Journal List > J Korean Ophthalmol Soc > v.54(7) > 1009419

Hyun, Woohyok, and Min: Comparison of Very Low Fluence and Low Fluence Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

Abstract

Purpose

To investigate the safe, effective light dose for photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC).

Methods

Thirty-eight eyes of 37 patients with chronic CSC were recruited for this study. From November 2009 to July 2010 and from April 2011 to February 2012, PDT was performed using 50% and 25% of the full light dose in 27 eyes of 27 patients (group I) and 11 eyes of 10 patients (group II), respectively. The minimum follow-up period was 6 months. Mean change in best corrected visual acuity (BCVA) and central retinal thickness, hyperpermeability change from abnormal cho-riocapillaris, success rate, recurrence rate, and complications were analyzed.

Results

Group I showed that BCVA (log MAR) improved significantly from 0.33 ± 0.17 to 0.14 ± 0.15 at 6 months ( p < 0.001). However, there was no significant improvement of BCVA ( p = 0.050) in group II. One eye out of 27 eyes (3.7%) in group I and 5 eyes out of 11 eyes (45.5%) in group II showed recurrence at the 6-month follow-up ( p = 0.016). After initial PDT, hyperpermeability from abnormal choriocapillaris reduced or disappeared at 95.5% in group I and 54.5% in group II at month 3 ( p = 0.016). No patient in either group experienced severe adverse events.

Conclusions

PDT performed with 50% of the full light dose appears to be a more useful method in the treatment of chronic CSC, with less frequent recurrence, than PDT using 25% of the full light dose.

References

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Figure 1.
Graph showing the serial changes in mean BCVA (best-corrected visual acuity) of patients in the 50% PDT group and in the 25% PDT group. While 50% PDT group showed significant visual improvement at month 3 and month 6 after treatment, 25% PDT group showed no significant visual improvement. And there was no significant difference in mean change of BCVA at every follow-up period between two groups.
jkos-54-1046f1.tif
Figure 2.
Graph showing the serial changes in mean CMT (central macular thickness) in the 50% PDT group and in the 25% PDT group. 25% PDT group showed no significant decrease in CMT at month 3 after treatment but had significance at month 6. Meanwhile, 50% PDT group showed significance at every follow-up period. There was no significant difference in mean change of CMT at every follow-up period between two groups.
jkos-54-1046f2.tif
Table 2.
Clinical data in patients with CSC treated by using 25% energy PDT
Groups 50% PDT* 25% PDT p-value
Baseline characteristics
Participants (eyes) 27 11
Sex (M : F) 22:5 7:4
Age (years) 47.5 7.7 51.18 8.13 0.116
Duration of symptoms (months) 11.7 8.3 17.27 19.74 0.169
BCVA (log MAR) 0.33 0.17 0.31 0.38 0.124
CMT (m) 352.89 82.55 350.18 102.90 0.975

Values are presented as mean SD (range) or n.

BCVA = best corrected visual acuity in logarithm of the minimum angle of resolution; CMT = central macular thickness.

* Photodynamic therapy with 25 J/cm2;

Photodynamic therapy with 12.5 J/cm2;

Between-group comparison was evaluated by Mann-Whitney U test.

Table 2.
Clinical data in patients with CSC treated by using 25% energy PDT
No Sex/Age Duration of symptom (month) Follow up (month) BCVA (log MAR) Optical coherence tomography Recurrence Leak in ICGA at 3 months Cx Retreatment
1 F/54 6 6 0.09 0.04 0 SRF No SRF No SRF No response Persistent No 50% PDT
2 M/53 6 6 0 0.04 0.15 SRF SRF No SRF Yes Persistent No 50% PDT
3 F/59 5 10 0.69 0.52 0.39 SRF No SRF No SRF No Disappeared No
4 M/61 6 12 1.09 0.82 0.69 SRF No SRF No SRF No Disappeared No
5 M/54 48 12 0.15 0.69 0.22 SRF No SRF No SRF No Disappeared No
6 M/54 48 12 0.15 0.04 0.04 SRF SRF No SRF Yes Persistent No 50% PDT
7 F/45 4 9 0 0 0 SRF No SRF No SRF No Reduced No
8 M/33 10 16 0.09 0 0 SRF SRF SRF+PED Yes Reduced and Newely developed No Intraviteal bevacizumab
9 M/44 6 6 0.09 0.30 0.1 SRF No SRF No SRF No response Persistent No 50% PDT
10 F/58 6 6 0.82 0.52 0.40 SRF No SRF No SRF No Reduced No
11 M/48 6 6 0.22 0.05 0 SRF No SRF No SRF No Disappeared No

ICGA = indocyanine green angiography; BCVA = best corrected visual acuity; Cx = complication; SRF = subretinal fluid; PED = pigment epithelium detachment.

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