Photodynamic Therapy With Verteporfin using Half Fluence for Chronic Central Serous Chorioretinopathy

Mun Hee Chang; Seong Woo Kim; Jae Ryung Oh; Kuhl Huh

doi:10.3341/jkos.2009.50.9.1326

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Chang, Kim, Oh, and Huh: Photodynamic Therapy With Verteporfin using Half Fluence for Chronic Central Serous Chorioretinopathy

Original Article

J Korean Ophthalmol Soc 2009;50(9):1326-1333.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1326

Photodynamic Therapy With Verteporfin using Half Fluence for Chronic Central Serous Chorioretinopathy

Mun Hee Chang, MD, Seong Woo Kim, MD, PhD, Jae Ryung Oh, MD, PhD, Kuhl Huh, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Kuhl Huh, MD, PhD Department of Ophthalmology, Guro Hospital, Korea University College of Medicine #80 Guro-dong, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: dumky@unitel.co.kr

Received 19 February 2009 Accepted 16 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical results of half-fluence photodynamic therapy (PDT) using verteporfin in patients with chronic central serous chorioretinopathy (CSC).

Methods

The author reviewed the charts of 20 patients (22 eyes) who underwent PDT for chronic central serous chorioretinopathy. All 22 eyes were treated using an irradiance of 300 mW over 83 second (25 J/cm²). Postoperative evaluation included improvements in visual acuity, complications, changes in central macular thickness with the optical coherence tomogram (OCT), and recurrence.

Results

The best-corrected visual acuity improved significantly from 0.50±0.32 to 0.12±0.19 logMAR at 3 months (p<0.01), and the mean central macular thickness decreased from 377.7±86.3 μ m to 166.2±29.3 μ m at 3 months (p<0.01). Exudative serous macular detachments were resolved completely in all eyes within 3 months. There was no recurrence after PDT during the followup period.

Conclusions

PDT using half fluence appeared to be a beneficial treatment option for patients with chronic CSC. Further studies are needed to verify treatment safety as well as the time and rate of recurrences.

Keywords: Chronic central serous chorioretinopathy, Half fluence photodynamic therapy

References

1. Schatz H, Madeira D, Johnson RN, McDonald HR. Central serous chorioretinopathy occurring in patients 60 years of age and older. Ophthalmology. 1992; 99:63–7.

2. Gass JD. Pathogenesis of disciform detachment of the neuro-epithelium: II Idiopathic central serous choriodopathy. Am J Ophthalmol. 1967; 63:587–615.

3. Gass JD. Stereoscopic atlas of macular diseases: diagnosis and treatment. 4th ed.St. Louis: Mosby;1997. p. 52–70.

4. Costa RA, Scapucin L, Moraes NS, et al. Indocyanine green-mediated photothrombosis as a new technique of treatment for persistent central serous chorioretinopathy. Curr Eye Res. 2002; 25:287–97.

5. Prunte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol. 1996; 121:26–34.

6. Gilbert CM, Owens SL, Smith PD, Fine SL. Long-term follow up of central serous choriortinopathy. Br J Ophthalmol. 1984; 68:815–20.

7. Wang MS, Sander B, Larsen M. Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2002; 133:787–93.

8. Idia T, Yannuzzi LA, Spaide RF, et al. Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina. 2003; 23:1–7.

9. Robertson DM. Argon laser photocoagulation treatment in central serous chorioretinopathy. Ophthalmology. 1986; 93:972–4.

10. Piccolino FC. Laser treatment of eccentric leaks in central serous chorioretinopathy resulting in disappearance of untreated juxtafoveal leaks. Retina. 1992; 12:96–102.

11. Battaglia Parodi M, Da Pozzo S, Ravalico G. Photodynamic therapy in chronic central serous chorioretinopathy. Retina. 2003; 23:235–7.

12. Cardillo Piccolino F, Eandi CM, Ventre L, et al. Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003; 23:752–63.

13. Chan WM, Lam DS, Lai TY, et al. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003; 87:1453–8.

14. Yannuzzi LA, Slakter JS, Gross NE, et al. Indocyanine green angiography guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina. 2003; 23:288–98.

