Sir,

Central serous chorioretinopathy (CSC) is characterized by an idiopathic serous detachment of the neurosensory retina at the macula resulting from altered barrier function and deficient pumping function at the level of the retinal pigment epithelium (RPE). Serous detachment often resolves spontaneously and visual prognosis is relatively good. However, in some patients, chronic CSC may be associated with persistent subretinal exudation, extensive RPE atrophy, cystoid macular degeneration, and choroidal neovascularization and lead to a less favourable visual prognosis.1, 2, 3, 4 Herein, we describe a case with chronic CSC receiving intravitreal bevacizumab. Rapid resolution of macular detachment and termination of focal RPE leaking were found after treatment.

Case report

A 42-year-old businessman presenting with a history of CSC complained of decreased vision in the left eye for 2 months. Visual acuity (VA) measured 20/40, and retinal evaluation revealed a focal leak at the level of the RPE on the fluorescein angiogram (FA, Figure 1a) and a foveal neurosensory detachment confirmed with optical coherence tomography (Figure 1b). He was observed for 2 months without improvement. The area of leakage was judged to be too close to the foveal centre to risk the iatrogenic damage that might occur with laser photocoagulation. Treatment with intravitreal bevacizumab (1.25 mg/0.05 ml, Avastin®, rhuMAb-VEGF; Genentech, South San Francisco, CA, USA) was given in his left eye. Two weeks after treatment, VA improved to 20/20, with termination of focal RPE leaking on FA (Figure 1c) and complete resolution of the neurosensory detachment (Figure 1d). During the next 6 months of follow-up, VA remained 20/20 and macular exudation did not recur.

Figure 1
figure 1

(a) Late-phase FA before treatment showing a focal leak at the level of the RPE. (b) Vertical-line optical coherence tomography (OCT) before treatment showing subfoveal neurosensory detachment. (c) Late-phase FA after treatment showing mottled hyperfluorescence without focal leakage. (d) Vertical-line OCT after treatment showing resolution of retinal detachment.

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Comment

Persistent subretinal fluid in chronic CSC can produce severe and irreversible visual loss. Laser photocoagulation5 and photodynamic therapy with verteporfin6, 7 have both been demonstrated to be effective in resolution of subretinal fluid. In our patient, we demonstrated that intravitreal bevacizumab can terminate RPE leaking and prompt resolution of subretinal fluid, which can be associated with rapidly improving vision and remain stable for 6 months. Although the exact mechanism of bevacizumab in chronic CSC is unknown, it may be due to the effect of antimicrovascular permeability.8

Of course, one case report does not prove the efficacy of intravitreal bevacizumab in chronic CSC. However, intravitreal bevacizumab may provide another treatment option for patients with chronic CSC. Further studies with greater number of eyes and longer follow-up are necessary to determine its value in these patients.