Choroidal neovascularization emerged right from the focal choroidal excavation in eyes with central serous chorioretinopathy post half-dose photodynamic therapy: a case report

BACKGROUND: Focal choroidal excavation (FCE) is a common concurrent disease with central serous chorioretinopathy (CSC) and choroidal neovascularization (CNV). Photodynamic therapy (PDT) was able to cease the course of CSC with efficacy and safety. To retrospectively observed and followed up a special course in eyes with CSC and concurrent FCE treated by a half-dose of PDT. CASE PRESENTATION: In this case report analysis, two eyes with CSC and concurrent FCE treated with half-dose PDT, were followed up with monthly retinal fundus examinations. Best corrected visual acuity (BCVA) and ophthalmic fundus examination were examined, including fundus photos, optical coherence tomography (OCT) and angiography. In Case 1, a 46-year-old female has been diagnosed as CSC and concurrent FCE. The baseline BCVA was 10/20. After a half-dose of PDT, complete resolution of SRF was achieved at one-month with stable BCVA. At 3 months, the patient complained of obvious metamorphosis. Multimodal images confirmed the existence of CNV, derived from the FCE, inside the zone of PDT irradiation. The development of CNV stopped promptly 1 month post the injection of ranibizumab. In Case 2, a 39 year-old male was diagnosed as bilateral CSC. The BCVA was 8/20 (od), and 16/20 (os). The multimodal images showed classic CSC manifestation in left eye, but atypical manifestation in right eye with subtle SRF and FCE. Post half-dose treatment, the SRF in left eye completely resolved at three-months, and the BCVA improved to 24/20. However, a lesion of CNV grew in the FCE after 1 month in right eye, with decreased BCVA, 4/20. One month post-injection of ranibizumab, obvious regression was witnessed, with improved BCVA, 6/20. The CNV proceeded to be a scar 2 months after injection. The BCVA maintained at 8/20. CONCLUSIONS: In this study, type II CNV was induced in two cases of CSC concurrent with FCE in 3 months post half-dose PDT. The CNV grew right from the FCE, inside the zone of PDT irradiation.