Journal List > J Korean Ophthalmol Soc > v.57(1) > 1010550

Yeo, Kim, Kim, and Kim: Photodynamic Therapy and Focal Laser Photocoagulation in Chronic Central Serous Chorioretinopathy

Abstract

Purpose

The aim of this study was to compare the treatment efficacy of photodynamic therapy (PDT) and focal laser photo-coagulation in chronic central serous chorio retinopathy (CSC).

Methods

A retrospective study in a clinical practice setting including 40 eyes of 40 patients with chronic CSC which were treated with PDT or focal laser photocoagulation were recruited in this study from March 2011 to December 2013. Mean change in best corrected visual acuity (BCVA), presence or absence of resolution of subretinal fluid (SRF) and pigment epithelial detachment (PED), recurrence rate, and complications were analyzed.

Results

PDT was performed in 23 eyes of 23 patients and focal laser photocoagulation was performed in 17 eyes of 17 patients, and all patients were followed up for more than six months. Location of leakage point and appearance of leakage showed no statistically significant difference between the two groups. Both groups showed significant improvement in BCVA at one month and six months after the treatment; however, there was no statistically significant difference in BCVA improvement between the two groups. In both groups, SRF and PED were partially or completely resolved. Resolution of SRF was better in the PDT group at one month after the treatment; however, no statistically significant difference in the resolution period was observed between the two groups. None of the patients experienced adverse events in the PDT group, but one patient developed choroidal neo-vascularization after treatment in the focal laser photocoagulation group. Two patients showed recurrence in the PDT group and needed retreatment.

Conclusions

Both treatments are beneficial in patients with chronic CSC. Focal laser photocoagulation can be a good treatment option in terms of cost-effectiveness and convenience.

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Figure 1.
Indirect focal laser photocoagulation. If the leakage point is located within 350 μ m of the fovea, focal laser photo-coagulation (×) is performed 3 to 5 times at the nearest but outside the 350 μ m radius circle (circle) from the fovea.
jkos-57-56f1.tif
Figure 2.
A patient in group B with complications after treatment. (A) One month after the focal laser photocoagulation treatment, choroidal neovascularization (white arrow) devel-oped and subretinal fluid is seen on optical coherence tomography. (B) One month after intravitreal injection of an-ti-VEGF, complete resolution of subretinal fluid and re-gression of CNV are observed. VEGF = vascular endothelial growth factor; CNV = choroidal neovascularization.
jkos-57-56f2.tif
Table 1.
Demographic features of the patients
Number of subjects Mean age (years) Gender (male:female) Duration of symptom (months) Duration of follow up (months)
Group A* 23 45.3 ± 5.8 20:3 11.21 ± 7.09 7.91 ± 6.16
Group B 17 51.5 ± 9.1 15:2 9.34 ± 6.12 8.08 ± 7.14
p-value 0.162 0.904§ 0.093 0.500

Values are presented as mean ± SD unless otherwise indicated.

* Photodynamic therapy group; Focal laser photocoagulation group; By Mann-Whitney U-test; § By Pearson chi square test.

Table 2.
Location of leakage point and appearance
Distance of leaking point from macular center
Appearance
<350 μ m (%) 350-500 μ m (%) >500 μ m (%) Focal (<250 μ m, %) Diffuse (>250 μ m, %)
Group A* (n = 23) 34.8 39.1 26.1 78.3 21,7
Group B (n = 17) 23.5 35.3 41.2 88.2 11.8
p-value 0.692 0.412

* Photodynamic therapy group; Focal laser photocoagulation group; By Pearson chi square test.

Table 3.
Comparison of visual acuity at baseline and 1 month post-treatment
Baseline BCVA (mean, log MAR) BCVA of 1 month post-treatment p-value§ Improvement of BCVA*
Group A* 0.53 0.38 0.017 0.19
Group B 0.54 0.34 0.003 0.15
p-value 0.058 0.423 0.377

BCVA = best corrected visual acuity.

* Photodynamic therapy group; Focal laser photocoagulation group; By Mann-Whitney U-test; § By Wilcoxon Signed-Rank test.

Table 4.
Comparison of visual acuity at baseline and 6 months post-treatment
Baseline BCVA (mean, log MAR) BCVA of 6 months post-treatment p-value§ Improvement of BCVA
Group 1* 0.53 0.07 <0.001 0.27
Group 2 0.54 0.21 0.001 0.26
p-value 0.058 0.130 0.124

BCVA = best collected visual acuity.

* Photodynamic therapy group; Focal laser photocoagulation group; By Mann-Whitney U-test; § By Wilcoxon Signed-Rank test.

Table 5.
Comparison of subretinal fluid resolution period and outcome of treatment after 1 month
Subretinal fluid
PED
Improvement (%) Resolution (%) Resolution period (mean, month) Improvement (%) Resolution (%)
Group A* (n = 23) 17.4 82.6 1.71 42.9 57.1
Group B (n = 17) 41.2 58.8 1.50 57.1 42.9
p-value 0.015§ 1.000 0.143§

PED = pigment epithelium detachment.

* Photodynamic therapy group; Focal laser photocoagulation group; By Mann-Whitney U-test; § By Pearson chi square test.

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