Original article
Half-Fluence Versus Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

https://doi.org/10.1016/j.ajo.2014.01.022Get rights and content

Purpose

To compare the efficacy and safety of half-fluence vs half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSC).

Design

Multicenter retrospective comparison study.

Methods

Retrospective review of 56 patients affected by chronic CSC, including 28 patients (31 eyes) who received half-fluence PDT and 28 patients (29 eyes) who received half-dose PDT. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and resolution of subretinal fluid on optical coherence tomography at 1 and 12 months were assessed.

Results

The mean logMAR BCVA improved significantly (P < .001), both in the half-fluence group (from 0.187 [± 0.187] to 0.083 [± 0.164]) and in the half-dose group (from 0.126 [± 0.091] to 0.068 [± 0.091]), at 12 months, without significant difference between the 2 groups. At 1 month a complete resolution of subretinal fluid was observed in 19 half-fluence-treated eyes (61.3%) and in 25 half-dose-treated eyes (86.2%) (P = .04). At 12 months, a complete resolution of subretinal fluid was achieved in 26 half-fluence-treated eyes (83.9%) and 29 half-dose-treated eyes (100%) (P = .0529). Nine eyes (29%) in the half-fluence group and 5 eyes (17.2%) in the half-dose group had at least 1 recurrence of subretinal fluid during the follow-up. Overall there were 15 and 5 recurrences in the half-fluence PDT and half-dose PDT groups, respectively (P = .07). In no eye of either groups was atrophy of the retinal pigment epithelium observed in the area of treatment.

Conclusion

Half-dose PDT induced a more rapid reabsorption of the fluid, a more lasting effect, and equal safety with respect to half-fluence PDT.

Section snippets

Methods

Retrospective review of medical records of 56 patients who had received PDT at the University Eye Clinics of Genova and Torino, Italy, in the last 2 years was conducted. The Institutional Review Board of the University of Genova and Torino approved the study protocol and the collection of data related to all the patients affected by CSC and treated by PDT. The data collection complies with Italian law. The study was conducted in accordance with the provisions stated in the Declaration of

Results

Thirty-one eyes (28 patients) received half-fluence PDT and 29 eyes (28 patients) received half-dose PDT. The baseline demographic data of both groups are shown in Table 1. There were no significant differences between the 2 groups. At baseline, the mean (SD) logMAR BCVA was 0.187 (± 0.187) in the half-fluence group and 0.126 (± 0.091) in the half-dose group. At the last follow-up visit, mean (SD) logMAR BCVA was 0.083 (± 0.164) in the half-fluence group and 0.068 (± 0.091) in the half-dose

Discussion

In this retrospective comparative case series study, we evaluated the efficacy and safety of half-fluence PDT with respect to half-dose PDT in the treatment of chronic CSC. We previously observed that posterior cystoid retinal degeneration is a negative prognostic factor to half-dose PDT outcome; therefore, we excluded eyes with that retinal complication from our study.14

Visual loss in CSC is basically attributable to the chronic persistence of the serous detachment of the neuroepithelium in

Massimo Nicolo', MD, PhD is Assistant Professor and clinical ophthalmologist at University Eye Clinic, Genova, Italy. He completed his Ophthalmology residency and obtained his PhD at University of Genova on 2000. He completed a research fellowship in retinal diseases at New England Eye Center, Tufts University of Boston, US. Dr Nicolo's clinical and research interests include retina, vitreous disease and imaging techniques. He has authored several publications in peer-reviewed journals.

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Massimo Nicolo', MD, PhD is Assistant Professor and clinical ophthalmologist at University Eye Clinic, Genova, Italy. He completed his Ophthalmology residency and obtained his PhD at University of Genova on 2000. He completed a research fellowship in retinal diseases at New England Eye Center, Tufts University of Boston, US. Dr Nicolo's clinical and research interests include retina, vitreous disease and imaging techniques. He has authored several publications in peer-reviewed journals.

Chiara M. Eandi, MD, PhD, is an Assistant Professor in the Eye Clinic of the Department of Surgical Science, at the University of Torino, Italy. She received her medical degree from the University of Torino in 1998. She completed her ophthalmology residency and obtained her PhD at the University of Torino, Italy. She completed a research fellowship in retinal diseases at the LuEsther T. Mertz Retina Research Center of Manhattan Eye, Ear and Throat Hospital, New York, US. Dr Eandi's clinical and research interests include retina and vitreous diseases and imaging techniques. She has authored several publications in peer-reviewed journals.

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