Elsevier

Ophthalmology

Volume 115, Issue 10, October 2008, Pages 1756-1765
Ophthalmology

Original article
Half-Dose Verteporfin Photodynamic Therapy for Acute Central Serous Chorioretinopathy: One-Year Results of a Randomized Controlled Trial

Presented in part as an oral presentation at: Nakajima Award Lecture, 21st Asia Pacific Academy of Ophthalmology Congress, June 2006, Singapore, Republic of Singapore.
https://doi.org/10.1016/j.ophtha.2008.04.014Get rights and content

Objective

To evaluate the efficacy of photodynamic therapy (PDT) with half-dose verteporfin for treating acute central serous chorioretinopathy (CSC).

Design

Prospective, double-masked, placebo-controlled, randomized clinical trial.

Participants and Controls

Sixty-three eyes of 63 patients with acute symptomatic CSC of 3 months' duration or less were recruited. Forty-three eyes were randomized to indocyanine green angiography (ICGA)-guided PDT with half-dose (3 mg/m2) verteporfin and 21 eyes were randomized to placebo.

Intervention

Patients in the verteporfin group received an infusion of half-dose verteporfin over 8 minutes, followed by ICGA-guided PDT 10 minutes from the start of infusion. Laser was applied for 83 seconds covering the choroidal abnormalities observed in ICGA, with a maximum laser spot size of 4500 μm.

Main Outcome Measures

The primary outcome measure was the proportion of eyes with absence of subretinal fluid at the macula at 12 months. Secondary outcome measures included changes in mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), subjective symptoms, optical coherence tomography (OCT) results, central foveal thickness (CFT), and angiographic findings during the 12-month study period.

Results

Thirty-nine patients in the verteporfin group and 19 patients in the placebo group completed 12 months of follow-up. Thirty-seven (94.9%) eyes in the verteporfin group compared with 11 (57.9%) eyes in the placebo group showed absence of subretinal fluid at the macula at 12 months (P = 0.001). The mean logMAR BCVA at 12 months was significantly better in the verteporfin group compared with the placebo group: –0.05 and 0.05, respectively (P = 0.008). All 39 (100%) verteporfin-treated eyes had stable or improved vision, compared with 15 (78.9%) eyes in the placebo group (P = 0.009). The mean OCT CFT for the verteporfin group also was significantly lower compared with the placebo group at 12 months (P = 0.001). No ocular or systemic adverse event was encountered in the study.

Conclusions

Photodynamic therapy with half-dose verteporfin is effective in treating acute symptomatic CSC, resulting in a higher proportion of patients with absence of exudative macular detachment and better visual acuity compared with placebo.

Financial Disclosures(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Study Design and Patient Recruitment

This study was a prospective, double-masked, randomized placebo-controlled trial conducted in the Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong. Patients with acute symptomatic CSC of 3 months' duration or less were recruited from Hong Kong Eye Hospital and Prince of Wales Hospital from December 2004 through December 2005. Inclusion criteria included: (1) patients with best-corrected visual acuity (BCVA) of 20/200 or better; (2) presence of subretinal

Results

Sixty-three eyes in 63 patients with acute CSC were recruited, of which 42 eyes were randomized to safety-modified PDT with half-dose verteporfin and 21 eyes were randomized to placebo. Figure 1 shows the flow of the patients in the study. At 12 months, 5 patients (3 in the verteporfin group and 2 in the placebo group) were lost to follow-up, and the remaining 58 (92.1%) patients were included in the analysis. The mean age±standard deviation (SD) of the patients was 41.0±6.7 years (range, 25–58

Discussion

Although CSC generally is considered as a self-limiting and benign condition, some patients may experience significant visual impairment caused by recurrent attacks of CSC, persistent chronic neurosensory retinal detachment, or RPE atrophy.5, 6 Moreover, because many patients are of working age, visual symptoms may interfere with their activities considerably. The ideal treatment option for CSC would be one that can result in visual improvement, can shorten the duration of symptoms, and can

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    Manuscript no. 2008-150.

    Financial Disclosure(s): Dr Lai has served as a consultant to an advisory board of Novartis, Inc. All other authors have no financial interest to declare.

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