Increasing Evidence for the Safety of Fovea-Involving Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Feenstra, Helena M.A.; Diederen, Roselie M.H.; Lamme, Martine J C M; Tsonaka, Roula; Fauser, Sascha; Yzer, Suzanne; Rijssen, Thomas van; Gkika, Theodora; Downes, Susan M.; Schlingemann, Reinier O.; Hoyng, Carel B.; Dijk, Elon H. C. van; Boon, Camiel J F

doi:10.1097/iae.0000000000003686

Cited by 9 publications

(8 citation statements)

References 31 publications

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“…Recent retrospective analysis of chronic CSCR half-dose PDT RCT data showed that patients who underwent fovea-involving PDT had no evidence of subsequent foveal atrophy or vision loss, and instead demonstrated significant anatomic and visual improvement. This effect was seen at a mean follow-up of 22.1 months, suggesting foveal involvement in safety-enhanced PDT protocols may have long-term safety and efficacy 32 …”

Section: Photodynamic Therapymentioning

confidence: 88%

“…This effect was seen at a mean follow-up of 22.1 months, suggesting foveal involvement in safetyenhanced PDT protocols may have long-term safety and efficacy. 32 While PDT has demonstrated efficacy in multiple trials for chronic CSCR, its efficacy as an early treatment for acute CSCR is less clear, and many practitioners will observe acute CSCR given its high rate of spontaneous resolution. A recent small single-center trial provided some evidence to support this practice.…”

Section: Photodynamic Therapymentioning

confidence: 99%

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Update on the Management of Central Serous Chorioretinopathy

Bordbar,

Skrehot,

Weng

2023

International Ophthalmology Clinics

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Section: Photodynamic Therapymentioning

confidence: 88%

Section: Photodynamic Therapymentioning

confidence: 99%

Update on the Management of Central Serous Chorioretinopathy

Bordbar,

Skrehot,

Weng

2023

International Ophthalmology Clinics

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“…Interestingly, MPL and focal laser were performed more frequently than PDT even though recent large randomized controlled trials, such as the PLACE and SPECTRA trial, found PDT to be superior to other treatment options [19, 20]. PDT also shows favorable long-term safety data [21] and can safely be performed bilaterally within a single treatment session [22]. While it is thus often considered the treatment of choice [4, 23], its use in our German study population was surprisingly low.…”

Section: Discussionmentioning

confidence: 99%

Clinical Landscape of Central Serous Chorioretinopathy in Germany: Retina.net CSC Registry Report Number 1

Lange,

Ohlmeier,

Kiskämper

et al. 2024

Ophthalmologica

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Introduction: The German Registry of central serous chorioretinopathy (CSC) collects data on CSC patients in a nationwide multicenter approach to analyze epidemiology, risk factors, clinical presentations, as well as diagnosis and treatment patterns. Methods: In this multicenter cohort study, patients with CSC were enrolled in nine tertiary referral centers in Germany between January 2022 and June 2023. After consenting to the study, demographic data, risk factors, reported symptoms, best-corrected visual acuity (BCVA), funduscopic findings, disease severity, and diagnostic and treatment decisions were recorded and analyzed. Results: A total of 539 eyes of 411 CSC patients were enrolled in this study including 308 males (75%) and 103 females (25%). Patients were predominantly of Caucasian origin and had a mean age of 55.5 years (IQR 41.0–70.0). 28% of eyes were classified as acute (<4 months duration) CSC, 28% as chronic (>4 months duration) CSC, 21% as inactive CSC, 11% as chronic atrophic CSC, and 12% as CSC with secondary CNV. 128 patients (31%) demonstrated bilateral CSC. The most common risk factors reported were psychological stress (52%), smoking (38%), arterial hypertension (38%), and a history of or current use of steroids (30%). Most frequently encountered symptoms included decreased visual acuity (76%), metamorphopsia (49%), relative scotoma (47%), blurred vision (19%), and dyschromatopsia (9%). The mean logMAR BCVA on initial examination was 0.2 (≈20/30, IQR 0.2–0.4) but showed significant variation with a tendency of lower BCVA in chronic cases. At the baseline visit, 74% of the overall cohort received no treatment, while 19% underwent local treatment and only 2% underwent systemic treatment. Of the local therapies, anti-VEGF injections were the most frequently performed procedure (33%, mainly for secondary CNV), followed by micropulse laser (28%), focal nonpulsed laser (23%), verteporfin photodynamic therapy (14%), and nonsteroidal anti-inflammatory eye drops (2%). Among intravitreal anti-VEGF agents, aflibercept was used most frequently, followed by bevacizumab and ranibizumab. Conclusion: This registry represents one of the largest cohorts of European patients with CSC to date. Patient age and the proportion of women were higher than expected and bilateral active disease was lower than anticipated, highlighting that neither age nor gender should be overemphasized when diagnosing CSC. Therapeutic interventions are heterogeneous and include verteporfin photodynamic therapy, micropulse laser, and anti-VEGF injections in case of secondary CNV.

