Photodynamic Therapy for Focal Retinal Pigment Epithelial Leaks Secondary to Central Serous Chorioretinopathy

Central serous chorioretinopathy: An evidence-based treatment guideline

Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.

Optical coherence tomography angiography-guided vs indocyanine green angiography-guided half-dose photodynamic therapy for acute central serous chorioretinopathy: 6-month randomized trial results

PURPOSE

This study aimed to compare the anatomic and functional results of optical coherence tomography angiography (OCTA)-guided half-dose photodynamic therapy (PDT) versus indocyanine green angiography (ICGA)-guided PDT in eyes with acute central serous chorioretinopathy (CSC).

METHODS

One hundred and thirty-one eyes of 131 patients with acute central serous chorioretinopathy (CSC) were recruited, and randomly assigned to the OCTA-guided group and ICGA-guided group. The primary outcome measures were the rates of complete subretinal fluid (SRF) resolution at 1 month, 3 months, and 6 months. The secondary outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), choroidal capillary flow deficit density at each scheduled visit, and recurrence rate of SRF at 3 months and 6 months.

RESULTS

There were 110 eyes that finished the follow-up, with 56 eyes in the OCTA-guided group and 54 eyes in the ICGA guided group. OCTA-guided PDT was demonstrated to be noninferior to ICGA-guided PDT for SRF resolution rate at 1 months and 6 months (P = 0.021 and P = 0.037), but not at 3 months for acute CSC (P = 0.247). The average CRT of the ICGA-guided group was significantly lower than that of the OCTA-guided group at 3-month visit (P = 0.046), but no significant difference was found between them at the 1-month and 6-month visits (P = 0.891 and 0.527). There was no significant difference between the two groups for BCVA (P = 0.359, 0.700, and 0.143, respectively) and the deficit area on CC (P = 0.537, 0.744,and 0.604, respectively) at 1, 3, and 6 months.

CONCLUSION

OCTA may replace ICGA to guide PDT for the treatment of acute CSC and their follow-up.

Continuous Eplerenone Treatment in Chronic Central Serous Chorioretinopathy: Long-Term Results from a Pilot Study

Purpose

To assess the long-term morpho-functional retinal and choroidal changes in chronic central serous chorioretinopathy (cCSC) pachychoroid eyes in response to continuous oral eplerenone (EPL) treatment.

Methods

This pilot study was conducted on patients with unilateral exudative cCSC. We enrolled a total of 17 exudative cCSC and 17 non-exudative fellow eyes of 17 patients. Baseline best-corrected visual acuity (BCVA) and anatomical (structural optical coherence tomography [OCT] and OCT angiography) parameters in both eyes were collected at baseline. Follow-up data were collected at 6, 12, and 48 months after initiation of EPL treatment.

Results

(i) Exudative cCSC eyes: Compared with baseline (0.34±0.13 LogMAR), BCVA significantly improved at follow-up examinations (6 months: 0.28±0.13 LogMAR, p=0.039; 12 months: 0.22±0.11 LogMAR, p=0.025; 48 months: 0.21±0.08 LogMAR, p=0.028). Furthermore, there was a significant reduction from baseline in all structural OCT parameters (subretinal fluid and subfoveal choroidal thickness [SFCT]; p<0.05). (ii) Non-exudative fellow eyes: There was no significant change in BCVA. There was a significant reduction from baseline in SFCT and choriocapillaris flow deficit percentage (p<0.05).

Conclusion

In this pilot study, continuous oral EPL therapy in cCSC pachychoroid eyes resulted in long-term morpho-functional improvement. The beneficial effect of EPL occurred within the first year and was maintained after four years. Based on these preliminary observations, EPL may be effective in the exudative forms of CSC.

Superficial Retinal Microvasculature and Choriocapillaris Alterations after Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

Purpose

To compare superficial retinal vascular, choriocapillaris (CC), and choroidal thickness changes in chronic central serous chorioretinopathy (CSCR) patients after half-dose photodynamic therapy (PDT).

Method

In this prospective interventional case series study, fifteen eyes of 14 patients with chronic CSCR undergoing half-dose PDT treatment were enrolled. All patients underwent enhanced depth imaging optical coherence tomography angiography (EDI-OCT) and optical coherence tomography angiography (OCTA) at baseline and 3 months after treatment. Best-corrected visual acuity (BCVA), superficial retinal vascular density, CC vessel density, foveal avascular zone (FAZ), central macular thickness (CMT), and choroidal thickness were compared.

