Original article
Association Between the Efficacy of Half-Dose Photodynamic Therapy With Indocyanine Green Angiography and Optical Coherence Tomography Findings in the Treatment of Central Serous Chorioretinopathy

https://doi.org/10.1016/j.ajo.2011.08.015Get rights and content

Purpose

To determine the efficacy of half-dose photodynamic therapy (PDT) in relation to indocyanine green angiography (ICGA) and optical coherence tomography (OCT) findings for treating chronic central serous chorioretinopathy (CSC).

Design

Observational case series.

Methods

Thirty-eight eyes of 37 patients with chronic CSC and symptoms for at least 6 months were recruited. PDT was performed using half the normal dose of verteporfin. A total light energy of 50 J/cm2 over 83 seconds was delivered to the area of choroidal hyperfluorescence as observed on ICGA. The resolution of the subretinal fluid and recurrence rates were assessed in relation to the different degrees of choroidal hyperfluorescence and the distribution of fluid in the neuroepithelium, namely subretinal fluid or posterior retinal cystoid degeneration.

Results

After half-dose PDT a dry macula was obtained in 86.8% and 92.1% of the eyes at 1 month and at the last follow-up (14.2 ± 5.8 months) respectively. ICGA at baseline showed intermediate and intense hyperfluorescence in 39.4% and 60.5% of the eyes respectively. All eyes with intermediate hyperfluorescence had only subretinal fluid at OCT and a dry macula was obtained in 87% and 100% at 1 month and at the last follow-up after half-dose PDT. In the intense hyperfluorescence group, 82.6% and 17.4% of the eyes had subretinal fluid only or both subretinal fluid and posterior retinal cystoid degeneration respectively. In the intense hyperfluorescence group with subretinal fluid only, a dry macula was obtained in 89.5% and 100% of the eyes at 1 month and at the last follow-up respectively. In the intense hyperfluorescence group with both subretinal fluid and posterior retinal cystoid degeneration, a dry macula was obtained in 75% and 25% of the eyes at 1 month and at the last follow-up respectively. Overall, of the 23 eyes with intense hyperfluorescence, 20 eyes (87%) had a dry macula starting from 1 month for the entire follow-up period.

Conclusion

The half-dose PDT success rate in eyes with chronic CSC depends also on the distribution of fluid in the neuroepithelium. Half-dose PDT might not be effective or the recurrence rate might be high in eyes with posterior retinal cystoid degeneration.

Section snippets

Methods

This study was a retrospective, interventional case series conducted in the Department of Neuroscience, Ophthalmology and Genetics of the University of Genova, Italy. Patients were offered treatment if they had persistent fluid involving the macula. Inclusion criteria were: 1) a 6-month history of CSC; 2) best-corrected visual acuity (BCVA) of 20/200 or better; 3) presence of subretinal fluid involving the fovea with or without posterior cystoid retinal degeneration on OCT; and 4) presence of

Results

A total of 38 eyes of 37 patients with chronic CSC received half-dose PDT. The mean ± SD age of patients was 48.5 ± 10.3 years (range 31–70) and 34 of the patients (91.8%) were male. Baseline mean ± standard deviation (SD) BCVA was 0.74 ± 0.19 (range 0.3–1.0). Mean follow-up was 14.2 ± 5.8 months (median 12, range 8–30). Baseline mean ± SD central foveal thickness was 345.61 ± 101.00 μm.

At baseline, 34 of the 38 eyes (89.5%) had subretinal fluid alone and 4 eyes (10.5%) had combined subretinal

Discussion

In the current study of 38 eyes, dry macula was obtained in 33 eyes (86.8%) at 1 month and in 35 eyes (92.1%) at the last follow-up visit after half-dose PDT. At baseline, the findings on ICGA were intense hyperfluorescence in 60.5% (n = 23) of the eyes and intermediate hyperfluorescence in 39.4% (n = 15) of the eyes. We did not find eyes without hyperfluorescence area on ICGA.

The effectiveness of half-dose PDT differed depending on the variations not only in the choroidal hyperpermeability as

Massimo Nicolò, MD, PhD, is a clinical ophthalmologist at University Eye Clinic, Di.N.O.G., San Martino Hospital, Genova, Italy. He completed his ophthalmology residency at University of Genova in 2000. His clinical and research expertise is in the area of medical retinal diseases, including diabetic retinopathy, age-related macular degeneration, and central serous chorioretinopathy.

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Massimo Nicolò, MD, PhD, is a clinical ophthalmologist at University Eye Clinic, Di.N.O.G., San Martino Hospital, Genova, Italy. He completed his ophthalmology residency at University of Genova in 2000. His clinical and research expertise is in the area of medical retinal diseases, including diabetic retinopathy, age-related macular degeneration, and central serous chorioretinopathy.

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