Analysis on Multimodal Imaging of 'stealth' Choroidal Neovascularization in Central Serous Chorioretinopathy

<p><strong>Purpose:</strong> To investigate the prevalence of concurrent choroidal neovascularization (CNV) in patients with clinically diagnosed of central serous chorioretinopathy (CSC) and analyze the multimodal imaging characteristics of CSC with &lsquo;stealth&rsquo; CNV (CSC-sCNV). <strong>Design: </strong>Retrospective, observational cross-sectional study. <strong>Methods</strong><strong>:</strong> The current study analyzed the clinical data of 111 clinically diagnosed of CSC patients (134 eyes) who received fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCTA) at their initial visit. The CSC-CNV that can be detected by FFA+ICG was defined as classic CSC-CNV (CSC-cCNV), and CSC-CNV that cannot be detected by FFA+ICG but can be detected by OCTA was defined as CSC-sCNV. The multimodal imaging characteristics of CSC-sCNV were analyzed.<strong> Results: </strong>The concurrent CNV was found in 29 eyes (21.6%) of 28 patients (25.2%), who were significantly older than those without CNV (P=0.039). Among the 29 eyes, 6 eyes (20.7%) were CSC-cCNV and 23 (79.3%) were CSC-sCNV. All CSC-sCNV eyes were type 1 CNV, of which, 22 had photoreceptor layer defects of varying severities. OCTA showed 4 (17.4%) were active CNV and 19 (82.6%) were inactive CNV based on the morphology features. CSC-sCNV lesions manifested as smoke-stack leakage, diffuse RPE changes with/without ink-blot leakage and normal fluorescence on FFA (1 eye, 7 eyes, 10 eyes and 5 eyes respectively). ICGA showed no typical CNV features in CSC-sCNV but choroidal vasodilation beneath CNV lesions and choroidal hyperpermeability at the posterior pole.<strong> Conclusion:</strong> CSC-sCNV may be the primary phenotype of CSC-CNV and its inactivity might be the reason that it cannot be detected by FFA.</p>