Results

Mean BCVA before and after PDT was 0.34 ± 0.26 and 0.19 ± 0.25 logMAR, respectively (p=0.011). Mean FAZ before treatment was 410.21 ± 117.00 μm², which increased to 433.50 ± 116.76 μm² (P=0.253). Mean vessel density at superficial capillary plexus (SCP) was 38.93 ± 11.12 at baseline, which increased to 39.04 ± 11.43 (P=0.886). Mean CC vessel density was 53.21 ± 4.14 at baseline, which significantly decreased to 51.85 ± 4.21 (P=<0.001). BCVA has no significant correlation with FAZ (P=0.282) and vessel density (P=0.0.241) at SCP. CMT significantly decreased from 380.87 ± 41.66 μ at baseline to 268.20 ± 28.07 μ at 3 months (P=0.132). We did not find any correlation between CMT and FAZ (P=0.040) and vessel density (P=0.686) at SCP. Mean subfoveal choroidal thickness reduced from 411 ± 171 μm before treatment to 372 ± 117 μm (P=0.106).

Conclusion

PDT treatment can affect retinal and choroidal structural parameters, but we could not find any significant influence on retinal vascular parameters, including FAZ area and vessel densityonly mean CC vessel density and subfoveal choroidal thickness decreased.

Sausaging and Bulbosities of the Choroidal Veins in Central Serous Chorioretinopathy

PURPOSE

To evaluate the caliber of the choroidal veins in central serous chorioretinopathy (CSC), a disease proposed to be associated with overloading of choroidal venous outflow.

METHODS

Widefield indocyanine green angiograms of eyes with CSC were graded for sausaging defined as 3 or more contiguous fusiform dilations that vary by at least 50% from the narrowest to largest diameters. A bulbosity was defined as a focal 2X dilation of a blood vessel as compared with the diameter of the surrounding host vessel. The data underwent statistical analysis including use of generalized estimating equations (GEE).

RESULTS

There were 73 eyes of 41 patients with a mean age of 53.5 years. Sausaging of vessels was seen in a mean and median of 3 quadrants per eye. Using GEE, the only significant risk factor for sausaging was use of corticosteroids. The two significant predictors of subfoveal choroidal thickness using GEE were age (P=.021) and proportion of quadrants involved by sausaging (P<.001). The decrease in choroidal thickness per year of age was estimated to be 3.7 µm, while the increase with 4 quadrant involvement with sausaging was estimated to be 236 µm. There was a total of 39 bulbosities in 26 (35.6%) eyes, preferentially involving intervortex venous anastomoses.

CONCLUSIONS

Variations in venous caliber are very common in eyes with CSC and appears to be associated with pathophysiologic alterations related to increased pressure within and remodeling of the larger choroidal veins. This may lead to overloading of the choriocapillaris with leakage as one manifestation.

Dose-Related Structural Effects of Photodynamic Therapy on Rabbit Choroidal Structure

INTRODUCTION

Photodynamic therapy with verteporfin (vPDT) has been shown to be effective against central serous chorioretinopathy (CSC) and was the preferred therapeutic for CSC treatment. However, alterations in choroidal structure after PDT were reported, and these effects were dose-dependent. This study aimed to compare the changes in choroidal structure after PDT with different doses of verteporfin in rabbits and may provide individualized therapeutic guidance for patients who failed to respond to initial half-dose vPDT.

METHODS

The full dose of verteporfin used in CSC was 6 mg/m2, which was used in patients with neovascular age-related macular degeneration. Laser fluence was 50 J/cm2 (irradiance, 600 mW/cm2, 83 s). There were 4 different dose groups in this study (100%, 70%, 50%, and 30%). The alterations were examined at 1 day, 1 week, and 1 month after vPDT using color fundus imaging, indocyanine green angiography, and histopathology analysis.

RESULTS

Various degrees of choroidal alterations were demonstrated at different dose groups. Examinations on day 1 showed that gradually reduced verteporfin dose tended to decrease photochemical reactions to the choroid in terms of the number of occlusion vessels and area of the lesion. After 1 month, choroid vessel alteration persisted in high-dose groups (100% and 70%); nevertheless, alterations of low-dose groups (50% and 30%) returned to normal.

CONCLUSIONS

vPDT can induce photochemical reactions of the choroid, high dose causes permanent change, and low dose causes recoverable change. The dose-dependent alterations need to be considered for the individual therapeutic plan according to the situation of a patient with CSC.

Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders

In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.

Long term outer retinal changes in central serous chorioretinopathy submitted to half-dose photodynamic therapy

PURPOSE

To evaluate long-term changes in the foveal and parafoveal outer retina after half-dose photodynamic therapy (HD-PDT) in central serous chorioretinopathy (CSC).

METHODS

Retrospective study including CSC patients submitted to HD-PDT. Best corrected visual acuity (BCVA) was evaluated. Spectral-domain optical coherence tomography automatic segmentation algorithm was used and data on retinal, inner retinal, outer retinal and outer nuclear layers (ONL) in both foveal 1 mm (C) and parafoveal 3 mm ETDRS circles for the superior, nasal, inferior and temporal sectors, were obtained at baseline and 3, 12 and 24 months post-treatment. Subfoveal choroidal thickness, photoreceptors' outer segment thickness, subretinal fluid (SRF) height and width were also measured.

RESULTS

Twenty-one eyes of 15 patients were included. At baseline, the mean ONL thickness in the foveal area was significantly thinner in affected eyes compared to their fellow unaffected ones (55,50 ± 32,75 μm vs 93,00 ± 17,0 μm; p = 0,011), and was negatively correlated to logMAR BCVA (R=-0,601, p = 0,008) ONL thickness increased by 10,94 ± 11,88 μm at 24 months in the foveal area, and all the parafoveal sectors presented a similar increase. Baseline SRF width was significantly correlated with baseline BCVA (R1 = 0,483, p = 0,036), and with ONL thickness in all sectors.

CONCLUSION

In our study we found a significant long-term increase in foveal and parafoveal ONL thickness in CSC after HD-PDT, suggesting that this seems to be a safe treatment for the outer retina. This is the first study mapping the outer retinal changes in the macular area to 24 months follow up.

One-year results of half-dose versus one-third-dose photodynamic therapy in chronic or recurrent central serous chorioretinopathy

Background

Central serous chorioretinopathy (CSC) is characterized by an accumulation of subretinal fluid (SRF) in the macula. It is usually treated by laser photocoagulation or photodynamic therapy (PDT) with consisting of different doses and power. This study aimed to compare the efficacy of half-dose PDT and one-third-dose PDT in chronic or recurrent CSC.

Methods

A retrospective review of patients with chronic or recurrent CSC who were treated with either a half-dose or one-third-dose PDT, and had follow up 12 months afterwards. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and resolution of subretinal fluid (SRF) at baseline as well as 1, 3, 6 and 12 months post-PDT were assessed.

Results

Forty-six eyes and 20 eyes received half-dose and one-third-dose PDT, respectively. The study showed efficacy of the one-third-dose PDT compared with half-dose PDT in BCVA improvement (0.10±0.04 logMAR for one-third-dose versus 0.17±0.04, for half-dose, P=0.148) and CRT improvement (125.6±24.6 μm for one-third-dose versus 139.1±16.54, for half-dose, P=0.933) at 12 months. The SRF recurrence rate was significantly higher in the one-third-dose PDT group compared with the half-dose PDT group (40.0% versus 15.2%, P=0.027) at 12-months.

Conclusion

At 12 months, the one-third-dose PDT was effective in terms of BCVA and CRT improvement, when compared with half-dose PDT. However, this study showed that one-third-dose PDT had a higher recurrence rate of SRF.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY-GUIDED PHOTODYNAMIC THERAPY FOR ACUTE CENTRAL SEROUS CHORIORETINOPATHY

PURPOSE

To compare the anatomic results of optical coherence tomography angiography (OCTA)-guided half-dose photodynamic therapy (PDT) versus indocyanine green angiography (ICGA)-guided PDT in eyes with acute central serous chorioretinopathy.

METHODS

This study is a prospective, single-center, noninferiority, double-masked, randomized, controlled clinical trial. Fifty-one eyes of 45 patients with acute central serous chorioretinopathy were recruited, and randomized to an ICGA-guided group and an OCTA-guided group. The primary outcome measures were the rates of complete subretinal fluid (SRF) resolution at 1 month and 3 months.

