Photodynamic therapy in combination with intravitreal ziv-aflibercept and aflibercept injection in patients with chronic or repeatedly recurrent acute central serous chorioretinopathy: a single-center retrospective study

Abstract

PurposeThe objective of the study was to assess the effect of off-label photodynamic therapy (PDT) in combination with intravitreal off-label ziv-aflibercept or off-label aflibercept injection in patients with chronic or repeatedly recurrent acute central serous chorioretinopathy (CSC).Patients and methodsChanges in best corrected visual acuity (BCVA) and subfoveal subretinal fluid (sSRF) and maximum subretinal fluid (mSRF) were retrospectively analyzed in a single-center cohort study of 17 patients (18 eyes) with persistent subretinal fluid for more than 3 months of duration of CSC. Treatment efficacy was measured between injection and PDT at 30±15 days, 90±15 days and 180±30 days after PDT.ResultsSignificant reduction of sSRF and mSRF was shown after therapy with ziv-aflibercept and aflibercept combined with PDT (p<0.001). Course of BCVA showed non-significant improvement within 6 months (p=0.065). One case of allergic reaction after fluorescein angiography and one case of ophthalmic migraine after ziv-aflibercept injection were documented. One case of reversible vision loss occurred during 6 months after combination therapy. No other adverse events or side effects were reported.ConclusionCombination therapy of ziv-aflibercept and aflibercept with PDT seems to be beneficial, even in cases of chronic or repeatedly recurrent acute CSC. This includes cases of CSC resistant to or recurrent after medical treatment, PDT alone or therapy with anti-vascular endothelial growth factor alone.

Predicting Post-Therapeutic Visual Acuity and OCT Images in Patients With Central Serous Chorioretinopathy by Artificial Intelligence

“…However, clinical data collected in the real world are often subject to bias due to the rigorous entry criteria of most clinical studies. In addition, disturbances related to refractory and repeatedly recurrent CSC are often masked by the average efficiency of most CSC clinical studies ( Doepfner et al, 2018 ; Sartini et al, 2019 ). Moreover, the improvement observed in the average VA after treatment does not represent the final improvement in vision for every CSC patient even if the SRF has been completely absorbed, as EZ atrophy that has occurred over a long time is not easily recovered in the short term ( Hasegawa et al, 2015 ; Chung et al, 2018 ; van Rijssen et al, 2018 ).…”

Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy

“…Diagnosis of chronic CSC was established based on the following findings: history of metamorphopsia and blurred vision for three months or longer; neurosensory detachment on optical coherence tomography (OCT) and ophthalmoscopy; and fluorescein angiography (FA) pattern. There is no consensus on the definition of chronic CSC; however, in many studies, CSC more than 3 months has been considered chronic CSC 10, 11, 12, 13…”

Ziv‐aflibercept: A cost‐effective, off‐label, highly potent antagonist of vascular endothelial growth factor

“…The first reported human use of intravitreal ziv-aflibercept resulted in successful treatment of a patient with refractory neovascular age-related macular degeneration (nAMD) (de Oliveira Dias et al 2015) and this was soon followed by a pilot study of four patients with nAMD and two patients with diabetic macular oedema (DME) (Mansour et al 2015). Based on the encouraging results of this pilot study, several prospective short-term and long-term studies (Figs 2-5) with monthly injections (de Andrade et al 2018), treat-and-extend (Mansour et al 2019a) or pro re nata (Eldeeb et al 2017;de Oliveira Dias et al 2019) regimens have been performed in the following countries: Brazil (Andrade et al 2016;de Oliveira Dias et al 2016;de Oliveira Dias et al 2019); Egypt (Ashraf et al 2017a); India (Videkar et al 2015;Chhablani et al 2016Chhablani et al , 2017Yogi et al 2017); Iran (Baghi et al 2017, Jabbarpoor Bonyadi et al 2018HodjatJalali et al 2017); Lebanon (Mansour et al 2015); Mexico (Hernandez-Da Mota et al 2019); Switzerland (Doepfner et al 2018), Syria (Marashi 2016); and the United States (Aleman et al 2019…”

“…Half‐dose photodynamic therapy with prior IVZ resolved subretinal fluid at 6 months in the majority of 15 eyes with chronic central serous chorioretinopathy (Doepfner et al. ). A 48‐year‐old patient treated with 1.25 mg IVZ (three doses at monthly intervals) for choroidal neovascularization due to chronic central serous chorioretinopathy achieved regression of the neovascularization, resolution of leakage and improvement of visual acuity from 20/400 to 20/40 at 6 months after the initial injection (Radke et al.…”