Subretinal fluid morphology in chronic central serous chorioretinopathy and its relationship to treatment: a retrospective analysis on PLACE trial data

Abstract

To explore subretinal fluid (SRF) morphology in chronic central serous chorioretinopathy (cCSC) after one session of either high-density subthreshold micropulse laser (HSML) treatment or half-dose photodynamic therapy (PDT). Methods:We retrospectively obtained optical coherence tomography (OCT) scans from a subset of patients from a randomized controlled trial on treatment-na€ ıve eyes with cCSC allocated to either HSML treatment or half-dose PDT. OCT scans were evaluated prior to treatment and 6-8 weeks posttreatment, where we measured maximum SRF height and width, calculated the maximum height-tomaximum width-ratio (maxHWR) and calculated the total SRF volume.Results: Forty-one eyes of 39 cCSC patients were included. SRF morphology ranged from flat to dome-shaped, quantified as maxHWR ranging between 0.02 and 0.12. SRF volume was median 0.373 ll (range: 0.010-4.425 ll) and did not correlate to maxHWR (rho = À0.004, p = 0.982). Halfdose PDT was superior to HSML treatment in complete SRF resolution (RR = 3.28, p = 0.003) and in morphological changes of SRF (D maximum height , p = 0.001; D maximum width , p < 0.001; D volume , p = 0.025). SRF resolved completely in 19/22 PDT-treated eyes (86%) and 5/19 HSML-treated eyes (26%). SRF volume increased in five eyes (26%) after HSML treatment, and in none of the eyes after half-dose PDT. SRF morphology at baseline did not predict treatment outcomes. Conclusion:SRF morphology changed after both HSML treatment and half-dose PDT in cCSC, with SRF disappearing in most PDT-treated patients, whereas SRF volume increased in a sizeable proportion of HSML-treated patients. Baseline SRF characteristics measured in this study were unable to predict outcomes after either HSML treatment or half-dose PDT.

Baseline Spectral Domain Optical Coherence Tomographic Retinal Layer Features Identified by Artificial Intelligence Predict the Course of Central Serous Chorioretinopathy

“…However, no predictive role of SRF morphology in treatment response could be extrapolated from that analysis. 20 In our study, our volumetric analysis reported that patients with aCSC had an increased SRF volume at baseline as opposed to cCSC. Feenstra et al described the SRF morphology in patients with cCSC and found that patients presenting the Fuji's sign, characterized by an external limiting membrane displaying a typical concave shape in the context of SRF, were more inclined to have a spontaneous resolution of SRF.…”

“…They found that the resolution of the disease was correlated with changes in central macular thickness and subfoveal choroidal thickness, whereas modifications in visual acuity at 12 months were associated with SRF height. 7 SRF morphology in CSC was also previously investigated by Subhi et al, 20 who described the SRF shape modification after halfdose PDT and high-density subthreshold micropulse laser. In this study, half-dose PDT was found to be significantly associated with SRF resolution and volume reduction in comparison with high-density subthreshold micropulse laser.…”

Perspectives and Update on the Global Shortage of Verteporfin (Visudyne®)

“…Initially Ophthalmol Ther for nAMD, but in recent years also for CSC and PCV [15][16][17]. For CSC, this has mainly been based on outcomes of two multicenter randomized controlled trials initiated in the Netherlands, the PLACE and SPECTRA trials, which favored PDT as the preferred firstline treatment [18][19][20][21][22]. Before the shortage, approximately 700 PDT procedures per year were performed in the Netherlands.…”

Risk of Central Serous Chorioretinopathy in Male Androgen Abusers

“…Patients with CSC typically complain of blurred central vision, metamorphopsia, disturbed color perception, and may experience a hypermetropic change in their refraction. Clinically, macular optical coherence tomography reveals subretinal fluid and a thick choroid [3,4]. Prolonged presence of subretinal fluid should be avoided as irreversible vision loss can occur due to photoreceptor atrophy [5,6].…”