15. Canakis C, Livir-Rallatos C, Panayiotis Z, et al. Ocular photodynamic therapy for serous macular detachment in the diffuse retinal pigment epitheliopathy variant of idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2003; 136:750–2.

16. Taban M, Boyer DS, Thomas EL, et al. Chronic central serous chorioretinopathy: photodynamic therapy. Am J Ophthalmol. 2004; 137:1073–80.

17. Chung SE, Kang JH, Kang SW. Chronic central serous chorioretinopathy: Photodynamic Therapy. J Korean Ophthalmol Soc. 2007; 48:279–84.

18. Schmidt-Erfurth U, Laqua H, Schlotzer-Schrehard U, et al. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol. 2002; 120:835–44.

19. Lai TY, Chan WM, Lam DS. Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy. Am J Ophthalmol. 2004; 137:826–33.

20. Schlotzer-Schrehardt U, Viestenz A, Naumann GO, et al. Dose- related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes. Graefes Arch Clin Exp Ophthalmol. 2002; 240:748–57.

21. Tao Xu, Yingxing Li, Xing Wu. Application of lower fluence rate for less microvasculature damage and greater cell-killing during photodynamic theray. Lasers Med Sci. 2004; 19:150–4.

22. Schmidt-Erfurth U, Michels S, Barbazetto I, et al. Photodynamic effects on choroidal neovascularization and physiological choroid. Invest Ophthalmol Vis Sci. 2002; 43:830–41.

23. Michels S, Schmidt-Erfurth U. Sequence of early vascular events after photodynamic therapy. Invest Ophthalmol Vis Sci. 2003; 44:2147–54.

24. Henderson BW, Gollnick SO, Snyder JW, et al. Choice of oxygen-conserving treatment regimen determines the inflamma-tory response and outcome of photodynamic therapy of tumors. Cancer Res. 2004; 64:2120–6.

25. Sacu S, Varga A, Michels S, et al. Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone:short-term results of a randomised study. Br J Ophthalmol. 2008; 92:1347–51.

26. Tzekov R, Lin T, Zhang KM, et al. Ocular changes after photodynamic therapy. Invest Ophthalmol Vis Sci. 2006; 47:377–85.

27. Michels S, Hansmann F, Geitzenauer W, Schmidt-Erfurth U. Influence of treatment parameters on selectivity of verteporfin therapy. Invest Ophthalmol Vis Sci. 2006; 47:371–6.

28. Azab M, Boyer DS, Bressler NM, et al. Verteporfin therapy of subfoveal minimally classic choroidal neovascularization in age- related macular degeneration: 2-year results of a randomized clinical tiral. Arch ophthalmol. 2005; 123:448–57.

29. Singh CN, Saperstein DA. Sapersein. Combination treatment with reduced-fluence photodynamic therapy and intravitreal injection of triamcinolone for subfoveal choroidal neovascularization in macular degeneration. Retina. 2008; 28:789–93.

30. Verteporfin in Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in Age- related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization-VIP report 2. Am J Ophthalmol. 2001; 131:541–60.

31. Verteporfin in Photodynamic Therapy Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin: one-year results of a randomized clinical trial-VIP report 1. Ophthalmology. 2001; 108:841–52.

32. Bressler NM, Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials-TAP report 1. Arch Ophthalmol. 1999; 117:1329–45.

33. Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials – TAP report 2. Arch Ophthalmol. 2001; 119:198–207.

34. Chan WM, Lai TY, Lai RY, et al. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy. One-year results of a randomized controlled trial. Ophthalmology. 2008; 115:1756–65.

35. Lai TY, Chan WM, Lai RY, et al. Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study. Br J Ophthalmol. 2006; 90:869–74.

36. Kim JL, Kim HW, Yoon IH. Photodynamic therapy with verteporfin for short time for chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2008; 49:1078–86.

Figure 1.

