Intravitreal Injections Affirmed as Treatment Option for Some Central Serous Chorioretinopathy

The anti vascular endothelial growth factor (VEGF) drug bevacizumab achieved long-term results for patients with central serous chorioretinopathy (CSCR), according to a new study.¹ Approximately 90% of eyes with CSCR showed at least 1 complete remission during a mean follow-up of 35 months, the research shows.¹ However, half the eyes that saw at least 1 complete resolution developed recurrence.¹

The study took into account 45 eyes from 44 patients at Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, in Incheon, Korea. Patients with acute or chronic CSCR received intravitreal bevacizumab injections (IVBIs) at 4-week intervals as needed to resolve subretinal fluid detected upon imaging. Researchers investigated the long-term outcomes of IVBIs, and examined what factors predicted recurrences of macular-involved CSCR. 

During a follow-up period of at least 2 years, 88.9% of the patients (40 eyes) with CSCR developed at least 1 complete resolution with a mean of 2.7 IVBIs, the study’s authors wrote.¹ Of the 40 eyes that showed at least 1 complete resolution, 20 developed 1 or more recurrences.¹ Researchers identified that having subfoveal choroidal thickness greater than or equal to 300.0 μm was associated with a greater chance for recurrence.¹ They speculate that mean subfoveal choroidal thickness may signify disease activity, including choroidal hyperpermeability — a thinner choroid in patients with CSCR “may indicate lower hydrostatic pressure.”¹

Photodynamic therapy (PDT) has shown more consistent outcomes than IVBIs for cases of CSCR, but may have complications, according to the literature.^1,2 These complications may include secondary choroidal neovascularization and choroidal hypoperfusion.^1,2 

Ophthalmologists often practice observation for CSCR because the majority of cases resolve without intervention in approximately 3 months.¹ The new study suggests that early intervention may be more called for than previously thought due to the fact that acute CSCR can recur less long-term after IVBIs by reducing choroidal hyperpermeability in the early state of the disease.¹

Due to their small sample size, the study’s lack of a control group, and the 10% of patients who did not show complete resolution of subretinal fluid after multiple IVBIs, the researchers recommend further comparison of treatment modalities: observation, IVBIs with PDT therapy, and a combination of therapies.¹

Research from 2015  outlined limited beneficial effects of bevacizumab in terms of visual acuity improvement and subretinal fluid reduction without significant complications.² That study explained that CSCR, although not associated with increased VEGF ocular levels, could benefit from anti-VEGF therapy to reduce the choroidal hyperpermeability.² It also introduced the hypothesis that the mineralocorticoid (MR) pathway plays an important role in the development and treatment of the disease.²

“These observations indicate that MR antagonism is a potential minimally invasive therapy for CSCR as shown by the strong treatment effect in the first clinical trials of oral MR antagonists,” the researchers explained.² “But their exact place in the therapeutic arsenal remains to be determined. The exact dose and duration of treatment depending on the clinical forms of the disease should also be evaluated.”²

References

1. Kang HM, Choi JH, Koh HJ, Lee SC. Long-term treatment response after intravitreal bevacizumab injections for patients with central serous chorioretinopathy. PLoS One. 2020:15(9): e0238725: doi: 10.1371/journal.pone.0238725

2. Daruich A, Matet A, Dirani A, et al. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Progress in Retinal and Eye Research. 2015:48(9):82-118. doi: 10.1016/j.preteyeres.2015.05.003.