Abstract

Managing central serous chorioretinopathy (CSC) with intervortex venous anastomosis (IVA) demonstrable on widefield indocyanine green angiography is a challenge unless the treatment target is shifted to choroid. In the milieu of profound hydrostatic pressure exerted by the widespread anastomosis in the choroid, the effect of conventional lasers is limited. We used multiple doses of 0.7mg dexamethasone implant (DEX) to achieve resolution of chronic CSC in a group of patients with documented IVA. The CSC resolved with a marked reduction of the choroidal thickness. No worsening of CSC was noted during the study period. The visual acuity improved. Given that DEX has physiological effects that are 25 to 30 times greater than hydrocortisone and is demonstrated to show its effect in choroid when injected intravitreally, the drug is poised to become the first drug with a targeted effect on the choroid and possibly change the way CSC is managed busting the myth of corticosteroids worsening CSC.