Clinical evaluation of neovascular and non-neovascular chronic central serous chorioretinopathy (CSC) diagnosed by swept source optical coherence tomography angiography (SS OCTA)

Purpose To evaluate the clinical characteristics of eyes with chronic central serous chorioretinopathy based on swept source optical coherence tomography angiography (SS OCTA). Methods Twenty-nine eyes presenting with chronic central serous chorioretinopathy (CSC) were examined with the Topcon SS OCTA, using the DRI optical coherence tomography (OCT) Triton machine, and were classified as neovascular or non-neovascular CSC depending on whether a vascular pattern was detected in the outer retina on OCT angiogram. The two groups were compared based on the following clinical findings: best corrected distance and reading visual acuity (BCDVA, best corrected reading acuity (BCRA)), rate of subretinal fluid, intraretinal fluid, hyperreflective flat pigment epithelial detachment (PED), and serous PED. Results Of 29 eyes with chronic CSC, 10 (34.5%) showed a neovascular pattern, suggesting neovascular CSC, in the outer retina of SS OCTA. Eyes with neovascular CSC showed a significantly worse initial and final BCDVA, with a mean value of 0.39 ± 0.20 logMAR (Snellen equivalent 20/49) and 0.33 ± 0.36 logMAR (Snellen equivalent 20/43), compared to eyes with non-neovascular CSC with a mean value of 0.16 ± 0.15 logMAR (Snellen equivalent 20/29) and 0.04 ± 0.11 logMAR (Snellen equivalent 20/22) ( p < 0.05), respectively. Final mean BCRA was 0.14 ± 0.20 logRAD for non-neovascular CSC compared to 0.34 ± 0.28 logRAD ( p = 0.031) for neovascular CSC. The mean time between the first and final visits was 3 years for both groups. The mean anti-VEGF injection rate was 6.4 for neovascular CSC and 2.9 for non-neovascular CSC, whereas 26.3% of non-neovascular CSC eyes had an additional half fluence photodynamic therapy (PDT). Conclusion SS OCTA provides a promising CNV detection rate, secondary to chronic CSC, in a clinical setting. Neovascular CSC is associated with a worse outcome in terms of visual and reading acuity compared to non-neovascular CSC.