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Abstract
Purpose
To evaluate the results of half-dose photodynamic therapy (PDT) and determine the correlation between morphological changes measured by spectral-domain optical coherence tomography (SD-OCT) and visual acuity in patients with chronic central serous chorioretinopathy (CSC).
Methods
Twenty-five eyes of 25 patients with chronic CSC who had received half-dose verteporfin PDT were enrolled in the present study. The best-corrected visual acuity (BCVA), outer nuclear layer (ONL) thickness, and the integrity of the photoreceptor inner and outer segment junction (IS/OS) using SD-OCT were evaluated at baseline and at 3 and 6 months after treatment.
Results
The neurosensory retinal detachment disappeared in all eyes 6 months after treatment. The BCVA improved significantly from 0.50 ± 0.32 to 0.31 ± 0.29 log MAR at 6 months (p < 0.001). The average ONL thickness at the central fovea was 88.76 ± 19.95 μm at 6 months and the ONL thickness was well correlated with the BCVA (γ = −0.64; p = 0.001). There was no significant correlation between the status of IS/OS and the BCVA.
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Figure 1.
Representative image of 53-year-old female patient with central serous chorioretinopathy. Perpendicular line was drawn from the internal limiting membrane to the external limiting membrane at the central fovea, and outer nuclear layer thickness was measured using the computer-based caliper tool in the spectral-domain optical coherence tomography.
Figure 2.
Representative pattern of the photoreceptor inner and outer segment junction (IS/OS) obtained by spectral-do- main optical coherence tomography in eyes with chronic central serous chorioretinopathy. (A) IS/OS line is nearly continuous and intact. (B) IS/OS line is fragmented and partially disrupted. (C) IS/OS line is absent.
Figure 3.
Temporal changes of best-corrected visual acuity (BCVA) and outer nuclear layer (ONL) thickness after half-dose photodynamic therapy in patients with chronic central serous chorioretinopathy. Error bars represent standard errors of the mean. By 3 month, the mean BCVA was significantly improved from 0.50 to 0.37 log MAR (p = 0.007). There was no significant difference in BCVA between 3 and 6 months (p = 0.54). The average ONL thickness at 6 months was 88.76 ± 19.95 μm and no significant difference in ONL thickness was noted at all time points (p > 0.05, Wilcoxon signed rank test).
Figure 4.
Graph showing the outer nucler layer (ONL) thickness at the central fovea in 25 patients with chronic central serous chorioretinopathy treated with half-dose photodynamic therapy compared with their best-corrected visual acuity (BCVA). The ONL thickness at 6 months is negatively correlated with log MAR BCVA at 6 months (Spearman's correlation coefficient γ = −0.642, p= 0.001).
Figure 5.
Fluorescein angiograph (FA) and spectral-domain optical coherence tomography (SD-OCT) images in a 58-year-old man with chronic central serous chorioretinopathy. (A, B) FA shows a characteristic leakage at the central macula in early and late phase. (C) Serous retinal detachment with irregular, thickened photoreceptor inner and outer segment junction (IS/OS) is noted at baseline. (D) The SD-OCT at 6 months after treatment shows complete resolution of the subretinal fluid and restoration of IS/OS. The outer nuclear thickness was measured as 47 μm. The best-corrected visual acuity was 0.52 log MAR with no improvement.
Figure 6.
Fluorescein angiograph (FA) and spectral-domain optical coherence tomography (SD-OCT) images in a 56-year-old woman with chronic central serous chorioretinopathy. (A, B) FA shows some leakage at the nasal macula in early and late phase. (C) Serous retinal detachment with elongation of outer segment is noted at baseline. (D) The SD-OCT at 6 months after treatment shows nearly complete resolution of the subretinal fluid and partial irregular photoreceptor inner and outer segment junction. The outer nuclear thickness was measured as 100 μm. The best-corrected visual acuity improved from 0.40 to 0.09 log MAR.
Table 1.
Demographic characteristics of the patients
Table 2.
Status of photoreceptor inner and outer segment junction (IS/OS) at baseline and after half-dose photodynamic therapy in 25 patients with chronic central serous chorioretinopathy
| Baseline | 3 months | 6 months | |
|---|---|---|---|
| IS/OS + | 7 (28%) | 15 (60%) | 16 (64%) |
| IS/OS ± | 2 (8%) | 5 (20%) | 5 (20%) |
| IS/OS- | 16 (64%) | 5 (20%) | 4 (16%) |
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