Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Piccolino, Felice Cardillo; Eandi, Chiara M.; Ventre, Luca; Longrais, R. C. Rigault De La; Grignolo, Fm

doi:10.1097/00006982-200312000-00002

Cited by 322 publications

(244 citation statements)

References 27 publications

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“…However, like red laser, PDT also failed to improve the visual outcome, as reported by others as well. 5,6 Canakis et al and later Taban et al have reported improved visual outcome after PDT for chronic CSC, which they correlated with preoperative visual acuity, and recommended early treatment for better results, 14,20 endorsed by others. 5,8,13,15 There is no consensus on how early the 'early' treatment should be applied: foveal atrophy may occur anytime after 4 months of foveal detachment, 15 chronic degenerative changes in macula are likely after 6 months; 5 both result in a poor visual outcome.…”

Section: Discussionmentioning

confidence: 96%

“…Interestingly, two reports that showed significant visual improvement with PDT in chronic CSC also used FFA rather than ICG, 14,20 considered essential by others. 2,5,6 TTT has been successfully used to treat subfoveal CNV of various aetiologies. [21][22][23] Owing to its thermal nature, TTT may act like conventional photocoagulation in CSC, causing RPE debridement, migration, transformation, and re-proliferation.…”

Section: Discussionmentioning

confidence: 99%

“…2 This subtype is associated with older age, chronic (46 months) detachment of the posterior pole, poorly defined RPE leakage or 'ooze,' multiple pigment epithelial detachments (PED), and poor visual prognosis owing to cystoid macular oedema, foveolar atrophy, subretinal fibrosis, and less commonly, choroidal neovascularization (CNV). [2][3][4][5][6][7][8] In spite of the innumerable studies on CSC, there is continued controversy in the literature on the need, timing, and choice of treatment. The most studied treatment, conventional laser photocoagulation, is controversial in the classic CSC and unsuccessful in the chronic type.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13] Alternative treatment modalities like photodynamic therapy (PDT) have reported anatomic, but rarely functional success, in DRPE. 5,6,14 Many recent reports on treatment and natural history have therefore recommended early treatment of CSC before foveal atrophy or RPE decompensation sets in. 5,7,[13][14][15] The presence of subfoveal focal leaks, which occur in less than 10% of CSC, 16 further confound the management dilemma.…”

Section: Introductionmentioning

confidence: 99%

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Transpupillary thermotherapy for subfoveal leaks in central serous chorioretinopathy

Shukla

Kolluru

Vignesh

et al. 2006

Eye

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Aim To evaluate transpupillary thermotherapy (TTT) for the treatment of subfoveal focal leaks in central serous chorioretinopathy (CSC). Methods The patients presenting with long-standing CSC, but without the features of chronicity, were offered the options of TTT, photodynamic therapy (for subfoveal leaks), photocoagulation (for extrafoveal leaks), or observation. The patients who opted for TTT or observation were enrolled in this study. TTT was performed using a spot diameter of 0.5 mm for 1 min. Best-corrected visual acuity (BCVA), status of macular detachment, and fluorescein angiographic status were evaluated at 1, 3, and 6 months. Results This study included 39 patients (40 eyes) with CSC between 4 and 12 months, of whom 25 patients (25 eyes) opted for TTT for subfoveal leaks. Fourteen patients (15 eyes) were followed up without treatment. The groups were comparable in age, sex, and baseline BCVA. Minimum follow-up was 6 months. Within 3 months, TTT resulted in the resolution of the serous detachment in 24 (96%) eyes with a single session; one eye required a repeat treatment. Eight control eyes demonstrated persisting CSC at the last follow-up. Visual acuity improved in 23 (92%) treated and five (33%) control eyes; the difference in outcome was statistically significant (Po0.001). One case developed choroidal neovascularization, which resolved with visual recovery to 20/20 after repeat-TTT. Conclusion TTT resulted in the resolution of CSC with subfoveal angiographic leaks with significant improvement in visual outcome, in comparison to the natural history of persistent CSC.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Transpupillary thermotherapy for subfoveal leaks in central serous chorioretinopathy

Shukla

Kolluru

Vignesh

et al. 2006

Eye

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“…[16][17][18] Selecting an appropriate fluence rate avoids collateral damage such as atrophy of the RPE, choroidal ischemia, and development of secondary CNV due to less choriocapillaris damage. [19][20][21] This retrospective study targets on a treatment regimen for CNV in chronic CSCR that has not been described in literature before: a combination of IVR/IVB and ICGAguided PDT with half-fluence rate.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal anti-vascular endothelial growth factor combined with half-fluence photodynamic therapy for choroidal neovascularization in chronic central serous chorioretinopathy

