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

Abstract

Purpose To explore the effect of photodynamic therapy (PDT) on the choroid of medial area from optic disc and factors correlated with treatment outcomes, we evaluated choroidal changes using ultra-widefield optical coherence tomography (UWF-OCT) after PDT for central serous chorioretinopathy (CSC). Methods In this retrospective case-series, we included CSC patients who received a standard-dose of full-fluence PDT. UWF-OCT were examined at baseline and 3 months after treatment. We measured choroidal thickness (CT), classified into central, middle, and peripheral sectors. We examined CT changes after PDT by sectors and treatment outcome. Results Twenty-two eyes of 21 patients (20 males; mean age 58.7 ± 12.3 years) were included. CT reduction after PDT was significant in all sectors, including peripheral areas: supratemporal, 330.5 ± 90.6 μm vs. 237.0 ± 53.2 μm; infratemporal, 240.0 ± 89.4 μm vs. 209.9 ± 55.1 μm; supranasal, 237.7 ± 59.8 vs 209.3 ± 69.3 μm; infranasal, 172.6 ± 47.2 μm vs. 155.1 ± 38.2 μm (P < 0.001, for all). In patients with retinal fluid resolution, despite no apparent difference in baseline CT, there was more significant reduction after PDT in supratemporal and supranasal peripheral sectors, compared with patients without resolution: supratemporal, 41.9 ± 30.3 μm vs. −1.6 ± 22.7 μm; supranasal, 24.7 ± 15.3 μm vs. 8.5 ± 3.6 μm (P < 0.019, for both). Conclusions Whole CT decreased after PDT, including in medial areas from optic disc. This may be associated with the treatment response of PDT for CSC.

Evaluating photodynamic therapy versus brolucizumab as a second-line treatment for polypoidal choroidal vasculopathy

“…Furthermore, PDT is the most effective treatment for central serous chorioretinopathy, one of the representative diseases of pachychoroid-spectrum disorders [ 38 ]. The choroidal blood flow overload is indicated as a crucial pathogenetic factor in pachychoroid-spectrum disorders [ 39 , 40 ], and PDT is suggested to alleviate stasis throughout the choroid, extending beyond the irradiated areas [ 41 ]. These findings correspond with the higher observed efficacy of PDT in treating PCV with a pachychoroid phenotype.…”

“…In the present study, cases that did not require additional treatment were significantly older than those that required further treatment. Previous reports have indicated that PDT can decrease choroidal blood flow, potentially alleviating choroidal vascular stasis [ 41 , 42 ]. Furthermore, choroidal blood flow has been reported to decline with increasing age [ 43 ].…”

A new method to solve the problem of troubled measurement of peripheral choroidal thickness

“…While we acknowledge that our method may not be flawless, we propose it as a novel approach to measuring peripheral choroidal thickness. 1,6,7 The observations raised by Mignone et al are valuable, and we are keen to maintain a constructive dialog on these matters. The critical issue of compensating for ocular axial length in measurements warrants ongoing consideration.…”

“…The study we have published used these methods to produce a widefield choroidal thickness map. 1,6,7…”

“…To rectify image distortion, we used several methods outlined below. 1,6,7 Initially, vertically magnified OCT images were adjusted to achieve a 1:1 vertical-to-horizontal scale. Second, we transformed the images to their real shape using the actual eye shape information acquired during imaging.…”