Photodynamic Therapy and Focal Laser Photocoagulation in Chronic Central Serous Chorioretinopathy

Young Do Yeo; Jee Hyun Kim; Yu Cheol Kim; Kwang Soo Kim

doi:10.3341/jkos.2016.57.1.56

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

J Korean Ophthalmol Soc 2015;57(1):56-62.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.56

Photodynamic Therapy and Focal Laser Photocoagulation in Chronic Central Serous Chorioretinopathy

Young Do Yeo, M.D, Jee Hyun Kim, M.D, Yu Cheol Kim, M.D, PhD, Kwang Soo Kim, M.D, PhD

Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Kwang Soo Kim, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-7706, Fax: 82-53-250-7705 E-mail: kimks@dsmc.or.kr

‗This study was presented as a narration at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 12 June 20151 September 2015 Accepted 29 October 2015

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

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.

Keywords: Chronic central serous chorioretinopathy, Focal laser photocoagulation, Photodynamic therapy

References

1. Gass JD. Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, 4th ed. St. Louis: Mosby,. 1997; 52–70.

2. Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol. 1967; 63:Suppl. 1–139.

3. Eandi CM, Ober M, Iranmanesh R. . Acute central serous cho-rioretinopathy and fundus autofluorescence. Retina. 2005; 25:989–93.

4. Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol. 1996; 121:26–34.

5. Spaide RF, Hall L, Haas A. . Indocyanine green video-angiography of older patients with central serous chorioretinopathy. Retina. 1996; 16:203–13.

6. Ie D, Yannuzzi LA, Spaide RF. . Subretinal exudative deposits in central serous chorioretinopathy. Br J Ophthalmol. 1993; 77:349–53.

7. Iida T, Yannuzzi LA, Spaide RF. . Cystoid macular degener-ation in chronic central serous chorioretinopathy. Retina. 2003; 23:1–7. quiz 137-8.

8. Yap EY, Robertson DM. The long-term outcome of central serous chorioretinopathy. Arch Ophthalmol. 1996; 114:689–92.

9. Wang MS, Sander B, Larsen M. Retinal atrophy in idiopathic cen-tral serous chorioretinopathy. Am J Ophthalmol. 2002; 133:787–93.

10. Loo RH, Scott IU, Flynn HW Jr. . Factors associated with re-duced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina. 2002; 22:19–24.

11. Matsumoto H, Kishi S, Otani T, Sato T. Elongation of photo-receptor outer segment in central serous chorioretinopathy. Am J Ophthalmol. 2008; 145:162–8.

12. Ciardella AP, Guyer DR, Spitznas M, Yannuzzi LA, editors. Retina. 3rd. St Louis: Mosby;2001. p. 1153–81.

13. Ahn DG, Kang SW. The clinical evaluation of atypical idiopathic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2000; 41:691–700.

14. Robertson DM, Ilstrup D. Direct, indirect and sham laser photo-coagulation in the management of central serous chorioretinopathy. Am J Ophthalmol. 1983; 95:457–66.

15. Verma L, Sinha R, Venkatesh P, Tewari HK. Comparative evalua-tion of diode laser versus argon laser photocoagulation in patients with central serous retinopathy: a pilot, randomized controlled trial [ISRCTN84128484]. BMC Ophthalmol. 2004; 4:15.

16. Battaglia Parodi M, Da Pozzo S, Ravalico G. Photodynamic ther-apy in chronic central serous chorioretinopathy. Retina. 2003; 23:235–7.

17. Cardillo Piccolino F, Eandi CM, Ventre L. . Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003; 23:752–63.

18. Chan WM, Lam DS, Lai TY. . 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.

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. Tzekov R, Lin T, Zhang KM. . Ocular changes after photo-dynamic therapy. Invest Ophthalmol Vis Sci. 2006; 47:377–85.

21. Ficker L, Vafidis G, While A, Leaver P. Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1988; 72:829–34.

22. Watzke RC, Burton TC, Woolson RF. Direct and indirect laser pho-tocoagulation of central serous choroidopathy. Am J Ophthalmol. 1979; 88:914–8.

23. Yannuzzi LA, Slakter JS, Gross NE. . Indocyanine green an-giography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina. 2003; 23:288–98.

24. Costa RA, Scapucin L, Moraes NS. . Indocyanine green-mediated photothrombosis as a new technique of treatment for persis-tent central serous chorioretinopathy. Curr Eye Res. 2002; 25:287–97.

26. Lim JW, Kang SW, Kim YT. . Comparative study of patients with central serous chorioretinopathy undergoing focal laser pho-tocoagulation or photodynamic therapy. Br J Ophthalmol. 2011; 95:514–7.

27. Ma J, Meng N, Xu X. . System review and meta-analysis on photodynamic therapy in central serous chorioretinopathy. Acta Ophthalmol. 2014; 92:e594–601.

28. Photocoagulation for diabetic macular edema, Early Treatment Diabetic Retinopathy Study report number 1 Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985; 103:1796–806.

29. Matsunaga H, Nangoh K, Uyama M. . Occurrence of choroidal neovascularization following photocoagulation treatment for cen-tral serous retinopathy. Nihon Ganka Gakkai Zasshi. 1995; 99:460–8.

30. Ha TW, Ham DI, Kang SW. Management of choroidal neo-vascularization following laser photocoagulation for central serous chorioretinopathy. Korean J Ophthalmol. 2002; 16:88–92.

31. Pikkel J, Rumelt S. Intravitreal bevacizumab for choroidal neo-vascularization secondary to laser photocoagulation for central se-rous chorioretinopathy. Eur J Ophthalmol. 2012; 22:488–91.

32. Wessing A. Central serous retinopathy and related lesions. Mod Probl Ophthalmol. 1971; 9:148–51.

33. Berrocal JA. Current worldwide management of central serous choroidopathy. Mod Probl Ophthalmol. 1974; 12:239.

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.

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.

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.

TOOLS

Similar articles