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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Oribio-Quinto C, Fernández-Vigo JI, Bilbao-Malavé V, Pérez-García P, Burgos-Blasco B, Arias-Barquet L, Donate-López J. Anatomical and functional impact of verteporfin shortage in patients with chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2023; 42:103501. [PMID: 36893954 DOI: 10.1016/j.pdpdt.2023.103501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND To describe the functional and anatomical impact that the worldwide shortage of verteporfin has had on patients diagnosed with chronic central serous chorioretinopathy (cCSCR) whose treatment with photodynamic therapy (PDT) had to be delayed. METHODS Prospective observational study. Patients were divided into two groups based on the time interval since PDT had been indicated: groups 1 and 2, with waiting times of less and more than 9 months respectively. Best corrected visual acuity (BCVA), the maximum height of the subretinal fluid (MSRF) and subfoveal choroidal thickness (SFCT) at the baseline visit and the last visit were compared. RESULTS 49 eyes of 48 patients with cCSCR were included. The mean waiting time for PDT was 9.0 ±3.8 months. The mean BCVA was 69.0 ±17.1 letters and 68.9 ±16.4 letters for the baseline and last visit respectively, showing no difference (p= 0.958). Although there was no difference in the mean global BCVA, 15 eyes (30.5%) showed a deterioration of ≥5 letters, including 7 eyes (14%) with a decrease of ≥10 letters. Mean MSRF height was 151.4 ±97.2 μm and 98.2 ±83.1 μm for the baseline and last visit respectively (p= 0.005), persisting in 74.5% of the eyes. CONCLUSION No significant impact was observed in the BCVA in cCSCR due to the shortage of verteporfin. However, one-third of patients had BCVA loss. There was a significant spontaneous decrease in MSRF, but it persisted in the majority of the patients, still susceptible to PDT.
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Affiliation(s)
- Carlos Oribio-Quinto
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain.
| | - José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Valentina Bilbao-Malavé
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Pérez-García
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
| | - Barbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
| | - Luis Arias-Barquet
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
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van Dijk EHC, Feenstra HMA, Bjerager J, Grauslund J, Boon CJF, Subhi Y. Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta-analyses. Acta Ophthalmol 2023; 101:140-159. [PMID: 36178171 DOI: 10.1111/aos.15263] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short-term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta-analyses to compare to non-treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half-dose or half-fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half-dose or half-fluence PDT (OR: 20.6; 95% CI: 6.3-66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0-655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7-6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best-corrected visual acuity was only obtained by half-dose/-fluence PDT (-0.13 logMAR; 95% CI: -0.20 to -0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half-dose/-fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long-term data available for PDT-based treatments finding persisting treatment results, half-dose or half-fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, The Netherlands
| | - Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Lee GW, Kim YY, Choi KJ, Kang SW. Factors related to changes in visual symptoms after successful photodynamic therapy in central serous chorioretinopathy. PLoS One 2023; 18:e0284899. [PMID: 37083728 PMCID: PMC10121034 DOI: 10.1371/journal.pone.0284899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
To investigate biomarkers related to visual symptom and best corrected visual acuity (BCVA) improvement after photodynamic therapy (PDT) for central serous chorioretinopathy. This retrospective cross-sectional study involved 42 consecutive eyes, from 42 patients who underwent successful PDT, divided into two groups according to improvement in subjective visual complaints: complete (20 eyes) and incomplete recovery (22 eyes). The clinical characteristics of each group, including central foveal thickness (CFT), foveal avascular zone (FAZ) area, and degree of change in signal voiding of the choriocapillaris on optical coherence tomography angiography, were compared. Correlations between best-corrected visual acuity (BCVA) and baseline clinical features were investigated. At baseline, CFT and FAZ areas showed significant differences between the two groups (all p < 0.05). Multiple binary logistic regression analysis revealed that greater CFT predicted complete recovery from visual complaints (p = 0.002). Reduction or disappearance of signal voiding in the choriocapillaris 6 months post-PDT occurred more frequently in the complete recovery group (p < 0.05). FAZ area before PDT correlated with BCVA before and 6 months after PDT and BCVA improvement during the study period (all p < 0.05). CFT and FAZ area before PDT correlated with completeness of visual symptom recovery after PDT. Smaller FAZ area before PDT correlated with better BCVA before and after treatment.
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Affiliation(s)
- Geun Woo Lee
- Department of Ophthalmology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yun Young Kim
- Department of Ophthalmology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Kyung Jun Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gobeka HH, Mentes J, Nalcaci S, Oztas Z, Cay Y. Morphological integrity of the outer retinal layers and visual prognosis in chronic central serous chorioretinopathy after half-dose photodynamic therapy: a qualitative SD-OCT analysis. Lasers Med Sci 2022; 38:9. [PMID: 36539551 DOI: 10.1007/s10103-022-03676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022]
Abstract
The study aims to investigate the morphological integrity of the outer retinal layers (ORLs) (an ellipsoid layer (EL) + external limiting membrane) and visual prognosis in chronic central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) completely resorbed after half-dose photodynamic therapy (HD PDT) using enhanced-depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). This retrospective study included 40 eyes of 38 chronic CSCR patients treated with HD PDT between December 2012 and June 2016. However, only 34 eyes (85%) with complete SRF resorption 3 months after HD PDT had their 6th and 12th month data analyzed. Morphological integrity of the ORLs was further analyzed in relation to best-corrected visual acuity (BCVA) and disease duration. Thirty-four eyes of 34 patients (male/female: 82.35/17.65%) with mean age of 49.90 ± 7.80 (32-61) years were studied. The mean logMAR BCVA improved significantly from 0.52 ± 0.31 at baseline to 0.34 ± 0.36 and 0.26 ± 0.26 at the 6th and 12th months after HD PDT, respectively (p < 0.001). The proportion of eyes with completely normal morphological ultrastructural integrity of the ORLs was 44.12% at the 6th month, which increased to 64.71% at the 12th month after HD PDT. However, the EL morphological disruption was associated with significantly lower mean logMAR BCVA 12 months after HD PDT (p = 0.029). The disease duration had no effect on mean logMAR BCVA gain. Even after complete resorption of serous neurosensory retinal detachment after HD PDT in chronic CSCR, the ORLs, especially the EL, may not be anatomically restored. The EL morphological ultrastructural integrity seems to be the most important factor influencing visual prognosis.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Jale Mentes
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Serhad Nalcaci
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Zafer Oztas
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yigit Cay
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
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Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy : Status 18 October 2021. DIE OPHTHALMOLOGIE 2022; 119:108-122. [PMID: 35384482 DOI: 10.1007/s00347-022-01614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 01/25/2023]
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Honda S, Kohno T, Yamamoto M, Hirayama K, Kyo A, Hirabayashi M, Honda S. Early anatomical changes and association with photodynamic therapy induced acute exudative maculopathy in patients with macular diseases. Sci Rep 2022; 12:9105. [PMID: 35650246 PMCID: PMC9160278 DOI: 10.1038/s41598-022-13208-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
The purpose of this study was to investigate the occurrence rate and predictors of photodynamic therapy (PDT) induced acute exudative maculopathy (PAEM). This retrospective study included 39 eyes of 39 patients (32 males and 7 females), who were treated with initial PDT. PAEM was defined as an increase in central retinal thickness (CRT) of 15% or more measured by OCT on day 3 after PDT compared with baseline. Sixteen of 39 eyes (41%) were classified in the PAEM+ group. CRT and central choroidal thickness (CCT) were significantly increased at 3 days in the PAEM+ group and significantly decreased at 1 month after PDT in the PAEM- group. In a multiple comparison, neovascular age-related macular degeneration (nAMD) had a significantly higher incidence of PAEM compared to polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC). The incidence of PAEM was lower in PCV and CSC, and higher in nAMD. BCVA at 1 month was significantly worse in the PAEM group, which may be related to visual prognosis after PDT. Since both CRT and CCT decrease at 1 month, the detection of PAEM needs to be assessed a few days after PDT.
