J Korean Ophthalmol Soc.  2009 Jul;50(7):1035-1043. 10.3341/jkos.2009.50.7.1035.

The Result of Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

• Kim M
• Chung H

• KMID: 2212491
• DOI: http://doi.org/10.3341/jkos.2009.50.7.1035

Abstract

PURPOSE
To determine the efficacy and complication of photodynamic therapy (PDT) with verteporfin in chronic central serous chorioretinopathy (chronic CSC). METHODS: The authors retrospectively examined 27 eyes of 26 patients who were diagnosed with chronic CSC and treated with PDT between February 2005 and February 2008, to determine visual acuity improvement, resolution of serous retinal detachment and occurrence of complications or recurrences. RESULTS: One month after PDT, neurosensory detachment had disappeared in all patients. In addition, visual acuity had improved in 9 eyes by two lines or more on the Snellen chart, remained unchanged in 14 eyes, and decreased in 4 eyes by two lines or more on the Snellen chart. Final visual acuity had improved in 18 eyes, and remained unchanged in 9 eyes. Choroidal neovascularization (CNV) had occurred in two patients, 9 days and 6 months after PDT. Intravitreal injection of Bevacizumab was performed and closure of CNV was obtained. One eye showed choroidal ischemia 1 month after PDT, although visual acuity was not decreased. CONCLUSIONS: PDT appears to be an effective treatment for chronic CSC, and the recurrence rate after PDT is low. However, CNV may occur after PDT. Further studies are necessary to verify treatment safety and modulate the parameters of PDT to reduce complications such as CNV.

Keyword

Central serous chorioretinopathy; Choroidal neovascularization; Photodynamic therapy

MeSH Terms

Antibodies, Monoclonal, Humanized
Central Serous Chorioretinopathy
Choroid
Choroidal Neovascularization
Eye
Humans
Intravitreal Injections
Ischemia
Photochemotherapy
Porphyrins
Recurrence
Retinal Detachment
Retrospective Studies
Triazenes
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized
Porphyrins
Triazenes

Figure

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  Figure 1. A 43-year-old male (patient 12 in Table 1). A, Fundus photography showed a pocket of subretinal fluid (SRF) at the posterior pole. B and C, Fluorescein angiography (FA) showed a perifoveal focal leak. D, Optical coherence tomography (OCT) showed SRF. E, SRF at the posterior pole decreased but still remained 9 months later on the fundus photography. F, Indocyanine green angiography (ICGA) showed dilated choroidal vessels with choroidal hyperperfusion. G, Focal leak at the superotemporal arcade decreased but there was still a faint leak in the FA. H, OCT also showed remnant SRF at the macular region. I and L, 4 months after PDT, fundus photography and OCT showed no SRF at the macular region. J, Hyperperfusion and dilated vessels seen on the pre-PDT ICGA had disappeared. K, FA showed no leak at the previous leaking point.

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  Figure 2. A 43-year-old male (patient 25 in table 1) with baseline visual acuity 1.0. A and C, Fundus photography and OCT showed PED at the juxtafoveal area. B, FA showed a mild diffuse leak. 9 days after PDT, visual acuity decreased suddenly. 1 month after PDT, his visual acuity was 0.1. D, Fundus photography showed CNV with subretinal hemorrhage. E and F, ICGA and OCT showed CNV at the previous PDT area. 4 months after intravitreal bevacizumab injection, his visual acuity recovered to 1.0. G and I, Fundus photography and OCT showed disappeared CNV and subretinal hemorrhage. H, FA showed no active leak.

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  Figure 3. A 58-year-old female (patient 9 in table 1) with baseline visual acuity 0.15. A, Fundus photography showed serous detachment with RPE atrophy at the posterior pole. B and C, ICGA showed choroidal hyperpermeability and hot spots at the foveal area. D, OCT showed a shallow serous detachment. E, serous detachment resolved and RPE atrophy remained in the fundus photography 3 months later. F and G, ICGA of the same patient 1 month after PDT showed reduced perfusion of the choriocapillaris in the laser-treated area. H, OCT showed a resolution of serous detachment 1 month after PDT. Her visual acuity was 0.4 at 1 month and recovered to 0.6 at 10 months.

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