Elsevier

Ophthalmology

Volume 121, Issue 5, May 2014, Pages 1073-1078
Ophthalmology

Original article
Collaborative Retrospective Macula Society Study of Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

https://doi.org/10.1016/j.ophtha.2013.11.040Get rights and content

Purpose

To assess the visual and anatomic outcomes of central serous chorioretinopathy (CSC) after verteporfin photodynamic therapy (PDT).

Design

Retrospective case series.

Participants

Patients with CSC who underwent PDT.

Methods

Members of the Macula Society were surveyed to retrospectively collect data on PDT treatment for CSC. Patient demographic information, PDT treatment parameters, fluorescein angiographic information, optical coherence tomography (OCT) metrics, pre- and post-treatment visual acuity (VA), and adverse outcomes were collected online using standardized forms.

Main Outcome Measures

Visual acuities over time and presence or absence of subretinal fluid (SRF).

Results

Data were submitted on 265 eyes of 237 patients with CSC with a mean age of 52 (standard deviation [± 11]) years; 61 were women (26%). Mean baseline logarithm of the minimum angle of resolution (logMAR) VA was 0.39±0.36 (20/50). Baseline VAs were ≥20/32 in 115 eyes (43%), 20/40 to 20/80 in 97 eyes (37%), and ≤20/100 in 47 eyes (18%). Normal fluence was used for PDT treatment in 130 treatments (49%), half-fluence was used in 128 treatments (48%), and very low fluence or missing information was used in 7 treatments (3%). The number of PDT treatments was 1 in 89%, 2 in 7%, and 3 in 3% of eyes. Post-PDT follow-up ranged from 1 month to more than 1 year. Post-PDT VA was correlated with baseline VA (r = 0.70, P < 0.001). Visual acuity improved ≥3 lines in <1%, 29%, and 48% of eyes with baseline VA ≥20/32, 20/40 to 20/80, and ≤20/100, respectively. Subretinal fluid resolved in 81% by the last post-PDT visit. There was no difference in the response to PDT when analyzed by age, race, fluence setting, fluorescein angiography (FA) leakage type, corticosteroid exposure, or fluid location (subretinal or pigment epithelial detachment; all P > 0.01). Complications were rare: Retinal pigment epithelial atrophy was seen in 4% of patients, and acute severe visual decrease was seen in 1.5% of patients.

Conclusions

Photodynamic therapy was associated with improved VA and resolution of SRF. Adverse side effects were rare.

Section snippets

Methods

Macula Society members of the Research and Education Committee and the Website Committee collaborated with the Jaeb Center for Health Research to perform an investigator-reported retrospective, online study of outcomes after PDT in eyes with CSC. Macula Society members were invited to participate in an internet-based electronic survey. Patient demographic information, PDT treatment parameters, fluorescein angiographic information, optical coherence tomography (OCT) metrics, pre-treatment and

Results

Data were submitted on 237 patients with CSC from 11 countries and were submitted by 37 of 384 Macula Society members. By controlling for baseline VA, there was no effect of investigators on VA outcomes for investigators enrolling 10 or more eyes (P > 0.01). There were 110 patients from the United States, 47 patients from Italy, 17 patients each from Japan and the United Kingdom, 16 patients from Germany, 9 patients from Saudi Arabia, 6 patients each from Colombia and Northern Ireland, 4

Discussion

This retrospective investigator-reported study represents the largest collection of cases with chronic CSC treated with verteporfin PDT. In our study, PDT therapy resulted in improved VA, resolution of SRF (on both clinical examination and OCT), and reduction in fluorescein angiographic leakage in the majority of the treated eyes. There was no association between VA outcome and fluence setting, baseline ocular characteristics, gender, age, or lesion type. Adverse side effects were uncommon, and

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    Supplemental material is available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): RFS receives royalty payments from Topcon.

    Grant Support: Unrestricted educational grant from QLT to the Macula Society, Core Grant EY01792 (University of Illinois at Chicago), and an unrestricted grant from Research to Prevent Blindness.

    A list of members of the Macula Society CSC Collaborative Study Group, Research and Education Committee and Website Committee appear in Appendix 1 (www.aaojournal.org).

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