Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study

Abstract

Aim: To evaluate short term safety of an enhanced photodynamic therapy (PDT) protocol with half dose verteporfin for treating chronic central serous chorioretinopathy (CSC). Methods: 20 eyes of 18 patients with symptomatic chronic CSC underwent PDT using 3 mg/m 2 verteporfin. Verteporfin was infused over 8 minutes followed by indocyanine green angiography guided laser application 2 minutes later. Serial optical coherence tomography (OCT) and multifocal electroretinography (mfERG) recordings were performed before PDT, at 4 days, 2 weeks, and 1 month after PDT. The best corrected visual acuity (BCVA), OCT central retinal thickness, and mean mfERG response amplitudes and peak latencies were compared longitudinally. Subgroup analysis was further performed for eyes with or without pigment epithelial detachment (PED). Results: At 1 month after PDT, the median BCVA improved from 20/40 to 20/30 (p = 0.001). The mean central retinal thickness also reduced from 276 mm to 158 mm (p,0.001) and 17 (85%) eyes had complete resolution of serous retinal detachment and/or PED. MfERG showed no significant changes in the mean N1 and P1 response amplitude and latency for all eyes. Subgroup analysis demonstrated that eyes without PED had a significant increase in the mean central mfERG P1 response amplitude with reduction in P1 peak latency at 1 month post-PDT. For eyes with PED, transient reduction in the mean central P1 response amplitude was observed at 4 days post-PDT. Conclusions: The modified safety enhanced PDT protocol with half dose verteporfin appeared to be a beneficial treatment option for patients with chronic CSC, especially in eyes without serous PED. Further controlled study is warranted to demonstrate the long term safety and efficacy of this treatment option.

Photodynamic therapy for central serous chorioretinopathy

“…11, These included three RCTs (Bae et al, Semeraro et al and Chan et al) that compared PDT with other treatment options as well as 28 STROBE-qualified studies, which also evaluated the efficacy of using PDT to treat CSCR. 11,15,[41][42][43][44] A summary of the three RCTs have been tabulated in Table 2. A meta-analysis could not be performed because of the heterogeneity of the studies.…”

“…11,15,[41][42][43][44] Three studies contained the use of PDT in treating acute CSCR (n ¼ 3), whereas the remaining 28 studies assessed the efficacy of using PDT to treat chronic CSCR (n ¼ 28). 11,15,[41][42][43][44] Acute CSCR. Of our three studies identified, one was an RCT and the other two were case series.…”

“…11,15,[41][42][43][44] The total number of eyes in the studies varied from 5 to 82 (mean 25). Eleven of these studies used standard TAP protocol.…”

“…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.…”

Finasteride is effective for the treatment of central serous chorioretinopathy

“…32 Nevertheless, PDT carries a potential risk for choroidal ischaemia, RPE atrophy, RPE rip, iatrogenic choroidal neovascularization, and vision loss, even with the generally preferred half-fluence settings. 1,[32][33][34][35][36][37] It has been shown that vascular endothelial growth factor (VEGF) levels are not elevated in patients with CSC, 38,39 and use of intravitreal anti-VEGF agents has been found inferior to PDT. 40 Therefore, these agents have a relatively minor and controversial role in the treatment of CSC.…”