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Affiliation(s)
- Satoshi Honda
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Manabu Yamamoto
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan.
| | - Kumiko Hirayama
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Akika Kyo
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | | | - Shigeru Honda
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
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Stellungnahme von BVA, DOG und RG zur Chorioretinopathia centralis serosa (CCS). Klin Monbl Augenheilkd 2022; 239:217-232. [PMID: 35211942 DOI: 10.1055/a-1725-3125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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van Rijssen TJ, van Dijk EH, Tsonaka R, Feenstra HM, Dijkman G, Peters PJ, Diederen RM, Hoyng CB, Schlingemann RO, Boon CJ. Half-Dose Photodynamic Therapy Versus Eplerenone in Chronic Central Serous Chorioretinopathy (SPECTRA): A Randomized Controlled Trial. Am J Ophthalmol 2022; 233:101-110. [PMID: 34214454 DOI: 10.1016/j.ajo.2021.06.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the efficacy and safety between half-dose photodynamic therapy (PDT) and eplerenone therapy for treating chronic central serous chorioretinopathy (cCSC). DESIGN This was a multicenter, open-label, randomized controlled trial. METHODS This investigator-initiated trial was conducted in 3 academic medical centers in the Netherlands. Eligible patients were randomized at a 1:1 ratio to receive either indocyanine green angiography-guided half-dose PDT or oral eplerenone for 12 weeks. Both anatomical and functional outcomes were evaluated at 3 months after the start of treatment. RESULTS A total of 107 patients were randomly assigned to receive either half-dose PDT (n = 53) or eplerenone treatment (n = 54). Thirteen patients (3 in the PDT group and 10 in the eplerenone group) did not adhere to the study protocol. At the 3-month evaluation visit, 78% of patients in the PDT group had complete resolution of subretinal fluid accumulation compared to only 17% of patients in the eplerenone group (P < .001). Mean best-corrected visual acuity in Early Treatment of Diabetic Retinopathy Study letters at the 3-month evaluation visit was 83.7 ± 10.8 and 82.8 ± 9.0 in the PDT and eplerenone groups, respectively (P = .555). In addition, mean retinal sensitivity on microperimetry was 25.4 ± 3.4 dB and 23.9 ± 4.0 dB in the PDT and eplerenone groups, respectively (P = .041). Finally, mean vision-related quality of life scores were 87.2 ± 8.5 and 83.8 ± 12.1 in the PDT and eplerenone groups, respectively (P = .094). Three patients (6%) in the PDT group experienced adverse events during the study compared to 18 patients (33%) in the eplerenone group. CONCLUSIONS Half-dose PDT is superior to oral eplerenone for cCSC with respect to both short-term safety and efficacy outcomes.
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10
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Penas S, Beato J, Rosinha P, Araújo J, Costa A, Carneiro Â, Falcão-Reis F, Rocha-Sousa A. Longitudinal multimodal functional macular analysis after half-dose photodynamic therapy for central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2021; 37:102704. [PMID: 34954386 DOI: 10.1016/j.pdpdt.2021.102704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Half-dose photodynamic therapy (HD-PDT) has been widely used for central serous chorioretinopathy (CSC) with good anatomical results. However, long-term functional outcomes after this treatment remain uncertain. This study aimed a longitudinal multimodal macular assessment, correlating functional and anatomical outcomes. METHODS This is a retrospective study performed in a tertiary referral center including 111 eyes from 95 CSC patients. Data on best corrected visual acuity (BCVA), central macular thickness (CMT), central retinal sensitivity (CRS) using microperimetry (MP) and multifocal electroretinography (mfERG) at baseline and 3, 6, 12, 18, 24, 36, 48 and 60 months after treatment were registered. A correlation analysis was performed. RESULTS Mean follow-up was 34.5 ± 26.3 months. A significant improvement in BCVA and CMT was registered in all the visits. CRS significantly improved until 24 months (p<0.001 at 12 months, p<0.05 at 24 months), worsening afterwards. The mfERG amplitude of N1 and P1 waves significantly improved in the first 12 months, aggravating afterwards. The implicit time improved until 24 months, deteriorating after 48 months. This long-term decline was also described in some inactive untreated fellow eyes CONCLUSIONS: : A multimodal longitudinal analysis of CSC patients after HD-PDT shows that, after the first 12 to 24 months, the significant sustained improvement in BCVA and CMT is not paired by a sustained improvement in macular sensitivity or electrical response. This long-term functional deterioration might result from the disease itself and not directly from the treatment.
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Affiliation(s)
- Susana Penas
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto.
| | - João Beato
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Patrícia Rosinha
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Joana Araújo
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Ana Costa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Ângela Carneiro
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário de São João, E.P.E.,Porto, Portugal. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto
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[Statement of the Professional Association of Ophthalmologists in Germany (BVA), the German Ophthalmological Society (DOG) and the Retinological Society (RG) on central serous chorioretinopathy : Status 18 October 2021]. Ophthalmologe 2021; 119:148-162. [PMID: 34905071 DOI: 10.1007/s00347-021-01549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
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Torres-Costa S, Penas S, Cerqueira AR, Brandão E, Carneiro Â, Rocha-Sousa A, Falcão-Reis F. Long term outer retinal changes in central serous chorioretinopathy submitted to half-dose photodynamic therapy. Photodiagnosis Photodyn Ther 2021; 34:102235. [PMID: 33631379 DOI: 10.1016/j.pdpdt.2021.102235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate long-term changes in the foveal and parafoveal outer retina after half-dose photodynamic therapy (HD-PDT) in central serous chorioretinopathy (CSC). METHODS Retrospective study including CSC patients submitted to HD-PDT. Best corrected visual acuity (BCVA) was evaluated. Spectral-domain optical coherence tomography automatic segmentation algorithm was used and data on retinal, inner retinal, outer retinal and outer nuclear layers (ONL) in both foveal 1 mm (C) and parafoveal 3 mm ETDRS circles for the superior, nasal, inferior and temporal sectors, were obtained at baseline and 3, 12 and 24 months post-treatment. Subfoveal choroidal thickness, photoreceptors' outer segment thickness, subretinal fluid (SRF) height and width were also measured. RESULTS Twenty-one eyes of 15 patients were included. At baseline, the mean ONL thickness in the foveal area was significantly thinner in affected eyes compared to their fellow unaffected ones (55,50 ± 32,75 μm vs 93,00 ± 17,0 μm; p = 0,011), and was negatively correlated to logMAR BCVA (R=-0,601, p = 0,008) ONL thickness increased by 10,94 ± 11,88 μm at 24 months in the foveal area, and all the parafoveal sectors presented a similar increase. Baseline SRF width was significantly correlated with baseline BCVA (R1 = 0,483, p = 0,036), and with ONL thickness in all sectors. CONCLUSION In our study we found a significant long-term increase in foveal and parafoveal ONL thickness in CSC after HD-PDT, suggesting that this seems to be a safe treatment for the outer retina. This is the first study mapping the outer retinal changes in the macular area to 24 months follow up.