The left eye of a 38-year-old man (No. 8) (Table 1) with chronic central serous chorioretinopathy (CSC) showing a submacular neurosensory retinal detachment (A) and focal retinal pigment epithelium (RPE) leakage (B). (C) The baseline OCT showing a neurosensory retinal detachment in the macular region. (D) Red-free fundus photography taken 3 months after PDT showing no submacular neurosensory retinal detachment. (E) Late phase FA taken 3 months after PDT showing no angiogenic leakage. (F) The OCT image obtained at 3 months showing complete resolution of the subretinal fluid.

Figure 2.

The right eye of a 48-year-old man (No. 6) (Table 1) with chronic central serous chorioretinopathy (CSC) showing a submacular neurosensory retinal detachment (A) and focal retinal pigment epithelium (RPE) leakage (B). (C) The baseline OCT showing a neurosensory retinal detachment in the macular region. (D) Red-free fundus photograph taken 3 months after PDT showing no submacular neurosensory retinal detachment. (E) Late phase FA taken 3 months after PDT demonstrating the absence of fluorescein leakage at macula with window defect at the fovea. (F) The OCTimage obtained at 3 months showing complete resolution of the subretinal fluid.

Table 1.

The characteristics of patients

Case No.	Age	Sex		Duration (months)	No. of previous recurrence	PDT^† spot size (μm)	BCVA^∗(LogMAR)			CMT^‡(μm)			Regression of SSRD^§	F/U (months)
Case No.	Age	Sex		Duration (months)	No. of previous recurrence	PDT^† spot size (μm)	Pre-PDT	Post– PDT 1 mon	Post-PDT 3 mon	Pre-PDT	Post– PDT 1 mon	Post-PDT 3 mon	Regression of SSRD^§	F/U (months)
1	35	M	L	6	1	2520	1.00	1.00	0.52	356	303	162	delayed	5
2	53	F	L	6	1	6640	1.00	0.10	0.00	355	163	174	early	13
3	72	F	R	31	1	4500	0.52	0.15	0.10	430	157	154	early	9
4	72	F	L	31	1	4500	1.00	0.30	0.10	430	146	138	early	9
5	45	F	R	7	2	3000	1.00	0.05	0.00	435	176	155	early	8
6	48	M	L	6	1	2800	0.52	0.22	0.05	367	160	147	early	7
7	38	M	R	12	1	3300	0.30	0.40	0.00	245	132	111	early	6
8	38	M	L	6	1	2200	0.22	0.22	0.00	240	133	133	early	6
9	47	M	R	9	2	1500	0.22	0.15	0.00	263	183	180	early	5
10	52	M	L	6	1	4500	0.15	0.00	0.00	481	209	206	early	4
11	44	M	R	9	3	2600	1.00	1.00	0.70	419	162	159	early	3
12	51	M	L	6	1	2290	0.70	0.30	0.15	297	230	195	delayed	3
13	47	M	R	6	2	2500/3000	0.49	0.10	0.00	497	185	185	early	3
14	38	M	L	6	7	2200	0.30	0.15	0.10	473	227	207	early	3
15	39	M	R	7	1	3000	0.52	0.52	0.40	417	128	130	early	3
16	39	M	L	8	1	3000	0.00	0.00	0.00	261	157	145	early	3
17	41	F	R	6	1	1800	0.10	0.10	0.05	442	248	220	delayed	3
18	63	F	R	12	1	2200	0.30	0.20	0.00	459	196	194	early	3
19	47	M	L	6	1	2100/2100	0.40	0.40	0.22	277	167	168	early	3
20	34	M	R	12	1	4000	0.40	0.30	0.15	285	133	150	early	3
21	56	M	R	6	1	1920	0.30	0.05	0.00	473	220	203	early	3
22	47	F	R	9	2	3590	0.52	0.22	0.10	408	124	140	early	3

^∗ Best corrected visual acuity;

^† Photodynamic therapy;

^‡ Central macular thickness in optical coherence tomogram;

^§ Serous sensory retinal detachment.

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