Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

Young Seung Kim; Young Hoon Lee; Hyoung Seok Kim; Sun Young Jin; Tae Gon Lee

doi:10.3341/jkos.2013.54.10.1526

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Kim, Lee, Kim, Jin, and Lee: Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

Original Article

J Korean Ophthalmol Soc 2013;54(10):1526-1533.

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1526

Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

Young Seung Kim, MD¹, Young Hoon Lee, MD¹, Hyoung Seok Kim, MD¹, Sun Young Jin, MD¹, Tae Gon Lee, MD²

¹Department of Ophthalmology, Konyang University College of Medicine, Daejon, Korea

²Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Myung-Gok Eye Research Institute, Seoul, Korea

Address reprint requests to Young Hoon Lee, MD, Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 302-812, Korea, Tel: 82-42-600-9258, Fax: 82-42-600-9176, E-mail: astrix001@gmail.com

Received 29 March 2013 Revised 17 July 2013 Accepted 1 October 2013

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

In this study we compared the effectiveness between half energy photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection for chronic central serous chorioretinopathy (CSC).

Methods

Forty-five eyes of 42 patients diagnosed as chronic CSC from March 2008 to April 2011 were treated with half energy PDT or IVB injection. The subjects were chosen for a retrospective study and analysis was performed on changes in best corrected visual acuity and existence of subretinal fluid, recurrence rate and changes in central macular thickness.

Results

Similar improvement of visual acuity was observed in both treatment groups 1 month after treatment and no meaningful difference was found in each stage for both groups (p = 0.001, p = 0.0012, respectively). However, 6 to 12 months after the treatment, the half energy PDT group showed more improvement in visual acuity compared to the IVB injection group (p = 0.019, p = 0.043, respectively). Nineteen out of 21 cases showed full recovery of subretinal fluid in the half energy PDT group with an average treatment period of 1.3 ± 0.8 months and 7 out of 24 cases showed full recovery in the IVB injection group with an average treatment period of 3.2 ± 2.8 months. There was a single case of recurrence in the half energy PDT group and 4 in the IVB injection group. The half energy PDT group showed a meaningful decline in central macular thickness at 1, 3, and 6 months after treatment (p = 0.001, p = 0.005, p = 0.007, respectively) compared to the IVB injection group and showed numerous cases with decline in central macular thickness below the 2 standard deviation from normal values (p = 0.002).

Conclusions

Both half energy PDT and IVB injection were effective for the treatment of chronic central serous chorioretinopathy. However, the half energy PDT group comparatively showed better anatomical and functional outcomes. The thinning of central macular thickness below normal value was also observed, thus careful choice of treatment is necessary for patients with chronic central serous chorioretinopathy.

Keywords: Chronic serous chorioretinopathy (CSC), Intravitreal Bevacizumab injection, Photodynamic therapy

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Figure 1.

Time course of mean visual acuity and visual gain during 12 months after treatment.

Figure 2.

Time for resolusion of subretinal fluid of patients with chronic central serous chorioretinopathy.

Figure 3.

Time course of central macular thickness during 12 months after treatment.

Table 1.

Baseline characteristics of patients with chronic central serous chorioretinopathy

Characteristic	hf-PDT (n = 21 eyes)	IVB (n = 24 eyes)	p-value
Sex (male:female)	20:1	22:2	1.000^†
Age (years)	51.1 ± 9.1	51.5 ± 8.8	0.991^*
Laterality (OD:OS)	13:8	11:13	0.218^†
Duration of chronic CSC (months)	29.4 ± 41.6	25.7 ± 42.6	0.630^*
Fluoroangiographic pattern
Focal leaking	5	15
Diffuse, granular leaking	16	9	0.016^†
Follow up period (months)	8.4 ± 7.7	10.0 ± 9.0	0.498^*
Number of treatment	1	1.9 ± 1.3	0.001^*

Values are presented as mean ± SD unless otherwise indicate.

SD = standard deviation; CSC = central serous chorioretinopathy.

^* Mann-Whitney U-test;

^† Fisher exact test.

Table 2.

Clinical results of patients with chronic central serous chorioretinopathy

BCVA (log MAR)	hf-PDT (n = 21 eyes)			IVB (n = 24 eyes)			p-value^†
BCVA (log MAR)	n	BCVA	Visual gain from baseline (p-value^*)	n	BCVA	Visual gain from baseline (p-value^*)	p-value^†
Baseline	21	0.53 ± 0.31		24	0.43 ± 0.34		0.267
Post 1 month	21	0.32 ± 0.27	0.001	24	0.35 ± 0.35	0.012	0.854
Post 3 months	10	0.30 ± 0.23	0.011	16	0.24 ± 0.18	0.001	0.524
Post 6 months	5	0.11 ± 0.24	0.043	17	0.31 ± 0.25	0.091	0.12
Post 12 months	10	0.15 ± 0.22	0.005	7	0.21 ± 0.20	0.465	0.475

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviation.

^* Wilcoxon signed rank test;

^† Mann-Whitney U-test.

Table 3.

Clinical results of patients with chronic central serous chorioretinopathy

Visual gain (log MAR)	hf-PDT (n = 21eyes)		IVB (n = 24 eyes)		p-value^†
Visual gain (log MAR)	n	Visual gain	n	Visual gain	p-value^†
Post 1 month ∼ Baseline	21	0.19 ± 0.26	24	0.10 ± 0.18	0.174
Post 3 months ∼ Baseline	10	0.32 ± 0.31	16	0.23 ± 0.24	0.494
Post 6 months ∼ Baseline	5	0.52 ± 0.33	17	0.10 ± 0.26	0.019
Post 12 months ∼ Baseline	10	0.41 ± 0.28	7	0.18 ± 0.43	0.043

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviation.

^*Wilcoxon signed rank test;

^† Mann-Whitney U-test.

Table 4.

Subretinal fluid of patients with chronic central serous chorioretinopathy

Subretinal fluid	hf-PDT (n = 21 eyes)	IVB (n = 24 eyes)	p-value
Location (pre)
Subfoveal, only (<200 μm)	10	12
Extrafoveal (> 200 μm)	11	12
Extrafoveal, only	0	0	1.000^†
Remission
Complete	19	7
Incomplete	2	17	0.000^†
Period (months)	1.3 ± 0.8	3.2 ± 2.8	0.188^*

Values are presented as mean ± SD unless otherwise indicate.

SD = standard deviation.

^* Mann-Whitney Latest;

^† Fisher exact test.

Table 5.

Central macular thinning of patients with chronic central serous chorioretinopathy

Central macular thinning	hf-PDT (n = 21 eyes)	IVB (n = 24 eyes)	p-value
Pretreatment
(+)	4	3
(-)	17	21	0.591^*
Posttreatment
(+)	19	9
(-)	2	15	0.001^*

Values are presented as mean ± SD unless otherwise indicate.

SD = tandard deviation.

^* Fisher exact test.

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