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Affiliation(s)
- Sónia Torres-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Susana Penas
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Kabadayi K. Comparison of half-dose versus half-fluence versus standard photodynamic therapy in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2020; 33:102081. [PMID: 33157327 DOI: 10.1016/j.pdpdt.2020.102081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the efficacy and safety of half-dose vs. half-fluence vs. standard photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC). METHODS This retrospective study included 64 eyes of 61 patients with cCSC who were treated with half-dose PDT (verteporfin 3 mg/m2 and light energy 50 J/cm2), half-fluence PDT (verteporfin 6 mg/m2 and light energy 25 J/cm2) or standard PDT (verteporfin 6 mg/m2 and light energy 50 J/cm2). The complete resorption of subretinal fluid (SRF) and changes of best corrected visual acuity (BCVA) and central retinal thickness (CRT) over the follow-up period were also assessed. RESULTS Fifteen eyes (65.2 %) in the half-dose PDT group, 12 eyes (80 %) in the half-fluence PDT group, and 20 eyes (76.9 %) in the standard PDT group showed complete resolution of SRF. There were no statistically significant differences in the mean BCVA improvement, CRT and SRF height reduction, number of PDT sessions, complete success, and recurrence rates between groups (p > 0.05). None of the eyes with intact EZ showed failure. There were positive correlations between higher mean CRT values of the last visit, 1st, 3rd, 6th months and failure. None of the treated eyes (0%) developed any systemic or local adverse events. CONCLUSION Half-dose, half-fluence or standard PDTs are all effective and safe treatment choices in cCSC with similar BCVA improvements and CRT reductions. The higher mean CRT values of the follow-up period were correlated with failure, and in eyes with intact EZ showed no failure.
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Affiliation(s)
- Meltem Guzin Altinel
- Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Department, 34752, Atasehir, Istanbul, Turkey.
| | | | | | - Aylin Ardagil
- Atakoy Dunyagoz Hospital, 34158, Bakirkoy, Istanbul, Turkey.
| | - Kerem Kabadayi
- Bahcesehir University, Faculty of Medicine, 34734, Kadikoy, Istanbul, Turkey.
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Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy. Pharmaceuticals (Basel) 2020; 13:ph13110349. [PMID: 33137968 PMCID: PMC7692681 DOI: 10.3390/ph13110349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023] Open
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.
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Iwase T, Yokouchi H, Kitahashi M, Kubota-Taniai M, Baba T, Yamamoto S. Long-Term Effects of Half-Time Photodynamic Therapy on Retinal Sensitivity in Eyes with Chronic Central Serous Chorioretinopathy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3190136. [PMID: 32908883 PMCID: PMC7450301 DOI: 10.1155/2020/3190136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate the long-term effects of half-time photodynamic therapy (PDT) on the retinal sensitivity in eyes with chronic central serous chorioretinopathy (CSC). Twenty-two eyes of 22 patients with chronic CSC were studied. PDT was applied with full-dose verteporfin and half-time laser duration. The best-corrected visual acuity (BCVA) and retinal sensitivity in the central 2 and 10 degrees were evaluated at the baseline, and at 12 and 24 months after the half-time PDT. The retinal sensitivity was determined by Macular Integrity Assessment microperimetry (MAIA, Centervue, Padova, Italy). The results showed that the mean retinal sensitivities in the central 2 and 10 degrees were significantly improved at 12 months (25.6 ± 2.79 dB, median; 26.11 dB, 25.6 ± 2.25 dB, median; 25.65 dB, respectively; P < 0.001) and at 24 months (26.3 ± 2.62 dB, median; 27.38 dB, 26.6 ± 2.21 dB, median; 27.45 dB, respectively; P < 0.001) after the treatment compared to that at the baseline (19.2 ± 3.93 dB, median; 19.34 dB, 20.9 ± 2.92 dB, median; 20.9 dB, respectively). The BCVA was also significantly improved from 0.18 ± 0.19 median; 0.15 logarithm of the minimum angle of resolution (logMAR) units at the baseline to 0.07 ± 0.15 median; 0 logMAR units at 12 months (P < 0.001) and to 0.049 ± 0.16 median; -0.039 logMAR units at 24 months (P < 0.001). We conclude that half-time PDT results in a significant improvement of the mean central retinal sensitivity for at least 24 months in eyes with chronic CSC. Thus, half-time PDT is beneficial in resolving chronic CSC for a relatively long period.
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Affiliation(s)
- Takehito Iwase
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hirotaka Yokouchi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masayasu Kitahashi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mariko Kubota-Taniai
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
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ELONGATED PHOTORECEPTOR OUTER SEGMENT LENGTH AND PROGNOSIS OF CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina 2020; 40:750-757. [DOI: 10.1097/iae.0000000000002445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shin YI, Kim KM, Lee MW, Kim JY, Jo YJ. Long-term results of focal laser photocoagulation and photodynamic therapy for the treatment of central serous chorioretinopathy. Jpn J Ophthalmol 2019; 64:28-36. [PMID: 31863228 DOI: 10.1007/s10384-019-00697-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the long-term results of focal laser photocoagulation and photodynamic therapy (PDT) for treatment of central serous chorioretinopathy (CSC). STUDY DESIGN Retrospective chart review. METHODS Sixty-two patients with CSC, thirty-three of whom were treated with focal laser photocoagulation, and 29 with PDT and who were followed up for > 6 months, were enrolled. The focal laser was performed at sites of focal leakage (but not subfoveal leaks) shown in fluorescein angiography. PDT was performed at sites of subfoveal or juxtafoveal focal leakage or not definite focal leakages. Best corrected visual acuity (BCVA), central macular thickness (CMT), resolution of subretinal fluid (SRF) and recurrence were analyzed. RESULTS The follow-up duration of the focal laser group was 35.2 ± 22.6 and of the PDT group, 46.4 ± 21.5 months. Time to resolution of SRF was 1.8 ± 1.5 months for the focal laser group and 1.2 ± 0.5 months for the PDT group. SRF was rapidly absorbed in the PDT group. In both groups, the CMT was decreased 1 month after treatment. The BCVA improved significantly 1 month after treatment in the focal laser group and 3 months after treatment in the PDT group. However, there was no significant difference in CMT reduction and BCVA improvement between the two groups. It subsequently remained similar for up to 3 years. Ten patients (30.3%) in the focal laser group and three patients (10%) in the PDT group recurred during the follow-up period. CONCLUSIONS PDT showed early resolution of the SRF compared to focal laser. In CSC patients, both the CMT and BCVA remained stable for 3 years after treatment. After 3 or more years of follow-up, PDT showed a lower recurrence rate than focal laser.
