Please select the eligibility criteria that correspond to the clinical trial below.
Title: Intravitreal Aflibercept Injection for Persistent Central Serous Chorioretinopathy: A Prospective Pilot Study
Brief Summary: A preliminary study to determine the safety and efficacy of intravitreal aflibercept injection in patients with persistent central serous chorioretinopathy.


Options:
A: Inclusion Criteria:

1. best-corrected visual acuity (BCVA) between 0.0 and 1.0 logarithm of the minimal angle of resolution (logMAR)
2. presence of subfoveal fluid persisting for 3 months or more on optical coherence tomography (OCT)
3. presence of leakage and multifocal/diffuse RPE decompensation on fluorescein angiography (FA)
4. choroidal vascular hyperpermeability and abnormal dilation of choroidal vasculature on indocyanine angiography (ICGA)

Exclusion Criteria:

1. previous treatment, such as laser photocoagulation, PDT, intravitreal injection of steroid or anti-VEGF agent
2. evidence of choroidal neovascularization
3. any other ocular diseases that could affect visual acuity
4. systemic steroid treatment in the previous 12 months
5. media opacity such as cataract that could interfere with adequate acquisition of OCT, FA and ICGA images
B: Inclusion criteria:

* CSC of \>4 months duration

Exclusion Criteria:

* History of macular or chorioretinal inflammation
* Lens / corneal opacities
C: INCLUSION CRITERIA:

* male and female patients ≥ 18 years of age who are able to give written informed consent
* active chronic central serous chorioretinopathy
* subjective visual loss \> 6 weeks, interpreted as onset of active disease
* subretinal fluid that includes the fovea on OCT scanning at Baseline Examination.

Please NOTE: Subretinal fluid does not have to include fovea on OCT to be eligible for treatment at Control Visit 1, as long as there is persistent subretinal fluid in the macula, which is interpreted as persistently active disease (see 5.7 "Retreatment criteria and considerations").

* hyperfluorescent areas on ICG angiography
* ≥1 ill-defined hyperfluorescent leakage areas on fluorescein angiography with retinal pigment epithelial window defect(s) that are compatible with chronic CSC

EXCLUSION CRITERIA:

The participant may not enter the study if ANY of the following apply:

* any previous treatments for active CSC in the study eye
* current treatment with corticosteroids (topical or systemic), or anticipated start of corticosteroid treatment within the first 7-8 months from the start of the trial period
* evidence of other diagnosis that can explain serous subretinal fluid or visual loss
* BCVA \< 20/200 (Snellen equivalent)
* profound chorioretinal atrophy in central macular area on ophthalmoscopy and OCT
* myopia \> 6 dioptres
* visual loss and/or serous detachment on OCT \< 6 weeks
* continuous and/or progressive visual loss \> 18 months or serous detachment on OCT \> 18 months
* no hyperfluorescence on ICG angiography
* intraretinal edema on OCT
* (relative) contraindications for PDT treatment (pregnancy, porphyria, severely disturbed liver function). Pregnancy will not be routinely tested in female patients, but the possibility of pregnancy will be discussed during eligibility screening
* (relative) contraindications for fluorescein angiography or ICG angiography (known allergies especially against shellfish, previous reactions)
* Soft drusen in treated eye or fellow eye, signs of choroidal neovascularization on ophthalmoscopy and/or fluorescein angiography/indocyanine green angiography
D: Inclusion Criteria:

* Pre-treatment acuity of 20/40- 20/320
* Macular fluid on optical coherence tomography for greater than 3 months
* Leakage on fluorescein angiography
* Willing and able to comply with clinic visits and study-related procedures
* Provide signed informed consent

Exclusion Criteria:

* Treatment for CSCR in the study eye (anti-VEGF, PDT, or laser) within three months prior to study enrollment
* Presence of choroidal neovascularization on enrollment imaging
* Prior vitrectomy in the study eye
* Presence of any substantial ocular disease (other than CSCR) that may compromise vision in the study eye and /or confound interpretation of the data; e.g. substantial cataracts, advanced glaucoma, optic neuritis, optic neuropathy or atrophy, marked macular atrophy, ocular vascular occlusion, history of retinal detachment, uveitis, viral or other forms of chorioretinitis, etc.
* History of rhegmatogenous retinal detachment or macular hole (Stage 3 or 4) in the study eye
* Uncontrolled glaucoma in the study eye (defined as IOP ≥ 25 mmHg despite treatment with anti-glaucoma medication)
* Active ocular infection or inflammation in the study eye
* Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye
* Prior treatment with systemic anti-VEGF agents
* Cerebrovascular accident or myocardial infarction within the preceding 6 months.
* History of allergy to fluorescein, povidone iodine (Betadine) or aflibercept
* Participation in a study of an investigational drug or device within 30 days prior to potential enrollment into the study
* Pregnant or breast-feeding women Sexually active men\* or women of childbearing potential\*\* who are unwilling to practice adequate contraception during the study (adequate contraceptive measures include stable use of oral contraceptives or other prescription pharmaceutical contraceptives for 2 or more menstrual cycles prior to screening; intrauterine device \[IUD\]; bilateral tubal ligation; vasectomy; condom plus contraceptive sponge, foam, or jelly, or diaphragm plus contraceptive sponge, foam, or jelly)

  * Contraception is not required for men with documented vasectomy.

    * Postmenopausal women must be amenorrheic for at least 12 months in order not to be considered of child bearing potential. Pregnancy testing and contraception are not required for women with documented hysterectomy or tubal ligation.

Answer: D