Photodynamic Therapy for Variant Central Serous Chorioretinopathy: Efficacy and Side Effects

Abstract

Background: Retinal pigment epithelial detachment (PED) is a recognised associated finding in central serous chorioretinopathy (CSC). We report our experience in treating patients using photodynamic therapy (PDT) in a variant of chronic CSC that presents with only an isolated PED. We present long-term follow-up data and novel observations on the pattern of retinal pigment epithelium (RPE) changes seen after treatment. Methods: Retrospective case series. Results and Discussion: CSC with subfoveal PED can be associated with a poor visual prognosis especially when the PED becomes chronic. PDT has been used to treat typical CSC with good outcomes. Three eyes in 3 patients were successfully treated with PDT, using the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy protocol. However, marked RPE disturbance was observed after treatment directly overlying the areas of brisk choroidal hyperpermeability.

Isolated pigment epithelium detachment: evidence for relation to central serous chorioretinopathy and effect of photodynamic therapy

“…Most patients in this series retained excellent vision, with 78% having visual acuity 20/25 or better and 97% having 20/50 or better over an average follow-up of 7 years (Lewis 1978). Our results confirm that visual acuity can remain normal or near-normal after untreated observation, even if the PED does not disappear, as seen in a previous study (Gupta & Mohamed 2011). The chance of seeing metamorphopsia disappear was lower, however, with conservative management than with PDT.…”

“…Cases of isolated PED can be symptomatic, if located close enough to the centre of the fovea to produce metamorphopsia, binocular rivalry and astenopia. Successful flattening of the PED and the overlying neurosensory retina with elimination of metamorphopsia after PDT has been reported in smaller series (Yannuzzi et al 2003;Olivier et al 2005;Sch€ utt et al 2007;Chan et al 2008;Gupta & Mohamed 2011).…”

Photodynamic therapy for central serous chorioretinopathy

“…4,5 These areas are postulated to be caused by choroidal vascular hyperpermeability. 4,[6][7][8] Over the last two decades, numerous treatments for chronic CSCR have been investigated. These have included pharmacologic therapy, laser photocoagulation, photodynamic therapy (PDT) and most recently anti-vascular endothelial growth factor (anti-VEGF).…”

“…These have included pharmacologic therapy, laser photocoagulation, photodynamic therapy (PDT) and most recently anti-vascular endothelial growth factor (anti-VEGF). 4,5,[7][8][9][10][11][12][13] Each study with different treatment modalities has had its own drawbacks-small population size, treatment efficacy, and adverse event occurrence. In this review, we assess the studies that evaluated the use of PDT in the treatment of CSCR.…”

“…In this review, we assess the studies that evaluated the use of PDT in the treatment of CSCR. 5,7,8 In 1999, the treatment of age-related macular degeneration with photodynamic therapy (TAP) study group conducted a randomised control trial which showed superiority with the use of verteporfin vs placebo to treat wet age-related macular degeneration (Po0.01). The standard regime consisted of a light sensitive drug, verteporfin, (6 mg/m 2 ) which is administered via intravenous infusion of 30 ml over 10 min.…”