RESULTS

Forty-six eyes of 40 patients finished the follow-up and were analyzed. In the OCTA-guided group, the SRF was completely resolved in 13 (56.5%) eyes within 1 month and in 21 (91.3%) eyes within 3 months. In the ICGA-guided group, the SRF was resolved in 16 (69.6%) of the eyes within 1 month and in 22 (95.7%) of the eyes by 3 months. Optical coherence tomography angiography-guided PDT was demonstrated noninferior to ICGA-guided PDT for SRF resolution rate at 3 months (P = 0.016), but not at 1 month (P = 0.311) for acute central serous chorioretinopathy patients. Subretinal fluid did not recur in any of the eyes in the OCTA-guided group, but did recur in 2 eyes (8.7%) of the ICGA-guided group during the 3-month follow-up period.

CONCLUSION

Optical coherence tomography angiography-guided PDT seemed to be noninferior to ICGA-guided PDT for resolution of SRF at 3 months in eyes with acute central serous chorioretinopathy.

Central Serous Chorioretinopathy: Multimodal Imaging and Management Options

Central serous chorioretinopathy (CSCR) is an idiopathic maculopathy characterized by thickened choroid, retinal pigment epithelial detachment, and variable subretinal fluid. CSCR predominantly affects young men, with risk factors including corticosteroid use, the type A behavior pattern, and psychological stress. While usually self-limited with a good visual prognosis, recurrent and persistent CSCR can lead to outer retinal and/or retinal pigment epithelial atrophy, choroidal neovascularization, and visual loss. This article reviews current multimodal imaging and treatment options, which include observation, mineralocorticoid receptor antagonists, thermal laser photocoagulation, and off-label photodynamic therapy with verteporfin.

Risk of Recurrence and Transition to Chronic Disease in Acute Central Serous Chorioretinopathy

Purpose

To study the risk of recurrence in acute central serous chorioretinopathy (aCSC) and to evaluate the risk of transitioning to chronic CSC.

Patients and Methods

The medical records and multimodal imaging data of 295 aCSC cases were reviewed. Typical aCSC was defined as the presence of serous subretinal fluid (SRF), one focal leakage spot on fluorescein angiography (FA), retinal pigment epithelium (RPE) alterations limited in area to less than one optic disc diameter, and complete recovery from this first CSC episode. An increase in RPE alterations combined with persistent SRF was considered a sign of chronicity, which was determined in cases with >12 months follow-up. The main outcome measures included final visual acuity, percentage of disease recurrence, and percentage of cases moving toward a chronic phenotype. Treatment strategies and their efficacy were also reviewed.

Results

A total of 295 eyes in 291 patients with aCSC were included. Spontaneous recovery was awaited in 154 eyes (52%), whereas 141 eyes (48%) recovered following treatment. SRF recurrence occurred in 24% of untreated cases and in 4% of treated cases (p<0.001). An analysis of 61 eyes that underwent an FA after ≥12 months of follow-up revealed increased RPE alterations in 22 eyes (36%), and 14 eyes (23%) had both an increase in RPE alterations and SRF recurrence.

Conclusion

All aCSC cases recovered from the first disease episode, and none of the cases developed persistent SRF leakage. Among the cases for which long-term follow-up information was available, 36% showed a tendency toward chronicity in terms of increased RPE alterations, whereas 23% showed both an increase in RPE alterations and recurrent SRF. Early photodynamic therapy (PDT) may decrease the risk of recurrences.

Central Serous Chorioretinopathy: Pathogenesis and Management

Central serous chorioretinopathy (CSC) is a common retina disease and has a relative high recurrence rate, etiology, and pathogenesis of which remains largely ambiguous. The effects on the retina are usually self-limited, although some people are left with permanent vision loss due to progressive and irreversible photoreceptor damage or retinal pigment epithelium atrophy. There have been a number of interventions used in CSC, including, but not limited to, laser treatment, photodynamic therapy (PDT), intravitreal injection of anti-vascular endothelial growth factor agents, and subthreshold lasers. It is not clear whether there is a clinically important benefit to treating acute CSC, which often resolves spontaneously as part of its natural history. Of the interventions studied to date, PDT and micropulse laser treatment appear the most promising. 

Pharmacotherapy of Central Serous Chorioretinopathy: A Review of the Current Treatments

BACKGROUND

Central serous chorioretinopathy (CSC) is the fourth most frequent retinal disorder in terms of prevalence. It typically occurs in young subjects and affects men more often than women. CSC is characterized by serous retinal detachment (SRD) involving mainly the macular area. The clinical course is usually selflimited, with spontaneous resolution within 3 months. The persistence of SRD or multiple relapse may result in a chronic form of CSC distinguished by permanent retinal pigment epithelium (RPE) and photoreceptor damage. As the pathogenetic mechanism of CSC primarily involves RPE and choroidal vascularization, the current therapeutic approaches aim to restore the normal functions of RPE and normal choroidal vascular permeability. In this review, the authors aim to summarize the current therapeutic approach to CSC.

