Evaluation of the effect of intravitreal antivascular endothelial growth factor versus medical treatment in acute central serous chorioretinopathy

Objective To assess the effectiveness of intravitreal ranibizumab or aflibercept versus medical therapy for treatment of patients presented with acute central serous chorioretinopathy. Patients and method This comparative controlled clinical trial involved 45 eyes of 45 patients having acute central serous chorioretinopathy. Patients were divided into three equal groups: the first patient group received intravitreal aflibercept, the second one received intravitreal ranibizumab, and the third one, control group, received medical therapy: oral spironolactone 100 mg once daily and topical bromfenac 0.09% q.i.d. All groups were observed over a duration of 6 months and assessed for best-corrected visual acuity (BCVA), pattern on fundus fluorescein angiography, duration of visual recovery, recurrence rate, and possible complications after intravitreal injections. The central macular thickness (CMT), the subfoveal choroidal thickness (CT), the subretinal fluid (SRF), and the foveal vascular density were compared across the groups. Results By the end of the follow-up, BCVA significantly (P<0.01) improved in all groups. However, group comparison revealed no significant differences (P>0.05). A significant reduction in the CMT due to resolution of the SRF existed at 2 weeks after treatment in all groups till complete resolution at 6 months. For subfoveal CT, within-group analysis reported nonsignificant (P>0.05) differences in the intravitreal injection groups, whereas a significant (P<0.05) reduction in CT was recorded in the control group at 3 and 6 months. The foveal vascular density showed nonsignificant differences (P<0.05) within and among study groups. Conclusion Intravitreal injections had similar effects as medical treatment in improving BCVA, CMT, and SRF but had weaker action on CT.