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

• Published in: American journal of ophthalmology 2012-03, Vol.153 (3), p.474-480.e1
• Main Authors: Nicolò, Massimo, Zoli, Daniela, Musolino, Maria, Traverso, Carlo Enrico
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cardiovascular system; Central Serous Chorioretinopathy - diagnosis; Central Serous Chorioretinopathy - drug therapy; Chronic Disease; Coloring Agents; Diabetic retinopathy; Female; Fluorescein Angiography; Follow-Up Studies; Hospitals; Humans; Indocyanine Green; Investigative techniques, diagnostic techniques (general aspects); Ischemia; Macular degeneration; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Photochemotherapy; Photodynamic therapy; Photosensitizing Agents - administration & dosage; Porphyrins - administration & dosage; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retina; Retinopathies; Retrospective Studies; Studies; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2011.08.015

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.