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Affiliation(s)
- Yong-Il Shin
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Kyeung-Min Kim
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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van Rijssen TJ, van Dijk EHC, Yzer S, Ohno-Matsui K, Keunen JEE, Schlingemann RO, Sivaprasad S, Querques G, Downes SM, Fauser S, Hoyng CB, Piccolino FC, Chhablani JK, Lai TYY, Lotery AJ, Larsen M, Holz FG, Freund KB, Yannuzzi LA, Boon CJF. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73:100770. [PMID: 31319157 DOI: 10.1016/j.preteyeres.2019.07.003] [Citation(s) in RCA: 272] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022]
Abstract
Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.
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Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne Yzer
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jan E E Keunen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre 162, London, United Kingdom
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, West Wing, Oxford, United Kingdom
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jay K Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
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Sousa K, Viana AR, Pires J, Ferreira C, Queirós L, Falcão M. Outer Nuclear Layer as the Main Predictor to Anatomic Response to Half Dose Photodynamic Therapy in Chronic Central Serous Retinopathy. J Ophthalmol 2019; 2019:5859063. [PMID: 31737357 PMCID: PMC6815602 DOI: 10.1155/2019/5859063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the predictors for subretinal fluid resorption in patients with chronic central serous retinopathy (cCSR) submitted to half-dose photodynamic therapy (HD-PDT). METHODS Observational, longitudinal, and retrospective study of patients with cCSR submitted to HD-PDT in a tertiary ophthalmology department in Portugal between January 2015 and February 2018. Best-corrected visual acuity (BCVA) and SD-OCT at baseline and 12 ± 3 months after treatment were performed. The central macular thickness (CMT), outer nuclear layer (ONL) thickness, integrity of the external limiting membrane (ELM), ellipsoid (EZ) and interdigitation zone (IZ), subretinal fluid (SFR) height, and choroidal thickness (CT) were evaluated. Patients were classified into responders and nonresponders based on SRF resorption. RESULTS Sixty-one eyes of 42 patients were included; 75.4% were classified as responders. Final BCVA was significantly better in responders (p=0.002). The baseline ONL was thicker (p < 0.01) and intact ELM (67.2% vs. 16.4%), EZ (49.2% vs. 8.2%), and IZ (31.2% vs. 1.6%) were more prevalent in responders than in nonresponders. Anatomic response was correlated with a thicker ONL (rs (59) = 0.416, p=0.001 ∗ ), intact ELM (rs (59) = 0.261, p=0.04 ∗ ), EZ (rs (59) = 0.278, p=0.03 ∗ ), and IZ (rs (59) = 0.318, p=0.01 ∗ ). Binary logistic regression showed that a thicker ONL thickness increased the chance of an anatomic response to HD-PDT. The other evaluated retinal layers did not have statistical significance in the binary regression model. CONCLUSIONS cCSR responders to HD-PDT have a better final BCVA, a thicker baseline ONL, and an intact baseline ELM, EZ, and IZ. However, ONL was the only predictor in a logistic regression model for SRF resorption.
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Affiliation(s)
- Keissy Sousa
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
- Ophthalmology Department, Centro Hospitalar Universitário S. João, Porto, Portugal
| | | | - Joana Pires
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Carla Ferreira
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Lara Queirós
- Ophthalmology Department, Hospital Cuf Porto, Porto, Portugal
| | - Manuel Falcão
- Ophthalmology Department, Centro Hospitalar Universitário S. João, Porto, Portugal
- Ophthalmology Department, Hospital Cuf Porto, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Liu Y, Li L, Zhu EY, Yuan Y, Wang W, Xu G. A two-year study of diffused retinal pigment epitheliopathy treated with half-dose photodynamic therapy guided by simultaneous angiography and optical coherence tomography. Eye (Lond) 2018; 33:737-745. [PMID: 30531992 PMCID: PMC6707295 DOI: 10.1038/s41433-018-0284-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/18/2018] [Accepted: 11/04/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Diffused retinal pigment epitheliopathy (DRPE) is not necessarily the same as chronic central serous chorioretinopathy (CSC), but a severe subgroup under the umbrella of chronic CSC. This study was to evaluate the efficacy and safety of half-dose PDT treating DRPE. METHODS A retrospective case series design was used. Forty-eight consecutive patients (48 eyes) with DRPE treated with half-dose PDT underwent follow-up at baseline, 3 months, 6 months, 12 months and 24 months. Simultaneous FA, ICGA and OCT were used for the treatment and follow-up. The primary outcomes were the subretinal fluid and best-corrected visual acuity in optical coherence tomography. RESULTS Complete fluid absorption was achieved in 95.8% of eyes at 3 months and 100.0% of eyes at 24 months. The baseline logarithm of the minimum angle of resolution (logMAR) BCVA, which was 0.51 ± 0.36, significantly improved to 0.43 ± 0.38 (p < 0.001) at 6 months. The boost continued to 0.29 ± 0.37 (p < 0.001) at 12 months and 0.19 ± 0.39 (p < 0.001) at 24 months. The integrities of the ellipsoid zone (EZ) and interdigitation zone (IZ) improved throughout. Regression analyses showed the BCVA in logMAR was inversely correlated with the EZ (p < 0.01) and IZ (p < 0.01). The recurrence rate was 6.3%. No severe complications were witnessed. CONCLUSIONS In 48 eyes with DRPE, simultaneous angiography and OCT facilitated a more comprehensive guidance for half-dose PDT treatment and follow-up. The BCVA improvement occurred at 6 months, which may be attributed to the restoration of the outer retinal structure.
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Affiliation(s)
- Yang Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200032, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lei Li
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200032, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Elena Yingqiu Zhu
- Melbourne Medical School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Yuanzhi Yuan
- Department of Ophthalmology, Zhong Shan Hospital of Fudan University, Shanghai, 200032, China
| | - Wenji Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200032, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200032, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Statement of the Professional Association of German Ophthalmologists (BVA), the German Society of Ophthalmology (DOG) and the German Retina Society (RG) on central serous chorioretinopathy. Ophthalmologe 2018; 116:10-20. [DOI: 10.1007/s00347-018-0809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Son BK, Kim K, Kim ES, Yu SY. Long-Term Outcomes of Full-Fluence and Half-Fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy. Ophthalmologica 2018; 241:105-115. [PMID: 30110697 DOI: 10.1159/000490773] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/09/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of full-fluence photodynamic therapy (PDT) and half-fluence PDT in chronic central serous chorioretinopathy (CSC). PROCEDURES A retrospective review of CSC patients treated with full-fluence or half-fluence PDT for 12 months was performed. Best-corrected visual acuity (BCVA), central macular thickness (CMT), neural retinal thickness, subfoveal choroidal thickness (SFCT), resolution of subretinal fluid (SRF), and incidence of retinal pigment epithelium (RPE) atrophy at 12, 24, and 36 months were assessed. RESULTS Thirty-seven and 30 eyes received full-fluence and half-fluence PDT, respectively. The BCVA and CMT improved significantly in both the full-fluence and half-fluence groups at 36 months, without a significant difference between the groups. Both groups showed significant reductions in SFCT with full-fluence (416.8-316.8 µm) being better overall than half-fluence (409.7-349.1 µm, p = 0.002). All patients achieved complete resolution without recurrence after one PDT treatment per eye. A few cases of RPE atrophy occurred, which could be correlated to PDT in both groups during the follow-up. CONCLUSION Both treatments were effective and safe in chronic CSC, with significant improvements in anatomic and visual parameters, without recurrence of SRF.
