Comparison of Focal and Conventional Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Abstract

PurposeTo evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).MethodsThis study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.ResultsThe mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).ConclusionsFocal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.

Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy

“…Complications of PDT in cCSC were rarely reported; in detail no serious adverse event related to PDT administration was described. CNV occurred in a total of 4 cases [10,20], secondary RPE atrophy was described in the 7% of cases by Noh [18], and RPE hyperplasia was identified in 9/72 subjects by Moreno [20]. In the other studies, no complication related to PDT session or PDT effects was reported in 4 studies, whereas no specific data was presented in 6 studies.…”

“…Overall, follow-up ranged between 1 and 5 years with 8/13 studies with 1-year follow-up and 4/13 with prospective design [10,11,[17][18][19][20][21][22][23][24][25][26][27] (Table 1).…”

Central serous chorioretinopathy: Treatment

“…Although the pathogenesis of CSC has not yet been identified, several hypotheses have been proposed to explain it such as the alteration of the outer blood-retinal barrier, the function of the RPE pump due to defective choroidal circulation,[ 31 32 ] and mechanical obstructions of the vortex vein. [ 33 34 ] Two studies have shown asymmetrical dilatation of the vortex vein in patients with CSC.…”

“…[ 31 ] Furthermore, to decrease the risk of complications, a study was conducted on PDT spot size. [ 32 ] Noh et al . reported that focal verteporfin PDT, confined to areas of localized leakage demonstrated in ICGA compared with conventional verteporfin PDT, covered the total area of abnormal choroidal vessels, including the leakage, resulting in a significant decrease in SRF and subfoveal choroidal thickness as well as conventional PDT during the 1-year follow-up.…”

“…reported that focal verteporfin PDT, confined to areas of localized leakage demonstrated in ICGA compared with conventional verteporfin PDT, covered the total area of abnormal choroidal vessels, including the leakage, resulting in a significant decrease in SRF and subfoveal choroidal thickness as well as conventional PDT during the 1-year follow-up. [ 32 ] RPE atrophy was observed as a complication in one eye and three eyes in the focal and conventional verteporfin PDT groups, respectively. However, there was no statistical difference between the two groups.…”