Long-term chorioretinal changes after photodynamic therapy for chronic central serous chorioretinopathy

Abstract

Purpose To evaluate morphological and functional chorioretinal changes 5 years after standard photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods A retrospective, nonrandomized study, including patients with chronic CSC treated with standard PDT and followed for at least 60 months. All patients underwent a complete ophthalmological examination, and the location and number of treatments were registered. Five or more years after treatment, subfoveal and non-subfoveal treated areas were evaluated with Spectralis optical coherence tomography and microperimetry. Results Seventeen eyes of 15 patients were included, with mean age of 48.3±8.4 years and a mean follow-up of 80.6± 12.4 months (range from 62 to 104 months). All eyes had neurosensory detachment (NSD) at baseline. Treatment was performed under the fovea in 58.8 % and in a non-foveal area in 41.2 % of the eyes. At the final visit all eyes had resolution of the NSD, with a statistical significant reduction in central macular thickness (p=0.005) and preserved neuroretinal thickness (p=0.839). There was a statistical difference between initial and final BCVA (p<0.001) and a mean gain of 8.4±7.8 letters. Subfoveal morphological changes in external limiting membrane (ELM) and in photoreceptor inner and outer segment junction (IS/OS) were correlated with final BCVA (p=0.015 and p=0.014 respectively), but not with the variation of BCVA. There was a statistical correlation between morphological changes in IS/OS line and retinal sensitivity in the central 12°and 2°(p=0.003 and p=0.002 respectively). The morphological changes in the subfoveal layers were not dependent on treatment location (p=0.154, p=0.644, and p=1.0 for ELM, IS/OS line, and retinal pigment epithelium respectively). Subfoveal final mean choroidal thickness was 295.1±68.7 μm, and showed no statistical difference from the normal population (p=0.633). Conclusions Morphological and functional chorioretinal changes, observed 5 or more years after standard PDT for chronic CSC, were not correlated with the location of treatment, neither with the progression of visual acuity or with the location of treatment, and are more likely to be related to the disease itself than with the treatment provided.

Retinal sensitivity assessed by microperimetry and corresponding retinal structure and thickness in resolved central serous chorioretinopathy

“…In the present study, eyes with o50% of fixation points within Table 2 Comparison of BCVA, RS, and retinal thickness according to the history of half-fluence PDT (mean±SD) There are also many studies regarding RS and the status of the retinal microstructure on OCT after CSC resolution. [22][23][24] RS was compared according to the status of the external limiting membrane (ELM), the IS/OS line, the cone outer segment tips (COST) line, and the RPE line. Vasconcelos et al 22 reported that, in the central 121 and 21, RS was statistically correlated with morphological changes in the ELM and IS/OS line but not with RPE changes after PDT for chronic CSC.…”

“…[22][23][24] RS was compared according to the status of the external limiting membrane (ELM), the IS/OS line, the cone outer segment tips (COST) line, and the RPE line. Vasconcelos et al 22 reported that, in the central 121 and 21, RS was statistically correlated with morphological changes in the ELM and IS/OS line but not with RPE changes after PDT for chronic CSC. However, Ojima et al 23 suggested that both the irregular RPE line and defects of the IS/OS line were associated with decreased RS after CSC resolution.…”

“…13,14 The usefulness of microperimetry (MP) in evaluating retinal sensitivity (RS) and central retinal field function is well known in resolved CSC. [15][16][17][18][19][20][21][22][23][24] Although most MP evaluations of RS in patients after CSC resolution have used the MP-1 Microperimeter (Nidek Technologies, Padova, Italy), [15][16][17][18][19][20][21][22][23][24] this microperimeter presents MP values on a confocal scanning laser ophthalmoscope (cSLO) image without producing an optical coherence tomography (OCT) image. Therefore, direct comparisons between RS and retinal changes at a corresponding point are not possible.…”

“…Some studies have evaluated the relations between RS and OCT findings, but they must compare the two images separately. [22][23][24] Spectral OCT/ SLO (OPKO-OTI, Miami, FL, USA) can directly compare RS and retinal morphology at corresponding points because it also offers an add-in MP test option. The process combines simultaneous high-resolution crosssectional OCT imaging of retinal layers with en face fundus imaging of the retina using the cSLO.…”

Long-Term Outcomes of Full-Fluence and Half-Fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

“…Of these few, long-term studies showed significant improvements in visual and anatomic outcomes with low recurrence rates with full-fluence PDT for chronic CSC [14, 15]. …”