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Affiliation(s)
- Bo Kwon Son
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of
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Ntomoka CG, Rajesh B, Muriithi GM, Goud A, Chhablani J. Comparison of photodynamic therapy and navigated microsecond laser for chronic central serous chorioretinopathy. Eye (Lond) 2018; 32:1079-1086. [PMID: 29429986 PMCID: PMC5997803 DOI: 10.1038/s41433-018-0029-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/31/2017] [Accepted: 10/25/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To compare the visual and anatomical outcomes after photodynamic therapy (PDT) and navigated microsecond laser (nMSL) for chronic central serous chorioretinopathy (CSCR). METHODS This retrospective study included eyes with chronic CSCR who underwent either PDT or nMSL with a minimum of 6 months' follow-up. Eyes with a history of treatment with any other modalities in the past or during 6 months post PDT or microsecond laser follow-up were excluded. Primary outcome measures included change in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome measures included changes in subretinal fluid, hyper-reflective foci, cystic spaces, subfoveal choroidal thickness, and outer retinal structure integrity. RESULTS Forty-five eyes of 39 subjects (PDT group-23 eyes, nMSL group-22 eyes) with chronic CSCR were analyzed. At 6 months' follow-up, the nMSL group had significantly higher improvement in visual acuity compared to the PDT group (0.12 ± 0.24 vs -0.02 ± 0.20 (p = 0.039)). Reduction in central macular thickness was significantly higher in nMSL group compared to the PDT (85.5 ± 93.26 vs 24.47 ± 73.18 microns (p = 0.02)). Thirteen (59%) eyes in nMSL group had complete resolution of the SRF at 6 months compared to 5 (21.7%) eyes in PDT group. There was no significant difference in rest of the anatomical features between the groups. CONCLUSIONS nMSL seems to be superior over PDT in improving visual and anatomical outcomes at 6 months and can be considered as a cheap alternative to PDT in treatment of CSCR.
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Affiliation(s)
| | - Bindu Rajesh
- Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, 682020, Kerala, India
| | | | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India.
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Stellungnahme des Berufsverbandes der Augenärzte Deutschlands, der Deutschen Ophthalmologischen Gesellschaft und der Retinologischen Gesellschaft zur Chorioretinopathia centralis serosa (CCS). Ophthalmologe 2018; 115:388-399. [DOI: 10.1007/s00347-018-0680-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Anatomical Retinal Changes after Photodynamic Therapy in Chronic Central Serous Chorioretinopathy. J Ophthalmol 2018; 2018:4081874. [PMID: 29545952 PMCID: PMC5818899 DOI: 10.1155/2018/4081874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate anatomical retinal changes measured by spectral-domain optical coherence tomography (SD-OCT), after applying photodynamic therapy (PDT) for treatment of chronic central serous chorioretinopathy (CSC). Methods A retrospective analysis was conducted on 43 patients (48 eyes) with chronic CSC treated with PDT. Visual acuity (VA), central retinal thickness (CRT), outer nuclear layer (ONL) thickness, subretinal fluid (SRF), and photoreceptor ellipsoid zone (EZ) measured by SD-OCT were collected at baseline and at 3, 6, and 12 months after PDT. Differences between normally distributed variables were calculated by a paired-sample t-test; p < 0.05 was considered statistically significant. Results Mean age was 50 ± 9.8 years. Mean time from diagnosis to PDT was 12.5 months. Baseline VA was 0.51 ± 0.24 and significantly improved (p < 0.001) to 0.74 ± 0.26 one year after PDT. CRT and SRF significantly decreased (p < 0.001) at 3, 6, and 12 months after treatment. ONL thickness and EZ did not significantly change at any point during follow-up. Conclusions Not significant changes were found in the ONL or EZ 12 months after PDT.
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Matušková V, Vysloužilová D, Uher M. Half-Fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy: Predisposing Factors for Visual Acuity Outcomes. Semin Ophthalmol 2017; 33:690-699. [PMID: 29252091 DOI: 10.1080/08820538.2017.1416414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) is characterised by a serous detachment of the neurosensory retina in the macula. Chronic CSC tends to affect older individuals with a less favourable visual outcome. Photodynamic therapy (PDT) with verteporfin is a possible therapeutic approach in cases of CSC with no tendency for spontaneous resorption. PDT has shown good anatomic and functional results in treating chronic CSC. For the purpose of diminishing side effects, modifications of the standard protocol were used. MATERIALS AND METHODS This is a retrospective study of 32 eyes with CSC of 32 patients treated by half-fluence PDT. The patients underwent complete ophthalmology examination. On optical coherence tomography (OCT) we measured central retinal thickness (CRT), the outer nuclear layer (ONL), presence of subfoveolar detachment of retinal pigment epithelium (PED), disturbance of external limiting membrane (ELM), morphological changes in the inner segment/outer segment (IS/OS) line and retinal pigment epithelium (RPE) atrophy. We evaluated at baseline, 3 and 12 months after PDT. RESULTS The mean BCVA at baseline was 0.41 ± 0.23 log MAR, the mean BCVA at 3 months was 0.24 ± 0.20 and at the end of the follow-up it was 0.23 ± 0.200. We observed statistically significant improvements of visual acuity after 3 and 12 months (p < 0.001, Wilcoxon test). The mean central retinal thickness at baseline was 373 ± 87 µm, the mean CRT after 3 months was 234 ± 42 µm and after 12 months 223 ± 39 µm. A significant reduction from baseline was seen after 3 months and 12 months (p < 0.001, Wilcoxon test). Baseline ONL reached 80 ± 27 µm, after 3 months it was 78 ± 20 and after 12 months it was 74 ± 20 µm. We observed a statistically significant change in diminishing the amount of PED after PDT after 3 months and after 12 months (p = 0.021, McNemar's test). We observed that in patients with RPE ablation, there is lower chance for the restitution of the IS/OS layer (p = 0.045, Mann-Whitney test). We observed a negative association between the improvement of visual acuity after 12 months and the presence of RPE ablation (p = 0.031, Mann-Whitney test). Restitution of ELM was significantly more often in patients with shorter duration of symptoms, (p = 0.027 after 3 months, p = 0.033 after 12 months after PDT, Spearman correlation). Neither ocular nor systemic adverse effects were observed during the follow-up period. CONCLUSIONS Half-fluence PDT treatment has shown to be a usually safe and often effective therapy in patients with chronic CSC. This study suggests that the most important predictive factor is baseline visual acuity. The important anatomical change detected using OCT is a thinning of the outer nuclear layer. Nonetheless, other studies with a larger number of patients and a longer follow-up are required.
