Abstract
Purpose
To investigate factors associated with good response to intravitreal bevacizumab (IVB) in central serous chorioretinopathy (CSC) patients.
Methods
We retrospectively reviewed 42 eyes of CSC patients of symptom duration more than 3 months who received a single or multiple successive IVBs on an as-needed basis (0.05 ml, 1.25 mg). High responders (HRs) were defined as complete resolution of subretinal fluid (SRF) on spectral domain optical coherence tomography (SD-OCT). Moderate responders (MRs) were defined as SRF resolution of 50–99% of pretreatment volume and poor responders (PRs) as SRF resolution <50%. Clinical, SD-OCT, fluorescein, and indocyanine green angiography findings were analyzed to find factors associated with HR. Descriptive statistics for all demographic and clinical variables were calculated, and comparisons were made using Wilcoxon’s matched-pairs signed-rank test, the Mann–Whitney U-test for means with continuous data, Pearson’s χ2 test, and Fisher’s exact test for categorical data.
Results
The mean number of IVB was 1.9. At postoperative 1 month, there were 10 (24%) HRs, 18 (43%) MRs, and 14 (33%) PRs. At the last follow-up (the mean 8.6 months), there were 25 HRs (60%), 9 MRs (21%), and 8 PRs (19%). Thicker subfoveal choroid (P=0.036), smaller lesion diameter (P=0.019), and better baseline best-corrected visual acuity (P=0.002) predicted HRs at postoperative 1 month. HR at the last follow-up was associated with classic pattern fluorescein angiography finding.
Conclusions
Suboptimal effects of IVB on persistent CSC suggest primary IVB on selective cases with better vision, smaller lesion, and thicker choroid at baseline.
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References
Wang M, Munch IC, Hasler PW, Prunte C, Larsen M . Central serous chorioretinopathy. Acta Ophthalmol 2008; 86 (2): 126–145.
Prunte C . Indocyanine green angiographic findings in central serous chorioretinopathy. Int Ophthalmol 1995; 19 (2): 77–82.
Prunte C, Flammer J . Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol 1996; 121 (1): 26–34.
Hayashi K, Hasegawa Y, Tokoro T . Indocyanine green angiography of central serous chorioretinopathy. Int J Ophthalmol 1986; 9 (1): 37–41.
Yannuzzi LA . Central serous chorioretinopathy: a personal perspective. Am J Ophthalmol 2010; 149 (3): 361–363.
Bouzas EA, Karadimas P, Pournaras CJ . Central serous chorioretinopathy and glucocorticoids. Surv Ophthalmol 2002; 47 (5): 431–448.
Weenink AC, Borsje RA, Oosterhuis JA . Familial chronic central serous chorioretinopathy. Ophthalmologica 2001; 215 (3): 183–187.
Yannuzzi LA . Type A behavior and central serous chorioretinopathy. Trans Am Ophthalmol Soc 1986; 84: 799–845.
Lim JW, Kim MU . The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2011; 249 (7): 969–974.
Ruiz-Moreno JM, Lugo FL, Armada F, Silva R, Montero JA, Arevalo JF et al. Photodynamic therapy for chronic central serous chorioretinopathy. Acta Ophthalmol 2010; 88 (3): 371–376.
Yannuzzi LA, Slakter JS, Gross NE, Spaide RF, Costa D, Huang SJ et al. Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina 2003; 23 (3): 288–298.
Burumcek E, Mudun A, Karacorlu S, Arslan MO . Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up. Ophthalmology 1997; 104 (4): 616–622.
Pikkel J, Beiran I, Ophir A, Miller B . Acetazolamide for central serous retinopathy. Ophthalmology 2002; 109 (9): 1723–1725.
Nielsen JS, Jampol LM . Oral mifepristone for chronic central serous chorioretinopathy. Retina 2011; 31 (9): 1928–1936.
Artunay O, Yuzbasioglu E, Rasier R, Sengul A, Bahcecioglu H . Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study. Curr Eye Res 2010; 35 (2): 91–98.
Huang WC, Chen WL, Tsai YY, Chiang CC, Lin JM . Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eye (Lond) 2009; 23 (2): 488–489.
Inoue M, Kadonosono K, Watanabe Y, Kobayashi S, Yamane S, Arakawa A . Results of one-year follow-up examinations after intravitreal bevacizumab administration for chronic central serous chorioretinopathy. Ophthalmologica 2011; 225 (1): 37–40.
Lee ST, Adelman RA . The treatment of recurrent central serous chorioretinopathy with intravitreal bevacizumab. J Ocul Pharmacol Ther 2011; 27 (6): 611–614.
Lim SJ, Roh MI, Kwon OW . Intravitreal bevacizumab injection for central serous chorioretinopathy. Retina 2010; 30 (1): 100–106.
Schaal KB, Hoeh AE, Scheuerle A, Schuett F, Dithmar S . Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol 2009; 19 (4): 613–617.