Smretschnig

Hagen

Glittenberg

et al. 2016

Eye

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Purpose To evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) with half-fluence rate combined with intravitreal application of anti-VEGF in treating choroidal neovascularization (CNV) in chronic central serous chorioretinopathy (CSCR). Patients and methods In this retrospective cohort study 17 consecutive patients with secondary CNV due to chronic CSCR had their diagnosis verified with fluorescein angiography (FA) and ICGA at baseline. All eyes received either intravitreal ranibizumab (IVR) or bevacizumab (IVB). On the consecutive day following the initial IVR/IVB treatment, ICGAguided verteporfin (6 mg/m 2 ) PDT with halffluence rate (25 J/cm 2 ) was performed on every patient. IVR or IVB was rescheduled on a pro re nata regimen. Main outcome measures were changes in visual acuity (VA) according to the ETDRS letter score and changes in the central foveal thickness (CFT). Results Best-corrected VA at baseline was 65.6 letters (±6.7; n = 17) according to the ETDRS letter score. At 12 months, mean ETDRS letter score improved to 71.2 letters (P = 0.34). CFT was 309 μm and decreased to 216 μm at month 12 control (P = 0.0004). Nine eyes (52.9%) received additional treatment with IVR/IVB due to recurrence of subretinal fluid, with an overall mean number of IVR/IVB treatment of 1.8 ± 3.6 per patient with no systemic side effects during 12 months' follow-up. Conclusions IVR or IVB combined with ICGA-guided half-fluence PDT with verteporfin is effective in treating CNV in chronic CSCR, with choroidal hyperpermeability in ICGA, resulting in stable vision and significant reduction of CFT.

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A 50% vs 30% Dose of Verteporfin (Photodynamic Therapy) for Acute Central Serous Chorioretinopathy

et al. 2015

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IMPORTANCE A randomized clinical trial is needed to evaluate what is the best photodynamic therapy (PDT) protocol to use for acute central serous chorioretinopathy.OBJECTIVE To compare the efficacy and safety of a 50% dose of verteporfin (a method of PDT) with the efficacy and safety of a 30% dose for acute central serous chorioretinopathy. DESIGN, SETTING, AND PARTICIPANTSA multicenter, noninferiority, double-masked, randomized, controlled, clinical trial in which 131 patients (131 eyes) with acute central serous chorioretinopathy for less than 6 months were recruited with a follow-up of 12 months from university-based ophthalmology practices.INTERVENTIONS Patients were randomly assigned to either a 50% dose of verteporfin (the 50%-dose PDT group) or a 30% dose (the 30%-dose PDT group). MAIN OUTCOMES AND MEASURESThe 2 primary outcome measures were the proportion of eyes with complete absorption of subretinal fluid and the proportion of eyes with complete disappearance of fluorescein leakage at 6 and 12 months. The secondary outcome measures included the subretinal fluid recurrent rate, the fluorescein leakage recurrent rate at 12 months, the mean best-corrected visual acuity, the retinal thickness of the foveal center, and the maximum retinal thickness at each scheduled visit. RESULTSThe noninferiority of the 30%-dose PDT compared with the 50%-dose PDT for the primary outcomes was not demonstrated. The optical coherence tomography-based improvement rate in the 30%-dose PDT group was less than that in the 50%-dose PDT group both at 6 months (73.8% vs 92.9%; α = 0.0125, P = .006) and at 12 months (75.4% vs 94.6%; α = 0.0125, P = .004). The fluorescein angiography-based improvement rate in the 30%-dose PDT group was less than that in the 50%-dose PDT group both at 6 months (68.9% vs 91.1%; α = 0.0125, P = .003) and at 12 months (68.9% vs 92.9%; α = 0.0125, P = .001). The subretinal fluid recurrence rate in the 30%-dose PDT group was greater than that in the 50%-dose PDT group (24.0% vs 5.7% at 12 months; P = .010, determined by use of the log-rank test). The fluorescein leakage recurrent rate in the 30%-dose PDT group was significantly higher than that in the 50%-dose PDT group (16.7% vs 3.8% at 12 months; P = .03, determined by use of the log-rank test). No ocular adverse event was encountered in the study. CONCLUSIONS AND RELEVANCEA 50% dose of verteporfin may be more effective at resolving subretinal fluid and fluorescein leakage, and with better visual outcomes, than a 30% dose for acute central serous chorioretinopathy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01574430

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Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

Abstract: ICG-guided PDT performed according to the parameters outlined by the TAP Study seems effective for treating chronic CSC. Further studies are needed to verify treatment safety and the time and rate of recurrences.

Cited by 322 publications

References 27 publications

Transpupillary thermotherapy for subfoveal leaks in central serous chorioretinopathy

Transpupillary thermotherapy for subfoveal leaks in central serous chorioretinopathy

Intravitreal anti-vascular endothelial growth factor combined with half-fluence photodynamic therapy for choroidal neovascularization in chronic central serous chorioretinopathy

A 50% vs 30% Dose of Verteporfin (Photodynamic Therapy) for Acute Central Serous Chorioretinopathy

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