Optical Coherence Tomography Angiography-Guided Laser Management of Neovascular Central Serous Chorioretinopathy

PURPOSE: To analyze the efficacy and safety of optical coherence tomography angiography (OCTA)-based navigated laser treatment in central serous chorioretinopathy (CSCR) complicated by choroidal neovascularization (CNV). METHODS: This study included consecutive patients with neovascular non-resolving CSCR who received en face OCT-based navigated laser treatment without fluorescein angiography or were observed untreated for at least six months. In all treated cases the area of the double-layer sign with flow signal displayed with structural en face OCT image was treated with microsecond pulsing laser (up to three sessions), direct continuous wave focal laser photocoagulation, or their consecutive combination. Main outcome measure was complete resolution of subretinal fluid. RESULTS: Sixty-seven eyes of 67 patients (28 males, 41.8%) with a mean age of 57.5 ± 7.7 years were included in the treatment group. Thirty eyes of 30 patients (14 males (46.7%), mean age 58.1 ± 6.9 years) were included in the control group. Complete resolution of subretinal fluid was achieved in 32 eyes (47.8%) in the treatment group compared with none in the control group (p < 0.001). The odds ratio for the success of the laser treatment in the presence of fovea-involving CNV was 0.21 (95% CI 0.073 to 0.583). After excluding eyes with CNV involving the foveal center, the success rate achieved was 65.0%. No adverse effects in the treatment group were observed except two cases of CNV growth after focal laser photocoagulation. CONCLUSION: OCTA-guided laser treatment is a viable and safe option in the management of CSCR complicated by CNV, mostly effective in cases with extrafoveal CNV.