Nonhomogenous Hyperreflectivity in the Choriocapillaris Layer on Optical Coherence Tomography Angiography Implies Early Treatment with Anti-VEGF for Central Serous Chorioretinopathy

: Optical coherence tomography angiography (OCTA) facilitates the detection of choroidal neovascularization (CNV). This study explored the role of nonhomogenous hyperreflectivity implying putative CNV in the choriocapillaris layer on OCTA in central serous chorioretinopathy (CSCR). Methods: Thirteen eyes out of 12 patients with CSCR were examined with OCTA. The nonhomogenous hyperreflectivity was compared with the histological morphology of experimental CNV. The effect of intravitreal anti-vascular endothelial growth factor (VEGF) was evaluated by analyzing the changes in central macular thickness (CMT) and the height of subretinal fluid (SRF). Results: Comparison of the nonhomogenous hyperreflectivity on OCTA with the established CNV in two animal models strongly indicated these signals are putative CNV. During following-up, these nonhomogenous hyperreflectivity in CSCR developed into visible CNV on OCTA. Moreover, anti-VEGF treatment was effective to reduce both the SRF and CMT in CSCR with nonhomogenous hyperreflectivity or secondary CNV within 2 months. Conclusion: This study suggested that the nonhomogenous hyperreflectivity on OCTA could be served as a diagnostic biomarker for putative CNV in CSCR, implying early treatment with anti-VEGF.