Korean J Ophthalmol.  2019 Dec;33(6):506-513. 10.3341/kjo.2019.0065.

Comparison of Focal and Conventional Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

• Noh SR
• Kang MS
• Kim K
• Kim ES
• Yu SY

• KMID: 2465130
• DOI: http://doi.org/10.3341/kjo.2019.0065

Abstract

PURPOSE
To evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).
METHODS
This study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.
RESULTS
The mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).
CONCLUSIONS
Focal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.

Keyword

Chronic central serous chorioretinopathy; Photochemotherapy; Subfoveal choroidal thickness

MeSH Terms

Angiography
Central Serous Chorioretinopathy*
Choroid
Humans
Indocyanine Green
Photochemotherapy*
Retinal Detachment
Subretinal Fluid
Tomography, Optical Coherence
Indocyanine Green

Figure

• 

  Fig. 1 Example of a chronic central serous chorioretinopathy patient who was treated with conventional photodynamic therapy (PDT). (A,B) Fluorescein angiogram before PDT showed focal leakages from the retinal pigment epithelium at the macula. Indocyanine green angiogram before PDT showed hyperfluorescence secondary to vascular hyperpermeability at the macula. (C,D) Yellow circle indicates ‘focal PDT’ area and red circle indicates ‘conventional PDT’ area in middle phase indocyanine green angiogram. (E) Spectral-domain optical coherence tomography images before PDT. FA = fluorescein angiography; ICGA = indocyanine green angiography.

• 

  Fig. 2 (A) A case of focal photodynamic therapy (PDT) treatment in a 51-year-old male patient with chronic central subfield thickness (CSC) and (B) a case of conventional PDT treatment in a 58-year-old female patient with chronic CSC. Yellow circle indicates focal PDT area and red circle indicates conventional PDT area in middle-phase indocyanine green angiogram. Note that the focal PDT area was much smaller than the conventional area in the indocyanine green angiography. (C,D) The choroidal thickness (right bottom in optical coherence tomography) and central subfield thickness (right top in optical coherence tomography) were decreased significantly during the follow-up period compared with baseline in both groups.

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