this prospective interventional case series was approved by the review board / ethics committee of the ophthalmic research center of the university .
five eyes of 5 patients with diagnosis of refractory csc ( lasting more than 1 year ) were included in this study .
diagnosis was made by the history of recurrent blurred vision and metamorphopsia for more than one year , detection of neurosensory detachment in ophthalmoscopy and optical coherence tomography ( oct ) , and observation of active rpe leakage in flourscein angiography .
exclusion criteria consisted of any accompanying macular disease , severe media haziness which precludes oct evaluation , and noncompliance .
all eyes received a single injection of 0.05 ml ( 1.25 mg ) intravitreal bevacizumab ( avastin ; genentech inc . ,
south san francisco , ca , usa [ made for f. haffmann - la roche ltd . ,
basel , switzerland ] ) performed by a 30-guage needle through supratemporal quadrant 4 mm from the limbus under sterile condition .
all patients underwent a through ophthalmic examination 1 day , 1 week , and 1 , 2 , and 6 months after the injection .
best corrected visual acuity ( bcva ) of the eyes was checked by a masked optometrist .
it was changed to the logarithm of minimum angle of resolution ( logmar ) scale for statistical purposes and compared at months 2 and 6 with the baseline values .
central macular thickness ( cmt ) measured by oct ( 3d oct-1000 ; topcon corporation , tokyo , japan ) was performed at presentation and repeated 6 months after the intervention .
it was measured in a 1-mm circle centered on the fovea by an optician who was masked to the study .
none of the patients had history of intraocular surgery , diabetes mellitus , hypertension , cardiovascular disease and smoking .
an increase of bcva was noticed during the follow - up in all eyes except case 1 .
mean bcva at baseline was 0.60  0.25 that improved to 0.42  0.16 and 0.24  0.21 logmar up to the month 2 and 6 , respectively .
this improvement at 2 months did not reach to a meaningful level ( p = 0.064 ) ; however , it was statistically significant at 6 months ( p = 0.025 ) . no recurrence was observed in any of the eyes during the follow - up period .
central macular thickness decreased significantly from 370  65 m at baseline to 210  24 m at 6 months after injections ( p = 0.009 ) ( table 2 ) .
none of the eyes had intraocular pressure rise ( > 21 mmhg ) or cataract progression during the follow - up period .
they include acetazolamide , beta - blockers , vitamins , and non - steroidal anti - inflammatory drugs .
there are some controversial recommendations in the literature on the use of laser photocoagulation in this field .
some authors reporting that laser photocoagulation shortens the duration of disease and reduces recurrence rate , while others maintain that it does not affect final vision and recurrence rate .
furthermore , laser may be associated with permanent scotoma which may enlarge over time with rpe scar expansion , as the possible development of cnv .
it may hasten resolution of exudation by reducing choroidal blood flow and hence favoring cessation of leakage .
most recently , several case series have reported the use of indocyanine green guided pdt in the treatment of chronic csc .
ober et al .   reported the successful treatment of focal rpe leaks in csc by pdt in a small pilot series which showed resolution and visual improvement .
cardillo piccolino et al .   performed indocyanine green guided pdt in 16 eyes with chronic csc and treatment resulted in complete resolution of serous retinal detachment 1 month after treatment in 75% of eyes . at 3 months after pdt ,
69% of eyes had visual improvement of 1 or more lines . however , 31% of their cases developed secondary rpe changes at the site of pdt , which were thought to be due to hypoxic damage caused by choriocapillaris occlusion .
our study showed a significant visual improvement and cmt reduction following single injection of ivb ( 1.25 mg ) in 5 cases suffering from refractory csc for more than one year . in a similar study on 5 cases with csc , torres - soriano et al .
noticed an improvement in bcva , fluorescein angiographic leakage , and reduced or resolved neurosensory detachment .
however , they injected 2.5 mg ivb and included cases with history of decreased visual acuity more than 3 months , recurrent episodes of csc or even acute cases with excessive discomfort about visual acuity . in a case
.   showed that in cases with chronic csc ivb injection improved bcva and reduced cmt .
however , they performed multiple injections of 2.5 mg ivb at 6 to 8 week intervals ( range , 1 to 4 weeks )
. however , recurrence did not occur in any case of our study during follow up period .
in summery , the present study demonstrated a promising effect of ivb in the treatment of refractory csc ; however , we can not make specific treatment recommendations based on this small , uncontrolled case series .
 in a clinical case series , 5 patients with not - resolved central serous choroidoretinopathy ( csc ) lasting more than 1 year received one intravitreal bevacizumab injection ( ivb , 1.25 mg ) injection . 
 all patients underwent a through ophthalmic examination 1 day , 1 week , and 1 , 2 , and 6 months after the injection . 
 best corrected visual acuity ( bcva ) and central macular thickness were compared before and after treatment by optical coherence tomography . 
 mean bcva was improved significantly ( p = 0.020 ) from 0.60  0.25 to 0.50  0.18 and 0.29  0.19 logarithm of minimum angle of resolution at 6 and 18 weeks , respectively . 
 central macular thickness was also decreased significantly ( p = 0.010 ) from 370  65 to 208  23 m at 4 months . 
 no recurrence was occurred during follow - up . 
 ivb injection may have beneficial effect in the treatment of refractory csc . 