Therapy options for chronic central serous chorioretinopathy

Maier, Mathias; Valet, V.; Feucht, Nikolaus; Lohmann, Chris P.

doi:10.1007/s00347-011-2419-5

Cited by 7 publications

(12 citation statements)

References 30 publications

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“…Since no ‘gold standard' for the treatment of CSC is available yet, review articles and case series until 2012 suggest carbonic anhydrase, mild laser photocoagulation, SRT and PDT as well as intravitreal injections of bevacizumab, showing heterogeneous results [30,31,32]. However, since it is known that glucocorticoids induce and aggravate CSC and are known to bind to the mineralocorticoid receptor, a blockade of these receptors might be of benefit in treating this disease with a specific mineralocorticoid receptor antagonist as spironolactone [33].…”

Section: Discussionmentioning

confidence: 99%

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

Framme¹,

Walter²,

Berger³

et al. 2015

Ophthalmologica

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Purpose: Selective retina therapy (SRT), the confined laser heating and destruction of retinal pigment epithelial cells, has been shown to treat acute types of central serous chorioretinopathy (CSC) successfully without damaging the photoreceptors and thus avoiding laser-induced scotoma. However, a benefit of laser treatment for chronic forms of CSC is questionable. In this study, the efficacy of SRT by means of the previously used 1.7-µs and shorter 300-ns pulse duration was evaluated for both types of CSC, also considering re-treatment for nonresponders. Material and Methods: In a two-center trial, 26 patients were treated with SRT for acute (n = 10) and chronic-recurrent CSC (n = 16). All patients presented with subretinal fluid (SRF) in OCT and leakage in fluorescein angiography (FA). SRT was performed using a prototype SRT laser system (frequency-doubled Q-switched Nd:YLF-laser, wavelength 527 nm) with adjustable pulse duration. The following irradiation settings were used: a train of 30 laser pulses with a repetition rate of 100 Hz and pulse durations of 300 ns and 1.7 µs, pulse energy 120-200 µJ, retinal spot size 200 µm. Because SRT lesions are invisible, FA was always performed 1 h after treatment to demonstrate laser outcome (5-8 single spots in the area of leakage). In cases where energy was too low, as indicated by missing FA leakage, energy was adjusted and the patient re-treated immediately. Observation intervals were after 4 weeks and 3 months. In case of nonimprovement of the disease after 3 months, re-treatment was considered. Results: Of 10 patients with active CSC that presents focal leakage in FA, 5 had completely resolved fluid after 4 weeks and all 10 after 3 months. Mean visual acuity increased from 76.6 ETDRS letters to 85.0 ETDRS letters 3 months after SRT. Chronic-recurrent CSC was characterized by less severe SRF at baseline in OCT and weaker leakage in FA than in acute types. Visual acuity changed from baseline 71.6 to 72.8 ETDRS letters after 3 months. At this time, SRF was absent in 3 out of 16 patients (19%), FA leakage had come to a complete stop in 6 out of 16 patients (38%). In 6 of the remaining chronic CSC patients, repeated SRT with higher pulse energy was considered because of persistent leakage activity. After the re-treatment, SRF resolved completely in 5 patients (83.3%) after only 25 days. Conclusion: SRT showed promising results in treating acute CSC, but was less effective in chronic cases. Interestingly, re-treatment resulted in enhanced fluid resolution and dry conditions after a considerably shorter time in most patients. Therefore, SRT including re-treatment if necessary might be a valuable CSC treatment alternative even in chronic-recurrent cases.

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Section: Discussionmentioning

confidence: 99%

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

Framme¹,

Walter²,

Berger³

et al. 2015

Ophthalmologica

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“…Following treatments were indicated faster, and even within the 1st month (3 of 18 eyes), which is at least partly due to the retrospective study design. 32 , 33 The variety of treatments applied after combination therapy ( Table 2 ) is a limitation of our study, but also indicates the complexity and challenge inherent in this specific patient population. The limited duration of effect in a high number of eyes (12 of 18) following the combination therapy used in this study stands in contrast to the results of the two other studies of Arevalo and Maier, in which combination therapy of bevacizumab and pegaptanib with full-dose PDT in CSC showed good long-term results.…”

Section: Discussionmentioning

confidence: 99%

“…Combination therapy seemed to aid in the resolution of SRF and was shown to be a safe treatment option, yet the benefit was not significant. 32 , 33 We investigated the effects of the newer anti-VEGF agent ziv-aflibercept and aflibercept combined with PDT.…”

Section: Introductionmentioning

confidence: 99%

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

Doepfner

Michels

Graf³

et al. 2018

OPTH

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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.

