Clinical characteristics of responders to intravitreal bevacizumab in central serous chorioretinopathy patients

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 χ(2) 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.

Figure 1

Measurements of the greatest linear diameter, subfoveal choroidal thickness, and height of SRF. On SD-OCT, the greatest linear diameter of lesion boundaries, as basal area of detached retina, was measured (left). Also, the height of SRF was defined as the greatest distance from the retinal pigment epithelium (RPE) to the border of the detached neurosensory retina, within an area from 3 mm nasal and 3 mm temporal from the center of the fovea (right). Subfoveal choroidal thickness was measured from the RPE to the inner surface of the sclera within an area at the center of the fovea, on enhanced depth imaging optical coherence tomography (EDI-OCT) (right).

Figure 2

A 35-year-old man with central serous chorioretinopathy (CSC) who showed high response after single intravitreal bevacizumab treatment. Fluorescein angiography (a), indocyanine green angiography (b), and SD-OCT at baseline with thick choroid (614 μm, white arrow) (c). Complete resolution of SRF was noted at 1 month after intravitreal bevacizumab (d).

Figure 3

A 30-year-old man with CSC demonstrating poor response after single intravitreal bevacizumab treatment. Fluorescein angiography (a), indocyanine green angiography (b), SD-OCT at baseline with relatively thin choroid (289 μm, white arrow) (c). Slightly decreased, but remaining SRF was noted at 1 month after intravitreal bevacizumab (d).