Combined approach to the treatment of choroidal neovascularization in patients with chronic central serous chorioretinopathy

Purpose. To evaluate the effectiveness of combined treatment of chronic central serous chorioretinopathy (CCSCRP) complicated by 1st type choroidal neovascularization (CNV), using subthreshold micropulse laser exposure (SMILV) on the retina and intravitreal administration of angiogenesis inhibitors (IAOAI). Material and methods. In the period from 2017 to 2019, 37 patients (20 men and 16 women) with monolateral chronic recurrent CCSCRP complicated with CNV 1st type, were observed at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. The aged of patients were from 35 to 57 years. In the main group were included 22 patients (22 eyes). In the main group, the anti-VEGF drug was injected once at the initial stage of treatment. During the follow-up examination before the next injection, while the detachment of the neurosensory retina persisted, the patients were immediately transferred to the combination therapy (SMILV + IAOAI). 15 patients (15 eyes) were included in the control group, whose treatment was started with 5 loading doses of the anti-angiogenic drug with an interval of 4 weeks. Results. In the main group, the number of IAOAI varied from 5 to 8 (6.1 ± 0.8). After a single injection of an angiogenesis inhibitor, a positive result was achieved in 3 cases (14%). These patients were performed two additional IAOAI with an interval of 4 weeks, then the interval was increased to 8 weeks. 19 patients (86%) had the detachment of the neurosensory retina with a height of 135-252 µm (177±28.2 µm). SMILV followed by IAOAI was performed for these patients. During the year of observation, from 8 to 10 injections of the inhibitor (8.8 ± 0.77) were performed in the control group of the study. The positive effect after injections of the anti-VEGF drug for 5 months was achieved only in 6 cases (42%). Conclusion. The proposed combination of laser exposure followed by the administration of an angiogenesis inhibitor is effective and can be used as an alternative and safe treatment for 1st type choroidal neovascularization in patients with chronic cerebrovascular accident. Key words: choroidal neovascularization, chronic central serous chorioretinopathy, intravitreal administration of angiogenesis inhibitors, subthreshold micropulse laser exposure.