Choroidal vascular biomarkers for macular neovascularization in chronic central serous chorioretinopathy: insights from widefield indocyanine green angiography

BACKGROUND: To investigate the correlation between choroidal vasculature characteristics and the formation of macular neovascularization (MNV) in patients with chronic central serous chorioretinopathy (CSC), based on widefield indocyanine green angiography (WF-ICGA). METHODS: This was a retrospective, observational study. Patients with chronic CSC with complete medical records and multimodal imaging conducted between September 2022 and June 2025, were included. Eyes with chronic CSC were divided into the MNV and non-MNV groups based on the presence or absence of MNV. WF-ICGA was performed to obtain choroidal characteristics, including vortex vein (VV), dominant VV (DVV), posterior VV, intervortex venous anastomosis (IVA), and age-related scattered hypofluorescent spots on late-phase indocyanine green angiography (ASHS-LIA). Choroidal characteristics were quantitatively and qualitatively assessed and compared between eyes with and without MNVs. RESULTS: A total of 293 eyes from 212 patients (164 males, 77.36%) were analyzed. Of these, 96 presented with secondary MNV (32.76%), whereas 197 did not. Compared with that of the non-MNV group, the MNV group exhibited a more advanced age and worse visual acuity (all P < 0.001). Regarding choroidal characteristics, MNV cases more frequently exhibited an asymmetric distribution pattern (P = 0.032), solitary DVV (P = 0.041), superotemporal DVV location (P = 0.005), macular IVA (P = 0.027), and ASHS-LIA (P < 0.001). In the generalized linear-mixed model, which was adjusted for age, sex, and symptom duration, the occurrence of MNV correlated with the presence of superotemporal DVV, macular IVA, and ASHS-LIA (P < 0.001, P = 0.003, and P = 0.011, respectively). CONCLUSION: WF-ICGA-derived choroidal vascular characteristics were identified as potential biomarkers for the development of MNV in eyes with chronic CSC. The presence of superotemporal DVV, macular IVA, and ASHS-LIA may serve as independent associated factors for predicting the development of MNV.