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“…In einer Arbeit mit Half Dose-PDT wird jedoch berichtet, dass innerhalb von 6 Monaten ein langsamer Visusanstieg stattfand, obwohl die NSA schon nach 1 Monat beseitigt war [27]. Behandlungen mit Bevacizumab (Avastin) sind auch möglich [28], jedoch fällt der Effekt der NSA-Auflösung im direkten Vergleich mit der PDT schwächer aus, bei einigen Patienten gibt es gar keinen Effekt, und es treten mehr Rezidive auf [29]. Die Wirkungsweise bleibt unklar, insbesondere, da keine erhöhten VEGF-Spiegel im Auge gefunden wurden.…”

Section: Therapiemöglichkeiten Prognoseunclassified

“…Unbehandelt führt die Erkrankung zu einer Zunahme des gestörten Areals und damitwie später gezeigtzur weiteren Sehverschlechterung. Darüber hinaus kann mit einer Wahrscheinlichkeit von bis zu 2 % pro Jahr bei einer bestehenden chronischen CSC eine CNV auftreten [17], wahrscheinlich verursacht durch die chronischen Schäden am RPE. Diese CNV kann sowohl klassisch wie auch okkult sein.…”

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Chronische RCS (chronic Central Serous Chorioretinopathy cCSC) als Differenzialdiagnose der feuchten, altersbedingten Makuladegeneration (AMD)

Inhoffen

Ziemssen

Bartz-Schmidt

2012

Klin Monatsbl Augenheilkd

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Central neurosensory detachments (NSD) with time-dependent height constitute a disease called central serous chorioretinopathy (CSC), if not arising from uveitis, choroidal neovascularisations (CNV) or leaking retinal vessels. In 10 % of these patients, CSC develops into a chronic disease with recurrent NSD, atrophy of photoreceptors and severe drop in visual acuity. This review article summarises recent progress in understanding this disease and its appearance in funduscopy, FLA, ICG, OCT, autofluorescence as well as its progress, therapy and possible development into secondary CNV. The provided examples illustrate the progression of acute CSC into chronic CSC and with CNV over years. The different appearance of polypoidal choroidal vasculopathy (PCV) in ICG and some of the signs of atypical chronic CSC are discussed. To distinguish between cCSC and wet AMD--both exhibiting leakage in FLA--typical signs are helpful, e.g., "gravitational tracks", retinal precipitates and missing drusen. However, in small lesions, it may be difficult or almost impossible to ensure the correct diagnosis of the underlying disease. The same holds for occult and classic secondary CNV in cCSC vs. CNV in AMD, where photodynamic therapy (PDT) can be successful only in cCSC-CNV and in cCSC without CNV. Corticosteroids often lead to further impairment, even in cases of atypical cCSC, when frequently misdiagnosed as uveitis. As a duration of NSD of more than 4 months is suspected to induce an impairment of photoreceptors, regular examinations are necessary not only in chronic CSC but also after acute CSC (as this form can develop into chronic CSC), while effective therapies are available to resolve the NSD (PDT, anti-VEGF).

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Therapy options for chronic central serous chorioretinopathy

Abstract: The combination of PDT with bevacizumab in this case series appears to be an effective and safe therapy combination which is suitable as a therapeutic option for patients with chronic CCS without a tendency to recovery.

Cited by 7 publications

References 30 publications

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy

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

Chronische RCS (chronic Central Serous Chorioretinopathy cCSC) als Differenzialdiagnose der feuchten, altersbedingten Makuladegeneration (AMD)

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