Outer Nuclear Layer as the Main Predictor to Anatomic Response to Half Dose Photodynamic Therapy in Chronic Central Serous Retinopathy

Abstract

Purpose To evaluate the predictors for subretinal fluid resorption in patients with chronic central serous retinopathy (cCSR) submitted to half-dose photodynamic therapy (HD-PDT). Methods Observational, longitudinal, and retrospective study of patients with cCSR submitted to HD-PDT in a tertiary ophthalmology department in Portugal between January 2015 and February 2018. Best-corrected visual acuity (BCVA) and SD-OCT at baseline and 12 ± 3 months after treatment were performed. The central macular thickness (CMT), outer nuclear layer (ONL) thickness, integrity of the external limiting membrane (ELM), ellipsoid (EZ) and interdigitation zone (IZ), subretinal fluid (SFR) height, and choroidal thickness (CT) were evaluated. Patients were classified into responders and nonresponders based on SRF resorption. Results Sixty-one eyes of 42 patients were included; 75.4% were classified as responders. Final BCVA was significantly better in responders (p=0.002). The baseline ONL was thicker (p < 0.01) and intact ELM (67.2% vs. 16.4%), EZ (49.2% vs. 8.2%), and IZ (31.2% vs. 1.6%) were more prevalent in responders than in nonresponders. Anatomic response was correlated with a thicker ONL (rs (59) = 0.416, p=0.001∗), intact ELM (rs (59) = 0.261, p=0.04∗), EZ (rs (59) = 0.278, p=0.03∗), and IZ (rs (59) = 0.318, p=0.01∗). Binary logistic regression showed that a thicker ONL thickness increased the chance of an anatomic response to HD-PDT. The other evaluated retinal layers did not have statistical significance in the binary regression model. Conclusions cCSR responders to HD-PDT have a better final BCVA, a thicker baseline ONL, and an intact baseline ELM, EZ, and IZ. However, ONL was the only predictor in a logistic regression model for SRF resorption.

Outer nuclear layer recovery as a predictor of visual prognosis in type 1 choroidal neovascularization of neovascular age-related macular degeneration

“…Foveal ONL thinning is observed not only in various chorioretinal disorders 10 , 28 but also in relatively benign conditions such as drusen or pachychoroid pigment epitheliopathy 9 , 11 , indicating that ONL may correspond very sensitively to photoreceptor vitality. Thick ONL is considered a predictor for SRF resorption in chronic central serous chorioretinopathy treated with photodynamic therapy 29 . In this study, nAMD eyes also showed more ONL thinning and decreased visual acuity on baseline testing compared to the control eyes.…”

<p>532-nm Subthreshold Micropulse Laser for the Treatment of Chronic Central Serous Retinopathy</p>

“…However, anatomic response was not correlated with time until treatment as observed previously. 3,16,18 Most studies used a 577 nm or 810 nm wavelength and a 10-15% duty cycle. Five percent duty cycle were used by the PACORES group 14 and Malik et al 10 The PACORES group presented 92 eyes treated with 577 nm SML and a 12-month follow-up.…”

“…A resorption of ≥50% of SRF was considered a positive anatomical response. 16 All statistical analysis was performed using SPSS software version 25.0 (SPSS Inc., Chicago, IL) and p values <0.05 were considered statistically significant. Nonparametric tests were applied after non-normality of the sample was confirmed by Shapiro-Wilk test.…”