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“…To exclude the development of atrophy in the area treated with ssbPDT, the integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) was graded as described before. 20 In brief, eyes that had undergone fovea-involving ssbPDT and showed complete SRF resolution at the first follow-up and no recurrence, ELM and EZ integrity was graded as continuous/regular, interrupted/irregular, or indiscernible before and after treatment. Examples of these definitions were previously published.…”

Section: Methodsmentioning

confidence: 99%

“…This is further supported by evidence from our group that patients included in the PLACE trial did not develop RPE atrophy at 2 years after PDT. 20 Of note, 16 eyes of 12 patients had received intravitreal anti-VEGF injections. Only in a small minority of these, however, a secondary CNV was confirmed by the tertiary referral center (five eyes of four patients).…”

Section: Single-session Bilateral Pdt For Ccsc Pauleikhoff Et Almentioning

confidence: 99%

Single-Session Bilateral Reduced-Settings Photodynamic Therapy for Bilateral Chronic Central Serous Chorioretinopathy

Pauleikhoff

Diederen²,

Feenstra³

et al. 2023

Retina

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Purpose: We performed a multicenter, retrospective study on patients with bilateral chronic central serous chorioretinopathy (cCSC) who received single-session bilateral reduced-settings photodynamic therapy (ssbPDT) and assessed anatomical (resolution of subretinal fluid [SRF]) and functional (best-corrected visual acuity [BCVA]) outcomes and safety. Methods: Patients who underwent ssbPDT between 01/01/2011 and 30/09/2022 were included. The resolution of SRF at first, second, and final follow-up was assessed on optical coherence tomography (OCT), and BCVA measurements were collected at these visits. When fovea-involving ssbPDT was performed, ellipsoid zone (EZ) and external limiting membrane (ELM) integrity was graded before and after treatment. Results: Fifty-five patients were included in this study. Sixty-two of hundred and eight eyes (56%) showed a complete resolution of SRF at the first follow-up, which increased to 73/110 (66%) at the final follow-up. The mean logMAR BCVA improved by −0.047 (P = 0.02) over follow-up. EZ integrity increased from 14/21 (67%) to 24/30 (80%) while ELM integrity increased from 22/30 (73%) to 29/30 (97%). Conclusion: Patients with cCSC with bilateral SRF at baseline showed significant anatomical and functional improvements after ssbPDT, both at short-term and long-term follow-up. No relevant adverse events were noted.

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Increasing Evidence for the Safety of Fovea-Involving Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Cited by 9 publications

References 31 publications

Update on the Management of Central Serous Chorioretinopathy

Update on the Management of Central Serous Chorioretinopathy

Clinical Landscape of Central Serous Chorioretinopathy in Germany: Retina.net CSC Registry Report Number 1

Single-Session Bilateral Reduced-Settings Photodynamic Therapy for Bilateral Chronic Central Serous Chorioretinopathy

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