Optimal fluence rate of photodynamic therapy for chronic central serous chorioretinopathy

Abstract

AimsTo investigate the lowest effective fluence rate of photodynamic therapy (PDT) for treating chronic central serous chorioretinopathy (CSC).MethodsFifty-one eyes of 51 patients with chronic CSC were randomly treated with 30% (n=15), 40% (n=16) or 50% (n=17) of the standard-fluence rate of PDT and followed up for 12 months. The success rate, recurrence rate, mean best-corrected visual acuity (BCVA), central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), integrity of the outer retinal layer and complications were evaluated at baseline and at the follow-up periods after PDT.ResultsThe rate of complete subretinal fluid (SRF) resolution in the 30%-fluence, 40%-fluence and 50%-fluence groups was 60.0%, 81.2% and 100.0%, respectively, at 3 months (p=0.009), and 80.0%, 94.0% and 100.0%, respectively, at 12 months (p=0.06). The recurrence rate in the 50%-fluence group was lower than that in the 30%- and 40%-fluence groups at 12 months (30% vs 50%, 40% vs 50%; p=0.002, p=0.030, respectively (log-rank test)). The mean BCVA improved significantly 12 months after PDT only in the 40%- and 50%-fluence groups (p=0.005, p=0.003, respectively). Mean CFT and SFCT decreased significantly at 12 months in the three groups. The rate of complications did not differ significantly among the three groups.ConclusionsA 50%-fluence rate of PDT seems to be the most effective for treating chronic CSC, considering the low recurrence rate and high rate of complete SRF resolution, compared with other low-fluence PDT.Trial registration numberNCT01630863.

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

“…In parallel, a second treatment was administered in all cases of recurrences. Of note, the study of Park et al [42], clearly demonstrated that while the value of fluence is reduced there is an increase in the number of NSD recurrences and a reduction in the success rate of resorption of subretinal fluid in NSD. Of further interest, RPE atrophy was never reported in all studies with just 1 case of CNV occurrence in the Inoue's study.…”

“…Only few studies with at least one-year follow-up reported on the effects of modified fluence PDT for cCSC [41][42][43][44][45] (Table 3).…”

“…Unfortunately, no study examined the effect on RS. Most of the studies set the fluence to a value of 50% of standard PDT; Park et al compared three different fluences, 30-40-50% [42]. In 4/5 studies (80%), the NSD resolved completely in 100% of cases with 50% fluence.…”

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

“…Two studies compared different approaches to PDT. Park et al (2021) randomized patients to low-fluence PDT at different percentages of standard fluence (i.e. 30% vs. 40% vs. 50%).…”

Stellungnahme von BVA, DOG und RG zur Chorioretinopathia centralis serosa (CCS)

“…Bei der "half-dose PDT" wird die Medikamentendosis auf 3 mg/m 2 reduziert, bei der "half-fluence PDT" wird die Lichtintensität auf 25 J/cm 2 verringert. Eine weitere Reduktion der Lichtintensität auf 15 J/cm 2 (30 %) oder 20 J/cm 2 (40 %) scheint im Vergleich zur "half-fluence PDT" mit 25 J/cm 2 (50 %) bezüglich der Rezidivrate und der Resorption der subretinalen Flüssigkeit schlechter zu wirken [75]. Da die "halfdose PDT" genauso wirksam ist und insgesamt weniger Nebenwirkungen aufweist als die "full-dose", "half-fluence" oder "half-time PDT", wird in den meisten Behandlungszentren die "half-dose PDT" für die Behandlung der CCS bevorzugt [88].…”