasad, Sobha (2020) Multimodal imaging in the management of choroidal neovascularization secondary to central serous chorioretinopathy. Journal of Clinical Medicine, 9 (6). (doi:10.3390/jcm9061934).

Record type: Article

Abstract

The diagnosis and treatment of choroidal neovascularization (CNV) in eyes with chronic central serous chorioretinopathy (CSCR) can be challenging. The purpose of this study was to classify eyes with suspected CNV using multimodal imaging. Effect of intravitreal anti vascular endothelial growth factor (VEGF) was assessed and compared to controls. This retrospective study included chronic CSCR patients with suspected secondary CNV who received intravitreal bevacizumab. Eyes were divided into “definite CNV” and “no CNV” based on optical coherence tomography angiography (OCTA). Eyes that did not undergo OCTA imaging were considered as “Presumed CNV”. One-year outcome in visual acuity (VA) and central foveal thickness (CFT) were investigated and compared to non-treated control patients to assess the response to anti-VEGF. Logistic regression analysis was used to explore predictive biomarkers of CNV detection and improvement after anti-VEGF. Ninety-two eyes with chronic CSCR from 88 participants were included in this study. Sixty-one eyes received bevacizumab and 31 eyes were non-treated control subjects. Presence of subretinal hyperreflective material (SHRM) and shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) with sub-RPE hyperreflectivity on OCT was associated with a significantly increased risk of detecting CNV on OCTA. Intravitreal anti-VEGF caused significant functional and anatomical improvement in patients with neovascular CSCR as compared to non-treated eyes. In contrast, VA and CFT changes were not significantly different between treated and non-treated CSCR with no evidence of CNV on OCTA. No clinical or anatomical biomarkers were found to be associated with response to treatment. In conclusion, OCTA should be used to confirm the presence CNV in suspected chronic CSCR patients. Intravitreal anti-VEGF treatment resulted in a significantly better 1-year outcome in patients with definitive OCTA evidence of CNV.

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Accepted/In Press date: 12 June 2020
Published date: 21 June 2020

Identifiers

Local EPrints ID: 443999
URI: http://eprints.soton.ac.uk/id/eprint/443999
PURE UUID: eef44dab-44e1-43c9-888d-19ac3427e896
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 21 Sep 2020 17:09
Last modified: 26 Nov 2021 02:47

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Contributors

Author: Ahmed M. Hagag
Author: Shruti Chandra
Author: Hagar Khalid
Author: Ali Lamin
Author: Pearse A. Keane
Author: Andrew Lotery ORCID iD
Author: Sobha Sivaprasad

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