Choriocapillaris Flow Deficits Impact Macular Neovascularization Risk in Long-Term Follow-Up for Central Serous Chorioretinopathy

Purpose: To evaluate the influence of choriocapillaris flow deficit on macular neovascularization (MNV) development during extended follow-up for central serous chorioretinopathy (CSC). Design: Retrospective study. Participants: Thirty-six eyes from 36 patients with CSC, each followed for more than 3 years. Methods: All patients underwent comprehensive ophthalmic examinations, including optical coherence tomography (OCT) and OCT angiography (OCTA), at baseline, 3 months from baseline, and the final follow-up. Choriocapillaris flow deficit percentage (CCFD%) was calculated using OCTA images obtained 3 months from baseline. Patients were categorized into two groups based on MNV presence or absence at the final follow-up. Outcome Measures: Association between CCFD% and MNV development. Results: Of the 36 patients, 11 (30.6%) developed MNV during the follow-up period (mean duration: 48.3 ± 14.5 months). The CCFD% at 3 months from baseline was significantly higher in the MNV group than in the non-MNV group (36.6 ± 1.9% vs 35.5 ± 2.3%, p = 0.027). In nine of the 11 eyes (81.8%) with MNV, neovascular lesions spatially corresponded to areas of focal geographic choriocapillaris loss identified at 3 months. Conclusion: CCFD% measured by OCTA may serve as a prognostic biomarker for identifying CSC patients with elevated risk of MNV development. The spatial concordance between regions of choriocapillaris flow deficit and subsequent MNV formation supports the hypothesis that choriocapillaris ischemia substantially contributes to the pathogenesis of MNV in CSC.