Korean J Ophthalmol.  2015 Jun;29(3):160-167. 10.3341/kjo.2015.29.3.160.

The Association between Choroidal Thickness Variations and Response to Intravitreal Bevacizumab in Central Serous Chorioretinopathy

• Kim DY
• Joe SG
• Yang SJ
• Lee JY
• Kim JG
• Yoon YH

• KMID: 2363753
• DOI: http://doi.org/10.3341/kjo.2015.29.3.160

Abstract

PURPOSE
To analyze differences in the subfoveal choroidal thickness (SFChT) between bevacizumab responders (BevRs) and nonresponders (BevNRs) in patients with idiopathic central serous chorioretinopathy (CSC).
METHODS
The medical records of 30 unilateral chronic CSC patients who were treated with intravitreal bevacizumab (IVB) as a first line treatment were reviewed. Patients were categorized as BevNRs when CSC did not completely resolve after a minimum of 3 IVB treatments. Enhanced depth imaging-optical coherence tomography was used and SFChT was measured before and after treatment. Choroidal hyperpermeability was also evaluated using indocyanine angiography.
RESULTS
Twenty and 10 eyes were classified as BevRs or BevNRs, respectively. The mean number of IVB treatments was 2.22 +/- 0.89 in BevRs, and 4.80 +/- 1.03 in BevNRs. Compared with BevNRs, BevRs demonstrated significantly greater pretreatment SFChT (441.25 +/- 88.09 vs. 364.10 +/- 61.97 microm); SFChT reduction following IVB was significantly greater in BevRs than BevNRs. SFChT in the unaffected eyes was also greater in BevRs than BevNRs. Choroidal hyperpermeability was detected less frequently in BevNRs (hypofluorescence on late-phase, 0.0% and 33.3% in BevNRs and BevRs, respectively; p = 0.049).
CONCLUSIONS
Compared with CSC eyes that did not respond well to IVB, BevRs demonstrated significantly thicker SFChT at baseline, greater reduction in SFChT after IVB treatment, and hyperfluorescence on late-phase indocyanine green angiography. We recommend IVB injection as the first-line therapy for CSC eyes with relatively high SFChT and hyperfluorescence on late-phase indocyanine green angiography.

Keyword

Bevacizumab; Central serous chorioretinopathy; Enhanced depth image-optical coherence tomography; Subfoveal choroidal thickness

MeSH Terms

Adult
Angiogenesis Inhibitors/administration & dosage/*therapeutic use
Bevacizumab/administration & dosage/*therapeutic use
Central Serous Chorioretinopathy/*drug therapy/pathology
Choroid/*pathology
Female
Humans
Intravitreal Injections
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Angiogenesis Inhibitors
Bevacizumab

Figure

• 

  Fig. 1 Subfoveal choroidal thickness measurements. (a) Subfoveal choroidal thickness was vertically measured from the outer border of the retinal pigment epithelium to the inner border of the sclera.

• 

  Fig. 2 Late-phase indocyanine green angiography findings and the subfoveal choroidal thickness (SFChT) in central serous chorioretinopathic eyes. Late-phase indocyanine green angiography findings obtained between 10 to 15 minutes after dye injection were used to classify each eye as hyperfluorescent or hypofluorescent. (A) Late-phase hyperfluorescence was defined as the presence of well-defined homogeneous spots that were brighter than background fluorescence. Central serous chorioretinopathy eyes with late-phase hyperfluorescence and relatively thick SFChT are shown. (B) Late-phase hypofluorescence was defined as the presence of an area with no distinct fluorescence or slightly decreased fluorescence in comparison with background fluorescence. Central serous chorioretinopathy eyes with late-phase hypofluorescence and relatively thin SFChT are shown.

• 

  Fig. 3 Comparison of subfoveal choroidal thickness (SFChT). SFChT in bevacizumab responders (BevRs) was significantly greater than in bevacizumab nonresponders (BevNRs) (*Mann-Whitney test, p < 0.001). Significant differences were determined between the pretreatment and posttreatment SFCT values in BevRs (†Wilcoxon signed-rank test, p < 0.001). The SFChT values of the unaffected contralateral eye were also significantly different between BevRs and BevNRs (‡Mann-Whitney test, p = 0.026). The SFChT values of the unaffected contralateral eye were significantly greater in BevRs than in healthy controls (§Mann-Whitney test, p < 0.001).

• 

  Fig. 4 Correlation between symptom duration and pretreatment logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA). There was no significant correlation between symptom duration and pretreatment logMAR BCVA (Pearson correlation analysis, p = 0.474)

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