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Affiliation(s)
- Veronika Matušková
- a Department of Ophthalmology, University Hospital Brno and Medical Faculty , Masaryk University , Brno , Czech Republic
| | - Daniela Vysloužilová
- a Department of Ophthalmology, University Hospital Brno and Medical Faculty , Masaryk University , Brno , Czech Republic
| | - Michal Uher
- b Institute of Biostatistics and Analyses, Faculty of Medicine , Masaryk University , Brno , Czech Republic
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Sugiura A, Fujino R, Takemiya N, Shimizu K, Matsuura M, Murata H, Inoue T, Obata R, Asaoka R. The association between visual function and retinal structure in chronic central serous chorioretinopathy. Sci Rep 2017; 7:16288. [PMID: 29176603 PMCID: PMC5701134 DOI: 10.1038/s41598-017-16339-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/10/2017] [Indexed: 01/30/2023] Open
Abstract
The purpose of the current study was to investigate the association between visual function and retinal structure in central serous chorioretinopathy (CSC). In 22 eyes of 22 chronic CSC patients with serous retinal detachment at the macula, retinal sensitivity was measured using MP3 microperimetry (NIDEK, Japan) and mean sensitivity within two degrees (MS2), four degrees (MS4) and six degrees (MS6), as well as foveal sensitivity (MS0), were calculated. Retinal structure was measured using optical coherence tomography (OCT, Spectralis, Heidelberg). The relationship between visual function (LogMAR best-corrected visual acuity [LogMAR VA] and MS0, MS2, MS4, MS6) and serous retinal detachment height at the fovea (SRDH), central retinal thickness (CRT), macular volume (MV) and central choroidal thickness (CCT) was investigated. There were significant negative correlations between LogMAR VA and MS0 (p = 0.016), MS2 (p = 0.049). No significant relationship was observed between LogMAR VA and SRDH (p = 0.97) although there was a significant negative correlation between SRDH and MS2 (p = 0.028), MS4 (p = 0.049), MS6 (p = 0.023). In conclusion, in CSC, serous retinal detachment was significantly correlated with retinal sensitivity measured with MP3, but not with LogMAR VA.
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Affiliation(s)
- Aya Sugiura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryosuke Fujino
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Nobuko Takemiya
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kimiko Shimizu
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryo Obata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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Ambiya V, Khodani M, Goud A, Narayanan R, Tyagi M, Rani PK, Chhablani J. Early Focal Laser Photocoagulation in Acute Central Serous Chorioretinopathy: A Prospective, Randomized Study. Ophthalmic Surg Lasers Imaging Retina 2017; 48:564-571. [PMID: 28728183 DOI: 10.3928/23258160-20170630-07] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/27/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the role of early focal laser photocoagulation in acute central serous chorioretinopathy (CSC). PATIENTS AND METHODS A total of 58 eyes with acute naïve CSC (less than 2 months' duration) with focal leak on fundus fluorescein angiography (FFA) were randomized into either a laser or a sham laser group. Eyes with chronic CSC and subfoveal leak were excluded. Visual acuity assessment, microperimetry, optical coherence tomography, and FFA were done at baseline, 1 month (minus FFA), 3 months, and 6 months after treatment. RESULTS There was a significant improvement in best-corrected visual acuity, low-contrast visual acuity, retinal sensitivity, and central macular thickness at all visits in both groups (P < .001); however, there was no significant difference between the groups regarding time of resolution. Four eyes in the sham laser group needed rescue laser compared with one eye in early laser group (P = .16). CONCLUSION Early laser photocoagulation is not superior to sham laser for acute CSC; therefore, observation appears to the safest and most effective strategy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:564-571.].
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Comparison of half-dose photodynamic therapy and 689 nm laser treatment in eyes with chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2017; 255:1141-1148. [DOI: 10.1007/s00417-017-3626-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/30/2017] [Accepted: 02/21/2017] [Indexed: 11/27/2022] Open
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Lai FH, Ng DS, Bakthavatsalam M, Chan VC, Young AL, Luk FO, Tsang CW, Brelén ME. A Multicenter Study on the Long-term Outcomes of Half-dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy. Am J Ophthalmol 2016; 170:91-99. [PMID: 27519561 DOI: 10.1016/j.ajo.2016.07.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/28/2016] [Accepted: 07/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate long-term efficacy and prognostic factors of half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR). DESIGN Retrospective multicenter interventional case series. METHODS Patients with chronic CSCR undergoing half-dose PDT between 2005 and 2011 were reviewed. Main outcome measures included resolution of serous retinal detachment (SRD) with single PDT, change in best-corrected visual acuities (BCVAs), and recurrence rate of CSCR at 36 months after PDT. Prognostic factors of visual outcome and recurrence of CSCR after PDT were identified with multivariate regression analysis. RESULTS A total of 136 eyes of 123 patients were followed up for 57.7 ± 16.2 months. At 36 months after PDT, 132 eyes (97.1%) achieved complete resolution of SRD with single PDT and 4 eyes (2.9%) had CSCR recurrence. The mean logMAR BCVA improved from 0.36 ± 0.29 (Snellen equivalent 20/46; range: 0.1-1.2) at baseline to 0.15 ± 0.23 at 36 months (Snellen equivalent 20/28; range: 0.1-1.5; P < .001) and 0.16 ± 0.24 (Snellen equivalent: 20/29; range: 0.1-1.5; P < .001) at final follow-up. Forty-four eyes (32.4%) had ≥3 lines of BCVA gain while 5 eyes (3.7%) had ≥3 lines of BCVA loss at 36 months after PDT. Nine eyes (6.6%) developed CSCR recurrence at final follow-up. Baseline BCVA was significantly associated with the BCVA (P = .009) and the improvement in BCVA (P < .001) at final follow-up. History of bilateral CSCR was significantly associated with CSCR recurrence at final follow-up (P = .036; odds ratio = 15.84, 95% confidence interval = 1.20-208.32). Eight eyes (5.9%) had complications related to PDT. CONCLUSIONS Chronic CSCR patients treated with half-dose PDT can achieve long-term stable visual acuity and resolution of SRD. Patients with chronic CSCR are recommended to undergo half-dose PDT before they have significant visual deterioration. Patients with bilateral CSCR are more likely to develop CSCR recurrence after half-dose PDT.
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Ambiya V, Goud A, Mathai A, Rani PK, Chhablani J. Microsecond yellow laser for subfoveal leaks in central serous chorioretinopathy. Clin Ophthalmol 2016; 10:1513-9. [PMID: 27570446 PMCID: PMC4986913 DOI: 10.2147/opth.s112431] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of navigated yellow microsecond laser in treating subfoveal leaks in nonresolving central serous chorioretinopathy (CSC). Methods This prospective study included ten eyes of ten consecutive patients with nonresolving CSC with subfoveal leaks. All eyes were treated with 577 nm navigated yellow microsecond laser (5% duty cycle). Key inclusion criteria include a vision loss for a duration of minimum 3 months duration due to focal subfoveal leak on fluorescein angiography. Key exclusion criteria include prior treatment for CSC and any signs of chronic CSC. Comprehensive examination, in addition to low-contrast visual acuity assessment, microperimetry, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, was done at baseline, 1, 3, and 6 months after treatment. Rescue laser was performed as per predefined criteria at 3 months. Results The average best-corrected visual acuity improved from 73.3±16.1 letters to 75.8±14.0 (P=0.69) at 3 months and 76.9±13.0 (P=0.59) at 6 months, but was not statistically significant. Low-contrast visual acuity assessment (logMAR) improved from 0.41±0.32 to 0.35±0.42 (P=0.50) at 3 months and 0.28±0.33 (P=0.18) at 6 months. Average retinal sensitivity significantly improved from baseline 18.93±7.19 dB to 22.49±6.67 dB (P=0.01) at 3 months and 21.46±8.47 dB (P=0.04) at 6 months. Rescue laser was required only in one eye at 3 months; however, laser was required in three eyes at 6 months. Conclusion Microsecond laser is a safe and effective modality for treating cases of nonresolving CSC with subfoveal leaks.
