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Ophthalmology Department, Centro Hospitalar do Porto – Hospital Santo António, Oporto, PORTUGAL.

Purpose:

To report an alternative approach to treat choroidal neovascularization complicating a chronic central serous chorioretinopathy.

Case report:

A 54 years old male was referred to the Vitreoretinal Unit of our Department on February 2014, complaining of a recent decrease of right eye visual acuity, secondary to the presence of a submacular hemorrhage. He had a past history of bilateral retinal pathology, a presumed chronic central serous chorioretinopathy, diagnosed 30 years before.

At presentation on our department, right eye visual acuity was 20/400; on fundoscopy and fluorescein angiography, a submacular hemorrhage superior and temporal to the fovea was noticed, with signs of epitheliopathy, including a proeminent pigment epithelium detachment (PED). The RE OCT showed a hemorrhagic PED, with hyperreflective material and fluid on the subretinal space. He underwent pars plana vitrectomy with subretinal alteplase injection and SF6 tamponade.

One week after surgery the RE visual acuity improved to 20/80 with almost complete disappearance of submacular hemorrhage on fundoscopy, and decrease of the PED height on

OCT, with persistence of subretinal fluid. One week later, indocyanine green angiography was performed, suggesting the presence of choroidal neovascularization. It was decided to perform an intravitreal bevacizumab injection. Two weeks after anti-VEGF treatment the patient noticed an improvement of right eye visual acuity, though with metamorphopsia. The OCT revealed persistence of PED with intraretinal cysts. It was decided to repeat intravitreal bevacizumab injection and in the meantime, it is planned to perform half fluence photodynamic therapy.

Conclusion:

Central serous chorioretinopathy usually presents acutely, with good visual prognosis. In a small subset of patients, a chronic course may occur which can be complicated by choroidal neovascularization compromising visual function. This case illustrates a possible different therapeutic approach in these patients, which seems to be an alternative way to improve visual function.