title: Morphologic changes and visual outcomes in resolved central serous chorioretinopathy treated with ranibizumab.
abstract: BACKGROUND
  Central serous chorioretinopathy (CSC).
  
  
  OBJECTIVE
  To evaluate the effect of intravitreal ranibizumab injection and the correlation between foveal morphologic changes and visual outcomes in patients with resolved CSC.
  
  
  METHODS
  We measured outer nuclear layer (ONL) thickness, outer layer (OL) thickness and evaluated the integrity of the photoreceptor inner-outer segment (IS/OS) junction, the status of the external limiting membrane (ELM) at the central fovea using spectral-domain optical coherence tomography (OCT) in 35 eyes of 35 patients with resolved CSC. The eyes were divided into two groups: The initial medical treatment administered to Group1 (n = 17) then received intravitreal ranibizumab injections, Group 2 (n = 18) received medical treatment. Group 3 was composed of normal eyes (n = 20, as a control). We also investigated a correlation between the ONL thickness and best corrected visual acuity (BCVA).
  
  
  RESULTS
  The mean age was 45.7 ± 7.2 (ranged from 27 to 55 years). The mean follow-up period was 14.2 months (minimum 6, maximum 24 months). The mean ONL and OL thickness in Group 1 were significantly thinner than Group 3 (p < 0.005). The ONL thickness was correlated with the BCVA (r = 0.681, p = 0.001). Thirty-tree patients had improvement in BCVA after treatment. Discontinuity of the IS/OS junction was found in 15 eyes (88.2%) in Group 1, in 5 eyes (27.7%) in Group 2 and in no eyes in Group 3.
  
  
  CONCLUSIONS
  We demonstrated that prolonged serous detachment results in photoreceptor cell loss (apoptosis) and thinning of the ONL. Thinning of the ONL correlates with poorer vision, which has been found by other investigators. Furthermore, vascular endothelial growth factor (VEGF) may be neuroprotective to the photoreceptors which might explain the additional thinning in the patients treated with ranibizumab. This raises the possibility that treatment with VEGF inhibitors may be unfavourable to patients with CSC, even though it speeds recovery and vision does improve.
  
  
  CONCLUSIONS
  Intravitreal ranibizumab injection leads to thinning of the ONL and the OL in patients with resolved CSC. The ONL thickness reduction and discontinuity of the IS/OS junction results in poor visual prognosis in resolved CSC eyes.
authors.affiliation: Ophthalmology Department, Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey and.
authors.forename: Ozdemir
authors.initials: O
authors.lastname: Ozdemir
authors.forename: Muhammet Kazim
authors.initials: MK
authors.lastname: Erol
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D056833:Central Serous Chorioretinopathy / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab
keywords: Central serous chorioretinopathy; external limiting membrane; inner outer segment; outer layer; outer nuclear layer; pectral-domain optical coherence tomography; ranibizumab; retinal layers