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Affiliation(s)
- Vikas Ambiya
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Abhilash Goud
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Annie Mathai
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Padmaja Kumari Rani
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Jay Chhablani
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
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Yasui A, Yamamoto M, Hirayama K, Shiraki K, Theisen-Kunde D, Brinkmann R, Miura Y, Kohno T. Retinal sensitivity after selective retina therapy (SRT) on patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:243-254. [DOI: 10.1007/s00417-016-3441-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/26/2016] [Accepted: 07/07/2016] [Indexed: 11/24/2022] Open
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Stur M, Ansari-Shahrezaei S, Haas A, Tittl M. Leitlinien für die Betreuung und Behandlung von Patienten mit Chorioretinopathia centralis serosa. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-015-0276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cidad P, González E, Asencio M, García J. Structural and Functional Outcomes in Chronic Central Serous Chorioretinopathy Treated with Photodynamic Therapy. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:331-5. [PMID: 26457039 PMCID: PMC4595259 DOI: 10.3341/kjo.2015.29.5.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To study the retinal pigment epithelium (RPE) and retinal alterations in chronic central serous chorioretinopathy treated with photodynamic therapy, and its correlation with functional parameters such as best-corrected visual acuity (BCVA) and contrast sensitivity (CS). Methods Retrospective, noncomparative, consecutive evaluation by optical coherence tomography and its correlation with BCVA and CS in 31 eyes of 26 patients. Results In all affected patients, 88.5% were male with a mean age of 42.9 years. The right eye was involved in 64.5% of cases, bilateral in 19% and 73.9% were hyperopic (spherical refraction between 0 and +5.0 diopters). Of these cases, 51.5% had peri-RPE abnormalities, 17.3% hyperreflective substances at RPE, 19.4% RPE atrophy, 55.3% foveolar atrophy, 3.1% pigment epithelial detachment, 5.2% subretinal fluid persistence, 8.3% fibrin deposits, 68.4% photoreceptor inner and outer segment line interruption and 31.1% external limiting membrane interruption. Conclusions Time evolution and number of outbreaks were related to the decrease in foveal and chorodial thickness and in those with worse BCVA and CS. RPE abnormalities and atrophy were related to the age of onset of symptoms. Photoreceptor elongation has been correlated with poor BCVA and inner and outer segment line destructuring and interruption with poor CS.
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Affiliation(s)
- Pino Cidad
- Ophthalmology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Eugenia González
- Ophthalmology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Mónica Asencio
- Ophthalmology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús García
- Ophthalmology Service, Hospital Universitario La Paz, Madrid, Spain
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Comparing half-dose photodynamic therapy with high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy (the PLACE trial): study protocol for a randomized controlled trial. Trials 2015; 16:419. [PMID: 26390920 PMCID: PMC4578347 DOI: 10.1186/s13063-015-0939-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/03/2015] [Indexed: 12/15/2022] Open
Abstract
Background Chronic central serous chorioretinopathy (cCSC) is an eye disease characterized by an accumulation of serous fluid under the retina. It is postulated that this fluid accumulation results from hyperpermeability and swelling of the choroid, the underlying vascular tissue of the eye, causing a dysfunction of the retinal pigment epithelium. This fluid accumulation causes neuroretinal detachment. A prolonged neuroretinal detachment in the macula can lead to permanent vision loss. Therefore, treatment is aimed primarily at achieving resolution of subretinal fluid, preferably within the first 4 months after diagnosis of the disease. A broad spectrum of treatment modalities has been investigated in cCSC, but no consensus exists on the optimal treatment of cCSC. Currently, photodynamic therapy (PDT) and high-density subthreshold micropulse laser treatment (HSML) are among the most frequently cited treatments in obtaining successful neuroretinal reattachment. Methods/Design This is a randomized, controlled, open-label, multicenter trial comparing the efficacy of half-dose PDT to HSML in treating patients with cCSC. A total of 156 patients will be recruited, 78 patients in each treatment arm, with a maximum follow-up duration of 8 months after the first treatment. A complete ophthalmological examination with vision-related quality of life (NEI VFQ-25) and stress questionnaires, will be performed at baseline, 6 to 8 weeks after the first treatment, 6 to 8 weeks after a second treatment (if necessary), and at the final follow-up visit at 7 to 8 months after the first treatment. Treatment visits will be scheduled within 3 weeks after the baseline visit, and within 3 weeks after the first control visit, if a second treatment is required. Discussion Both half-dose PDT and HSML may be effective treatments in cCSC, but because of the lack of prospective randomized controlled trials, which treatment should be the first choice remains unclear. The aim of this study is to compare the efficacy of half-dose PDT to HSML. The primary endpoint to evaluate efficacy will be a complete absence of subretinal fluid on optical coherence tomography after treatment. Secondary functional endpoints include change in Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity, retinal sensitivity on microperimetry, and NEI VFQ-25 questionnaire of visual functioning. Registration number Institutional Review Board (CMO Arnhem-Nijmegen, the Netherlands): 2013/203 NL nr.: 41266.091.13 Trial registration ClinicalTrials.gov identifier: NCT01797861. Date of registration: 21 February 2013.
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Choroidal Thickness Changes After Photodynamic Therapy and Recurrence of Chronic Central Serous Chorioretinopathy. Am J Ophthalmol 2015; 160:72-84.e1. [PMID: 25887629 DOI: 10.1016/j.ajo.2015.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate long-term changes in subfoveal choroidal thickness (SCT) after photodynamic therapy (PDT) and their relationship with chronic central serous chorioretinopathy (CSC) recurrence. DESIGN Retrospective, observational, comparative case series. METHODS Fifty-seven eyes with chronic CSC (52 patients, ≥2 years follow-up) treated with half-fluence or half-dose PDT were divided into 2 groups: those with incomplete CSC resolution or subretinal fluid (SRF) recurrence (SRF+) and those with complete SRF absorption without disease recurrence (SRF-). The SCT was measured using spectral-domain optical coherence tomography and relative SCT ratios (follow-up SCT: baseline SCT ratio) were compared between the 2 groups. RESULTS Mean follow-up period was 33.9 ± 9.9 months (range: 24-62 months). Four of 57 eyes (7%) had persistent SRF after PDT and 12 of 53 eyes (22.6%) had initial SRF resolution with SRF recurrence. The SRF+ group had a slower reduction in SCT during the first month (P < .001) and a higher relative SCT ratio than the SRF- group throughout follow-up (P < .001). The relative SCT ratio at 1 month was highly predictive of CSC recurrence (area under the curve = 0.902, 95% confidence interval: 0.823-0.982). Using a relative SCT ratio cutoff of 93.1%, sensitivity of this measure was 93.8% and specificity was 78.1%. CONCLUSIONS Those with incomplete SRF absorption or SRF recurrence had a slower SCT decline at 1 month and a higher SCT ratio throughout follow-up compared to those without CSC recurrence. The SCT changes may reflect PDT efficacy and help predict long-term recurrence and early treatment outcomes.
