Photodynamic Therapy with Vertepofin for Short Time for Chronic Central Serous Chorioretinopathy

Jung Lim Kim; Hyun Woong Kim; Il Han Yoon

doi:10.3341/jkos.2008.49.7.1078

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Lim Kim, Woong Kim, and Han Yoon: Photodynamic Therapy with Vertepofin for Short Time for Chronic Central Serous Chorioretinopathy

Original Article

J Korean Ophthalmol Soc 2008;49(7):1078-1086.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.7.1078

Photodynamic Therapy with Vertepofin for Short Time for Chronic Central Serous Chorioretinopathy

Jung Lim Kim, M.D., Hyun Woong Kim, M.D., Il Han Yoon, M.D.

Department of Ophthalmology, College of Medicine, Inje University, Pusan, Korea Ophthalmology Research Foundation, Inje University, Pusan, Korea

Address reprint requests to Il Han Yoon, M.D. Department of Ophthalmology, InJe University Medical College #633-165 Kekum-dong, Pusanjin-gu, Pusan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: ihyun@inje.ac.kr

Received 15 April 2008 Accepted 30 August 2007

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 short duration photodynamic therapy (PDT) using verteporfin in patients with chronic central serous chorioretinopathy (CSC).

Methods

We retrospectively examined 15 eyes after PDT for chronic central serous chorioretinopathy. PDT for 83 seconds was evaluated for 8 eyes, and PDT for 60 seconds was evaluated for 7 eyes. Improvement in vision and changes in central macular thickness were evaluated with an optical coherence tomogram (OCT), and improvement in leaking was evaluated with a fluorescein angiogram (FA). Recurrence was also studied.

Results

Visual acuity improved from 0.39 to 0.57 (p=0.04), and the mean central macular thickness decreased from 426.29 µm to 184.71 µm (p<0.01) in 7 eyes treated with PDT for 60 seconds. There was no significant change in visual acuity between the two groups (p=0.77) or in central macular thickness (p=0.52). Central macular exudation resolved completely in all eyes. After PDT, there was no recurrence during the follow-up period.

Conclusions

Short duration PDT with verteporfin appears to be a beneficial treatment option for patients with chronic CSC.

Keywords: Chronic central serous chorioretinopathy, Indocyanine green angiography, Optical coherence tomography, Photodynamic therapy

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Figure 1.

Fluorescein angiogram and indocyanine green angiographic findings in the central serous chorioretinopathy. (A) Late phase fluorescein angiograph (FA) with characteristic leakage around the central macular consistent with central serous chorioretinopathy (CSC). (B) Late phase indocyanine green angiograph (ICGA) showing late extravascular leakage and hyperperfusion characteristic of CSC. Large choroidal vessels in the same area are visible. The circle represents the location and the size of the laser spot in photodynamic therapy (PDT).

Figure 2.

The left eye of patient no. 6 (Table 1), a 42-year-old man, with central serous chorioretinopathy (CSC) showing a shallow submacular neurosensory retinal detachment and persistent focal retinal pigment epithelium (RPE) leakage of 9 months duration, who was treated with vertepofin PDT for 83 seconds. (A) Late phase FA with characteristic leakage around the central macula consistent with CSC. (B) Late phase FA 3 months after PDT shows minimal changes of the pigment epithelial pigmentation and fluorescence around the macular region. (C) The pre-PDT OCT showing a shallow submacular neurosensory retinal detachment. The visual acuity at this time was 0.32. (D) The OCT 3 months after PDT demonstrates complete resolution of the macular detachment. The visual acuity improved to 0.5.

Figure 3.

The left eye of patient no. 9 (Table 1), a 46-year-old man, with central serous chorioretinopathy (CSC) showing a submacular neurosensory retinal detachment and persistent focal retinal pigment epithelium (RPE) leakage of 6 months duration, who was treated with vertepofin PDT for 60 seconds. (A) Late phase FA with characteristic leakage around the central macula consistent with central CSC. The visual acuity was 0.32. (B) Late phase FA 3 months after PDT shows no angiogenic leakage and minimal changes of the pigment epithelial pigmentation around the macular region. (C) The pre-PDT OCT showed the presence of subretinal fluid at the central macula. (D) The OCT 3 months after PDT demonstrates complete resolution of the macular detachment. The visual acuity improved to 0.4.

Table 1.

Patient Characteristics

	sex	age	Duration (months)	BCVA		OCT thickness (µm)		PDT Spot Size (µm)	Mean F/U Period (months)	PDT Duration (seconds)
	sex	age	Duration (months)	Initial	Final*	Initial	Final^†	PDT Spot Size (µm)	Mean F/U Period (months)	PDT Duration (seconds)
1	M	53	6	0.1	0.32	484	221	2700	18	83
2	M	60	10	0.5	1.0	349	179	2500	19	83
3	M	44	7	0.8	1.0	288	188	2700	15	83
4	M	49	33	0.1	0.125	427	227	1600	20	83
5	M	49	33	0.1	0.1	299	191	3300	20	83
6	M	42	9	0.32	0.5	278	167	2800	22	83
7	M	42	11	0.25	0.32	401	176	2000	12	83
8	M	48	16	0.8	1.0	309	165	2400	6	83
9	M	46	6	0.32	0.4	795	140	2200	8	60
10	M	45	7	0.125	0.2	349	179	3000	7	60
11	F	40	6	0.32	1.0	288	188	3300	6	60
12	F	48	8	0.32	0.5	427	227	2300	6	60
13	M	38	7	0.25	0.5	338	205	2400	6	60
14	M	39	10	0.4	0.4	312	163	2100	8	60
15	M	33	6	1.0	1.0	475	191	1600	6	60

^* 6 months after PDT;

^† 3 months after PDT; BCVA=best corrected visual acuity; OCT=optical coherence tomogram; PDT= photodynamic therapy; F/U=follow-up.

Table 2.

Clinical data of each group

	PDT for 83 seconds	PDT for 60 seconds	P-value
Number of eyes	8	7
Male : female	8:0	5:2	0.20^*
Mean age (years)	48.4±6.07	41.3±5.28	0.03^†
Duration of CSC (months)	15.63±11.13	7.14±1.46	0.04^‡
Duration of follow-up period (months)	16.5±5.29	6.71±0.95	<0.01^‡
Baseline mean BCVA	0.37±0.30	0.39±0.28	0.56^‡
BCVA 6 months after PDT	0.55±0.40	0.57±0.31	0.77^‡
Baseline mean OCT foveal thickness (µm)	354.36±75.25	426.29±175.25	0.38^‡
OCT foveal thickness (µm) 3 months after PDT	189.25±23.30	184.71±28.15	0.52^‡

^* Fisher’s exact test;

^† Mann-Whitney U test;

^‡ Mann-Whitney test; P-value of < 0.05 was defined as statistically significant; PDT=photodynamic therapy; CSC=central serous chorioretinopathy; BCVA=best corrected visual acuity; OCT=optical coherence tomogram.

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