Long-Term Effects of Half-Time Photodynamic Therapy on Retinal Sensitivity in Eyes with Chronic Central Serous Chorioretinopathy

Abstract

The purpose of this study was to evaluate the long-term effects of half-time photodynamic therapy (PDT) on the retinal sensitivity in eyes with chronic central serous chorioretinopathy (CSC). Twenty-two eyes of 22 patients with chronic CSC were studied. PDT was applied with full-dose verteporfin and half-time laser duration. The best-corrected visual acuity (BCVA) and retinal sensitivity in the central 2 and 10 degrees were evaluated at the baseline, and at 12 and 24 months after the half-time PDT. The retinal sensitivity was determined by Macular Integrity Assessment microperimetry (MAIA, Centervue, Padova, Italy). The results showed that the mean retinal sensitivities in the central 2 and 10 degrees were significantly improved at 12 months (25.6±2.79 dB, median; 26.11 dB, 25.6±2.25 dB, median; 25.65 dB, respectively; P<0.001) and at 24 months (26.3±2.62 dB, median; 27.38 dB, 26.6±2.21 dB, median; 27.45 dB, respectively; P<0.001) after the treatment compared to that at the baseline (19.2±3.93 dB, median; 19.34 dB, 20.9±2.92 dB, median; 20.9 dB, respectively). The BCVA was also significantly improved from 0.18±0.19 median; 0.15 logarithm of the minimum angle of resolution (logMAR) units at the baseline to 0.07±0.15 median; 0 logMAR units at 12 months (P<0.001) and to 0.049±0.16 median; -0.039 logMAR units at 24 months (P<0.001). We conclude that half-time PDT results in a significant improvement of the mean central retinal sensitivity for at least 24 months in eyes with chronic CSC. Thus, half-time PDT is beneficial in resolving chronic CSC for a relatively long period.

Functional Outcomes and Safety Profile of Trans-Foveal Subthreshold Micropulse Laser in Persistent Central Serous Chorioretinopathy

“…In these patients, treatment options are limited. Continuous laser photocoagulation at the fovea would lead to significant vision loss, and PDT could lead to chorioretinal atrophy and CNV formation with significant vision loss [ 24 , 25 ]. Therefore, trans-foveal SML could be the preferred treatment option in patients with limited SRF under the fovea due to the good safety profile.…”

“…Due to a favorable natural course in acute CSC patients, any intervention needs to have an excellent safety profile [ 22 ]. Eplerenone and spironolactone treatment can cause gynecomastia and hyperkalemia [ 23 ]; PDT adverse effects are choroidal hypoperfusion, choroidal neovascularization (CNV), and RPE atrophy [ 24 ]; and focal laser photocoagulation can cause RPE atrophy and CNV [ 17 , 25 ]. SML has a good safety profile as there have been no ocular adverse effects described when using appropriate laser pulse parameters [ 15 ].…”

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

“…Examples of microperimetry utilization in the evaluation of cCSC treatment efficacy can be found in the PLACE trial and SPECTRA trial, which found a significant improvement of retinal sensitivity after half-dose PDT (van Dijk et al, 2018;van Rijssen et al, 2022). Long-term significant benefit of half-dose PDT measured using microperimetry has also been reported in a cohort study (Iwase et al, 2020). Microperimetry remains underutilized in RCTs of cCSC and was not considered as an outcome for this study due to the lack of meta-analytic potential.…”

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

“…Half-time PDT has been shown to be safe and effective for chronic CSC in several retrospective studies [ 31 , 32 ] Liu et al [ 33 ] compared the result of half-time versus half-dose PDT in chronic CSC and showed that there were no significant differences in terms of VA improvement (−0.15 logMAR units versus −0.25 logMAR units) and proportion of complete SRF resolution (100% versus 91%) at 1 year. Similarly, Peng et al [ 34 ] showed no significant differences between half-time and half-dose PDT in terms of VA gain (−0.17 logMAR units versus −0.11 logMAR units) and proportion of complete SRF resolution (94% versus 94%) at 1 year.…”