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Abouammoh MA. Advances in the treatment of central serous chorioretinopathy. Saudi J Ophthalmol 2015; 29:278-86. [PMID: 26586979 PMCID: PMC4625218 DOI: 10.1016/j.sjopt.2015.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Central serous chorioretinopathy is a disease that is partly understood. Novel advancements have led to further understanding of the disease, and have identified choroidal dysfunction as the principal element in CSCR development. New imaging tools have aided in better monitoring disease response to various treatment models. Enhanced depth imaging optical coherence tomography, in particular, has helped in observing choroidal thickness changes after various treatment models. To date, photodynamic therapy and focal laser remain the main stay of treatment. More understanding of disease pathophysiology in the future will help in determining the drug of choice and the best management option for such cases.
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Kim YK, Ryoo NK, Woo SJ, Park KH. Comparison of visual and anatomical outcomes of half-fluence and half-dose photodynamic therapy in eyes with chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2015; 253:2063-73. [DOI: 10.1007/s00417-014-2926-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/28/2014] [Accepted: 12/30/2014] [Indexed: 01/13/2023] Open
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Saxena S, Srivastav K, Cheung CM, Ng JY, Lai TY. Photoreceptor inner segment ellipsoid band integrity on spectral domain optical coherence tomography. Clin Ophthalmol 2014; 8:2507-22. [PMID: 25525329 PMCID: PMC4266419 DOI: 10.2147/opth.s72132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Spectral domain optical coherence tomography cross-sectional imaging of the macula has conventionally been resolved into four bands. However, some doubts were raised regarding authentication of the existence of these bands. Recently, a number of studies have suggested that the second band appeared to originate from the inner segment ellipsoids of the foveal cone photoreceptors, and therefore the previously called inner segment-outer segment junction is now referred to as inner segment ellipsoidband. Photoreceptor dysfunction may be a significant predictor of visual acuity in a spectrum of surgical and medical retinal diseases. This review aims to provide an overview and summarizes the role of the photoreceptor inner segment ellipsoid band in the management and prognostication of various vitreoretinal diseases.
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Affiliation(s)
- Sandeep Saxena
- Retina Service, Department of Ophthalmology, King George's Medical University Lucknow, India
| | - Khushboo Srivastav
- Retina Service, Department of Ophthalmology, King George's Medical University Lucknow, India
| | | | - Joanne Yw Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
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Schliesser JA, Gallimore G, Kunjukunju N, Sabates NR, Koulen P, Sabates FN. Clinical application of optical coherence tomography in combination with functional diagnostics: advantages and limitations for diagnosis and assessment of therapy outcome in central serous chorioretinopathy. Clin Ophthalmol 2014; 8:2337-45. [PMID: 25473259 PMCID: PMC4247136 DOI: 10.2147/opth.s73119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose While identifying functional and structural parameters of the retina in central serous chorioretinopathy (CSCR) patients, this study investigated how an optical coherence tomography (OCT)-based diagnosis can be significantly supplemented with functional diagnostic tools and to what degree the determination of disease severity and therapy outcome can benefit from diagnostics complementary to OCT. Methods CSCR patients were evaluated prospectively with microperimetry (MP) and spectral domain optical coherence tomography (SD-OCT) to determine retinal sensitivity function and retinal thickness as outcome measures along with measures of visual acuity (VA). Patients received clinical care that involved focal laser photocoagulation or pharmacotherapy targeting inflammation and neovascularization. Results Correlation of clinical parameters with a focus on functional parameters, VA, and mean retinal sensitivity, as well as on the structural parameter mean retinal thickness, showed that functional measures were similar in diagnostic power. A moderate correlation was found between OCT data and the standard functional assessment of VA; however, a strong correlation between OCT and MP data showed that diagnostic measures cannot always be used interchangeably, but that complementary use is of higher clinical value. Conclusion The study indicates that integrating SD-OCT with MP provides a more complete diagnosis with high clinical relevance for complex, difficult to quantify diseases such as CSCR.
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Affiliation(s)
- Joshua A Schliesser
- Vision Research Center, Department of Ophthalmology, University of Missouri - Kansas City, School of Medicine, Kansas City, MO, USA
| | - Gary Gallimore
- Vision Research Center, Department of Ophthalmology, University of Missouri - Kansas City, School of Medicine, Kansas City, MO, USA
| | - Nancy Kunjukunju
- Vision Research Center, Department of Ophthalmology, University of Missouri - Kansas City, School of Medicine, Kansas City, MO, USA
| | - Nelson R Sabates
- Vision Research Center, Department of Ophthalmology, University of Missouri - Kansas City, School of Medicine, Kansas City, MO, USA
| | - Peter Koulen
- Vision Research Center, Department of Ophthalmology, University of Missouri - Kansas City, School of Medicine, Kansas City, MO, USA
| | - Felix N Sabates
- Vision Research Center, Department of Ophthalmology, University of Missouri - Kansas City, School of Medicine, Kansas City, MO, USA
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Chung HW, Yun CM, Kim JT, Kim SW, Oh J, Huh K. Retinal sensitivity assessed by microperimetry and corresponding retinal structure and thickness in resolved central serous chorioretinopathy. Eye (Lond) 2014; 28:1223-30. [PMID: 25081286 DOI: 10.1038/eye.2014.185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/26/2014] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To investigate the relationship between retinal sensitivity (RS) assessed by microperimetry (MP) and retinal structural changes in patients with resolved central serous chorioretinopathy (CSC). METHODS Spectral domain optical coherence tomography (OCT) examination and MP tests were performed in patients with resolved CSC. Point-to-point correlation was performed between RS and corresponding retinal structural changes using Pearson's correlation analysis. In addition, in a 1-mm zone in the central fovea, a correlation was calculated between the mean RS and the mean central retinal thickness (CRT). RESULTS Eighty-four eyes were analyzed. The total number of MP test points was 1092 (84 eyes × 13 points). The mean RS and retinal point thickness (RPT) of all test points were 13.53±3.84 dB and 208.6±48.0 μm, respectively. The RS and RPT were significantly decreased in the test points with loss of the ellipsoid portion of the inner segments (EPIS) (P<0.0001). Within the 1-mm foveal center zone, there was a significant correlation between mean RS and mean CRT (r=0.432, P<0.0001) and between RS and the corresponding RPT (r=0.339, P<0.0001). CONCLUSION RS was dependent on the status of the EPIS in patients with resolved CSC. The correlation between mean RS and mean CRT was compatible with the point-to-point correlation between RS and the corresponding RPT.
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Affiliation(s)
- H W Chung
- Korea University College of Medicine, Seoul, Korea
| | - C M Yun
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - J T Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S-W Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - J Oh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - K Huh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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