[Morphological and functional changes of secondary macular neovascularization in central serous chorioretinopathy under anti-VEGF treatment].

Background: Investigation of the morphological changes by optical coherence tomography angiography (OCT-A) and the development of visual acuity in secondary macular neovascularization (sMNV) in central serous chorioretinopathy (CCS) during anti-vascular endothelial growth factor (VEGF) treatment.

Patients and methods: Retrospective study of all treatment-naïve eyes with respect to anti-VEGF treatment, in which sMNV in CCS was detected by fluorescein angiography (FA) and OCT‑A and which were treated at the University Eye Hospital Würzburg between July 2021 and the end of December 2022. All patients were treated according to a pro re nata injection regimen (PRN regimen) and followed up for 1 year.

Results: In the study 20 eyes from 16 patients with sMNV in CCS were included. Using FA the sMNV could be confirmed in 35% of cases and using OCT‑A in 100% of cases. Morphologically, the sMNV was clearly demarcated by OCT‑A as "sea-fan"-like in 10 eyes and filamentous in 10 eyes. The decrease in area of the sMNV from 0.94 ± 1.2 mm² at baseline to 0.72 ± 0.82 mm² at 12 months was not statistically significant (p = 0.12). During the observational period an average of 8.7 ± 1.6 intravitreal injections (IVOM) were administered (5-12 IVOM, median 9 IVOM).

Discussion: Both FA and OCT‑A were used to detect sMNV in CCS, with OCT‑A providing more reliable detection of sMNV than FA. With OCT‑A two different types of sMNV could be detected: 1) the "sea-fan" type and 2) the filamentous MNV type. Within the first year of treatment sMNV in CCS requires a comparable number of IVOMs as the treatment of neovascular age-related macular degeneration.