Intravitreal anti-vascular endothelial growth factor combined with half-fluence photodynamic therapy for choroidal neovascularization in chronic central serous chorioretinopathy

Abstract

Purpose To evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) with half-fluence rate combined with intravitreal application of anti-VEGF in treating choroidal neovascularization (CNV) in chronic central serous chorioretinopathy (CSCR). Patients and methods In this retrospective cohort study 17 consecutive patients with secondary CNV due to chronic CSCR had their diagnosis verified with fluorescein angiography (FA) and ICGA at baseline. All eyes received either intravitreal ranibizumab (IVR) or bevacizumab (IVB). On the consecutive day following the initial IVR/IVB treatment, ICGAguided verteporfin (6 mg/m 2 ) PDT with halffluence rate (25 J/cm 2 ) was performed on every patient. IVR or IVB was rescheduled on a pro re nata regimen. Main outcome measures were changes in visual acuity (VA) according to the ETDRS letter score and changes in the central foveal thickness (CFT). Results Best-corrected VA at baseline was 65.6 letters (±6.7; n = 17) according to the ETDRS letter score. At 12 months, mean ETDRS letter score improved to 71.2 letters (P = 0.34). CFT was 309 μm and decreased to 216 μm at month 12 control (P = 0.0004). Nine eyes (52.9%) received additional treatment with IVR/IVB due to recurrence of subretinal fluid, with an overall mean number of IVR/IVB treatment of 1.8 ± 3.6 per patient with no systemic side effects during 12 months' follow-up. Conclusions IVR or IVB combined with ICGA-guided half-fluence PDT with verteporfin is effective in treating CNV in chronic CSCR, with choroidal hyperpermeability in ICGA, resulting in stable vision and significant reduction of CFT.

The good (logMAR), the bad (Snellen) and the ugly (BCVA, number of letters read) of visual acuity measurement

“…This is the score provided by the computerized adaptation of the ETDRS method . To use this system with the standard ETDRS chart with five letters per line, you need to either measure VA at a non‐standard 1 m (for patients with poor VA) or measure VA at the standard 4 m and add 30 letters to the number of letters read . This is clearly understood by researchers using the system in wet AMD studies, but the system is now permeating into standard clinics and confusion abounds.…”

Photodynamic therapy combined with antivascular endothelial growth factor treatment for recalcitrant chronic central serous chorioretinopathy

“… 16 Inoue et al 19 have also shown that intravitreal bevacizumab is well tolerated in maintaining vision and reducing serous retinal detachment in chronic CSC, even 1 year after treatment. Smretschnig et al 20 also found efficacy of this combined approach for chronic CSC in treatment-naive cases associated with definitive CNV. As noted earlier, we did not see definitive CNV in each case reported in this study.…”

Statement of the BVA, the DOG, and the RG on treatment of choroidal neovascularization in diseases other than neovascular age-related macular degeneration

“…Good functional results were seen for CSC-related CNV in particular [52,53]. Combining PDT with a VEGF inhibitor could potentially also be beneficial in this setting [54]. However, there are no large studies in this regard to date.…”