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

Abstract

Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

Half-fluence Photodynamic Therapy for Central Serous Chorioretinopathy in a Patient Receiving Corticosteroids for Behçet’s Uveitis

“…This standard PDT protocol is effective, but has been linked to some complications such as photosensitivity, transient visual loss, RPE atrophy, choriocapillaris ischemia, and secondary choroidal neovascularization. 13 To improve the safety of PDT, modified treatment parameters such as using half-fluence light energy or half-dose verteporfin have been considered. 14 Many retrospective studies in the literature have reported that the efficacy of halfdose and half-fluence PDT is similar, 14,15,16 except a multicenter retrospective study conducted by Nicolo et al 17 They reported faster reabsorption and less recurrence with half-dose PDT, but both treatment modalities had equal visual improvement and safety in 12-month follow-up.…”

Photodynamic Therapy—An Up-to-Date Review

“…Fullerenes can also be used as PSs, presenting advantageous properties, such as versatile functionalization, ability to undergo photochemistry, the possibility of self-assembly into supramolecular fullerosomes, and high resistance to photobleaching [5]. Moreover, reference [60] fullerene derivatives can be employed in the targeted delivery of drugs to the nuclear pore complex and tumor vasculature [87].…”

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

“…The standard protocol for ocular PDT involves intravenous infusion of verteporfin at a dose of 6 mg/m 2 body surface area (BSA) over 10 minutes [ 14 , 16 ]. At 15 minutes after initiation of infusion, a near-infrared light with wavelength 689 nm is applied to the targeted region for 83 seconds at a fluence rate of 50 J/cm 2 through a laser contact lens [ 14 , 16 ]. The light irradiation is applied when verteporfin is most concentrated in the target pathological tissue relative to surrounding normal tissue [ 14 ].…”

“…The light irradiation is applied when verteporfin is most concentrated in the target pathological tissue relative to surrounding normal tissue [ 14 ]. To enhance treatment safety, protocols with lower treatment energy or shorter duration have been developed [ 16 ]. These include half-fluence PDT, where a lower light energy setting of 25 J/cm 2 is used instead of 50 J/cm 2 , half-dose PDT, where a lower dosage of verteporfin at 3 mg/m 2 BSA is used instead of 6 mg/m 2 BSA, and half-time PDT, where the duration of light irradiation is halved compared to standard protocol [ 16 ].…”

“…The mechanism of PDT in pachychoroid diseases involves promotion of choriocapillaris hypoperfusion, which in turn reduces choroidal congestion, improves choroidal hyperpermeability, and decreases extravascular leakage [ 16 ].…”