Seong HK, Bae JH, Kim ES, Han JR, Nam WH, Kim HK . Intravitreal bevacizumab to treat acute central serous chorioretinopathy: short-term effect. Ophthalmologica 2009; 223 (5): 343–347.
Lim JW, Ryu SJ, Shin MC . The effect of intravitreal bevacizumab in patients with acute central serous chorioretinopathy. Korean J Ophthalmol 2010; 24 (3): 155–158.
Torres-Soriano ME, Garcia-Aguirre G, Kon-Jara V, Ustariz-Gonzales O, Abraham-Marin M, Ober MD et al. A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy [case reports]. Graefes Arch Clin Exp Ophthalmol 2008; 246 (9): 1235–1239.
Shin MC, Lim JW . Concentration of cytokines in the aqueous humor of patients with central serous chorioretinopathy. Retina 2011; 31 (9): 1937–1943.
Lim JW, Kim MU, Shin MC . Aqueous humor and plasma levels of vascular endothelial growth factor and interleukin-8 in patients with central serous chorioretinopathy. Retina 2010; 30 (9): 1465–1471.
Lee CS, Kang EC, Lee KS, Byeon SH, Koh HJ, Lee SC . Central serous chorioretinopathy after renal transplantation. Retina 2011; 31 (9): 1896–1903.
Tsujikawa A, Ojima Y, Yamashiro K, Ooto S, Tamura H, Nakagawa S et al. Punctate hyperfluorescent spots associated with central serous chorioretinopathy as seen on indocyanine green angiography. Retina 2010; 30 (5): 801–809.
Margolis R, Spaide RF . A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 2009; 147 (5): 811–815.
Ahn SE, Oh J, Oh JH, Oh IK, Kim SW, Huh K . Three-dimensional configuration of subretinal fluid in central serous chorioretinopathy. Invest Ophthalmol Vis Sci 2013; 54 (9): 5944–5952.
Gass JD . Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol 1967; 63 (3): Suppl 1–139.
Schmidt-Erfurth U, Laqua H, Schlotzer-Schrehard U, Viestenz A, Naumann GO . Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol 2002; 120 (6): 835–844.
Koytak A, Erol K, Coskun E, Asik N, Ozturk H, Ozerturk Y . Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin for chronic central serous chorioretinopathy. Retina 2010; 30 (10): 1698–1703.
Nomura Y, Obata R, Yanagi Y . Intravitreal bevacizumab for iatrogenic choroidal neovascularization due to laser photocoagulation in central serous chorioretinopathy. Jpn J Ophthalmol 2012; 56 (3): 245–249.
Krohne TU, Eter N, Holz FG, Meyer CH . Intraocular pharmacokinetics of bevacizumab after a single intravitreal injection in humans. Am J Ophthalmol 2008; 146 (4): 508–512.
Diabetic Retinopathy Clinical Research N, Scott IU, Edwards AR, Beck RW, Bressler NM, Chan CK et al. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema. Ophthalmology 2007; 114 (10): 1860–1867.
Jirarattanasopa P, Ooto S, Tsujikawa A, Yamashiro K, Hangai M, Hirata M et al. Assessment of macular choroidal thickness by optical coherence tomography and angiographic changes in central serous chorioretinopathy. Ophthalmology 2012; 119 (8): 1666–1678.
Li XJ, Zhang JS . Intravitreal bevacizumab injection for chronic central serous chorioretinopathy. Chin Med J (Engl) 2010; 123 (15): 2145–2147.
Peters S, Heiduschka P, Julien S, Ziemssen F, Fietz H, Bartz-Schmidt KU et al. Ultrastructural findings in the primate eye after intravitreal injection of bevacizumab. Am J Ophthalmol 2007; 143 (6): 995–1002.
Shimomura Y, Hirata A, Ishikawa S, Okinami S . Changes in choriocapillaris fenestration of rat eyes after intravitreal bevacizumab injection. Graefes Arch Clin Exp Ophthalmol 2009; 247 (8): 1089–1094.
Peng S, Adelman RA, Rizzolo LJ . Minimal effects of VEGF and anti-VEGF drugs on the permeability or selectivity of RPE tight junctions. Invest Ophthalmol Vis Sci 2010; 51 (6): 3216–3225.
Yamashita A, Shiraga F, Shiragami C, Shirakata Y, Fujiwara A . Two-year results of reduced-fluence photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol 2013; 155 (1): 96–102.
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One of the authors, Dr Hyoung Jun Koh, has financial conflict about ranibizumab. He has received grants for clinical research from Novartis, served as an advisor for Novartis, Bayer, and Allergan, and served as a speaker for Santen. The other authors have no proprietary or commercial interest in any materials discussed in this article.
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Partly presented at the 2013 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 2013 Seattle, WA, USA.
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Kim, G., Rim, T., Lee, S. et al. Clinical characteristics of responders to intravitreal bevacizumab in central serous chorioretinopathy patients. Eye 29, 732–741 (2015). https://doi.org/10.1038/eye.2015.58
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DOI: https://doi.org/10.1038/eye.2015.58
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