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.
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.
Table 1.
Case No. | Age | Sex | Duration (months) | No. of previous recurrence | PDT† spot size (μm) |
BCVA∗(LogMAR) |
CMT‡(μm) |
Regression of SSRD§ | F/U (months) | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pre-PDT | Post– PDT 1 mon | Post-PDT 3 mon | Pre-PDT | Post– PDT 1 mon | Post-PDT 3 mon | |||||||||
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 |