Decrease in choroidal blood flow after half and one-third dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy

Abstract

Background The effect of various reduced doses of verteporfin photodynamic therapy (PDT) on choroidal blood flow in chronic central serous chorioretinopathy (CSC) remains unclear. Therefore, this study aimed to evaluate choroidal blood flow after half-dose PDT (1/2PDT) and one-third dose PDT (1/3PDT) with verteporfin for chronic CSC using laser speckle flowgraphy and spectral-domain optical coherence tomography. Methods Twenty-seven eyes of 27 patients with serous retinal detachment (SRD) caused by chronic CSC for more than 6 months were included in this study. Patients were divided into the 1/2PDT (n = 12; January 2018 to July 2019) and 1/3PDT (n = 15; August 2016 to December 2017) groups based on the treatment period. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and mean blur rate in the macular area (m-MBR) and optic nerve head (ONH-MBR) were obtained using laser speckle flowgraphy and evaluated at baseline (pre-treatment), and 2 weeks, 1 month, 3 months, and 6 months after treatment. Results We found that SRD disappeared after 1 month in 92 and 93% of patients’ eyes in the 1/2PDT and 1/3PDT groups, respectively. Recurrence of SRD was observed in one eye at the 6-month follow-up after 1/2PDT and two eyes at the 3-month follow-up after 1/3PDT. No significant improvement was observed in baseline BCVA in the 1/3PDT and 1/2PDT groups. The average m-MBR against baseline significantly decreased at 2 weeks and 1, 3, and 6 months in the 1/2PDT group. The average m-MBR against baseline decreased significantly only at the 2 weeks follow-up in the 1/3PDT group. The average rate of change in the CCT against baseline decreased significantly throughout for up to 6 months in the 1/2PDT group and for up to 3 months in the 1/3PDT group. No significant fluctuation was observed in the ONH-MBR. Conclusions: Here, PDT significantly affected choroidal blood flow depending on the verteporfin dose in chronic CSC. Trial registration This trial was retrospectively registered (UMIN000026850; Approval date 03/04/2017).

Effect of photodynamic therapy on choroid of the medial area from optic disc in patients with central serous chorioretinopathy

“…Pathological studies have demonstrated that PDT can occlude CNV and choriocapillaris without damaging choroidal large vessels [ 28 ]. Kumashiro et al reported that choroidal blood flow decreased in CSC patients after PDT-irradiation [ 13 ]. Based on these results, it is reasonable that the decrease in CT in and around the irradiated area can be explained as a result of the reduction of choroidal volume caused by PDT.…”

“…Our evaluations of Haller’s vessels asymmetry were subjective. Additionally, we used OCT to evaluate changes based on morphological characteristics; blood flow was not quantified using laser speckle fundus flowgraphy [ 13 ]. In future research, it would be desirable to combine OCT and laser speckle flowgraphy in a larger sample size; prospective research is desirable.…”

“…The effectiveness of photodynamic therapy (PDT) for CSC has been reported by many studies [ 2 , 3 , 10 , 11 ]. PDT decreases choroidal blood flow and choroidal thickness (CT) in the macula; it can affect choroidal circulation and improve disease status in CSC [ 10 , 12 , 13 ]. Nevertheless, previous studies were limited to analyzing the PDT-irradiated area and its vicinity [ 10 , 12 – 14 ]; the effect of PDT on peripheral choroid away from the irradiated area is unknown.…”

Choroidal Hemodynamics in Central Serous Chorioretinopathy after Half-dose Photodynamic Therapy and the Effects of Smoking

“…Therefore, the primary pathogenesis of chronic CSC is speculated to be shifting to a localized area of choroidal hyperpermeability, although a thickened sclera and choroidal hyperperfusion may trigger the onset of CSC. With regard to the choroidal hemodynamics after half-dose PDT for CSC, Kumashiro et al reported that the macular MBR decreased after treatment; this effect was blunted by 1/3-dose PDT 20 . In the current study, the MBR in the PDT irradiation area was signi cantly decreased after half-dose PDT, which is consistent with the report by Kumashiro et al In addition, the current study showed that the MBR did not change in the untreated fellow eyes.…”

Choroidal hemodynamics in central serous chorioretinopathy after half-dose photodynamic therapy and the effects of smoking

“…Therefore, the primary pathogenesis of chronic CSC is speculated to be shifting to a localized area of choroidal hyperpermeability and RPE disturbance associated with localized blood flow alteration, although a thickened sclera and choroidal hyperperfusion may trigger the onset of CSC. With regard to the choroidal hemodynamics after half-dose PDT for CSC, Kumashiro et al reported that the macular MBR decreased after treatment; this effect was blunted by 1/3-dose PDT 20 . In the current study, the MBR in the PDT irradiation area was significantly decreased after half-dose PDT, which is consistent with the report by Kumashiro et al In addition, the current study showed that the MBR did not change in the untreated fellow eyes.…”