Purpose: To investigate whether choroidal neovascularization (CNV) can act as a trigger for central serous chorioretinopathy (CSCR) in patients with pachychoroid features, by analyzing cases where fluorescein angiography (FA)–confirmed leakage originated directly within the CNV lesion. Methods: We retrospectively reviewed patients with no prior history or signs of CSCR who presented with a first episode of CSCR and coexisting CNV. Inclusion required at least one FA–confirmed leakage point located within the neovascular complex. Multimodal imaging–including FA, spectral–domain optical coherence tomography (SD–OCT), and OCT angiography (OCTA)–was performed to detect CNV and evaluate its topographical relationship with leakage. Results: Among 202 patients screened, four met inclusion criteria (two males, two females; age range 54–58 years). All presented with a unilateral first episode of CSCR. In each case, FA and OCTA demonstrated precise colocalization of the leakage point within the CNV lesion. CNV was predominantly retrofoveal and appeared mature in morphology. Three patients were diagnosed simultaneously with CSCR and a neovascular membrane, while one developed CSCR during follow–up of a previously identified PNV. Subretinal fluid fluctuations were observed in all cases and often appeared independent of anti–VEGF treatment, suggesting a mechanism not exclusively driven by VEGF–mediated CNV activity. Conclusions: This case series suggests that, within the pachychoroid spectrum, CNV may not only complicate chronic or complex CSCR but may also act as a direct trigger of acute episodes. These findings underscore the importance of multimodal imaging, particularly FA and OCTA, for comprehensive assessment of CSCR.

Conflict of Interest: Dr Elodie Bousquet: consultant for Abbvie, Bayer Healthcare and Roche, No conflicting relationship exists for other authors.

This study did not receive any funding.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee of the French Society of Ophthalmology (00008855) gave ethical approval for this work.

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All data produced in the present study are available upon reasonable request to the authors