METHODS

A comprehensive review of the literature was conducted in PubMed by searching for relevant studies on the current therapeutic options for CSC, including simple observation, conventional laser treatment, subthreshold laser treatment (SLT), photodynamic therapy (PDT) with verteporfin, treatment with mineralocorticoid receptor (MR) antagonists and treatment with anti-vascular endothelial growth factor drugs.

RESULTS

Since most cases resolve spontaneously, the most common initial CSC treatment is observation. Current evidence suggests that PDT and SLT are valuable in improving visual acuity, reducing subretinal fluid and maintaining long-term effectiveness. No clear evidence of efficacy has been achieved for anti-VEGF. MR antagonists might be a viable choice for the treatment of chronic CSC.

CONCLUSION

The pathophysiology of CSC remains poorly understood and as a consequence, the gold standard of care for CSC is yet to be defined. To date, PDT and SLT continue to offer good clinical outcomes. Positive preliminary results seem to emerge from the studies of MR antagonists.

Central serous chorioretinopathy: Towards an evidence-based treatment guideline

Central serous chorioretinopathy (CSC) is a common cause of central vision loss, primarily affecting men 20-60 years of age. To date, no consensus has been reached regarding the classification of CSC, and a wide variety of interventions have been proposed, reflecting the controversy associated with treating this disease. The recent publication of appropriately powered randomised controlled trials such as the PLACE trial, as well as large retrospective, non-randomised treatment studies regarding the treatment of CSC suggest the feasibility of a more evidence-based approach when considering treatment options. The aim of this review is to provide a comprehensive overview of the current rationale and evidence with respect to the variety of interventions available for treating CSC, including pharmacology, laser treatment, and photodynamic therapy. In addition, we describe the complexity of CSC, the challenges associated with treating CSC, and currently ongoing studies. Many treatment strategies such as photodynamic therapy using verteporfin, oral mineralocorticoid antagonists, and micropulse laser treatment have been reported as being effective. Currently, however, the available evidence suggests that half-dose (or half-fluence) photodynamic therapy should be the treatment of choice in chronic CSC, whereas observation may be the preferred approach in acute CSC. Nevertheless, exceptions can be considered based upon patient-specific characteristics.

Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy

Purpose

To evaluate the effects of intravitreal bevacizumab (IVB) injection on chronic central serous chorioretinopathy (CSC).

Methods

In this prospective interventional case series, a total of 22 eyes of 22 patients, diagnosed with unresolved CSC for three months or longer, received 1.25 mg IVB injection. Also, in case of failure to achieve success parameters, double dose IVB injections continued in order to reach the complete subretinal fluid (SRF) absorption. A complete ophthalmic assessment was carried out one day, one week, and one-month post-injection, and then a monthly visit was performed, and re-injection was done if needed. Visual acuity, subretinal space volume (SSV), central macular thickness (CMT), and contrast sensitivity were measured and compared among baseline values and final post-treatment values.

Results

The mean best corrected visual acuity increased significantly from 0.70 ± 0.22 to 0.17 ± 0.15 logMAR (P <0.001), and the CMT showed a significant reduction from 557.36 ± 129.12 to 259.50 ± 116.73 μm (P <0.001 ). In addition, SSV decreased significantly from 10.53 ± 2.03 to 6.63 ± 1.80 (P = 0.001), and contrast sensitivity improved significantly from 13.8182 ± 2.64820 dB to 17.6818 ± 1.80967 dB (P <0.001).

Conclusion

In this series, SRF absorption occurred and visual acuity improved after IVB injections, however, further comparative studies are needed to show the effect of IVB in chronic CSC.

Micropulse Laser Treatment of Retinal Diseases

Subthreshold micropulse laser treatment has been intensively used for selected retinal diseases in the last decade; however, the exact mechanism of the action of lasers in the subthreshold micropulse mode is not yet fully understood. This kind of treatment is safe and cheap, and contrary to classic laser photocoagulation, it leaves the retinal cells intact. A modern theory of micropulse laser interaction with retinal tissue and a possible explanation of this mechanism are presented in this review. The authors present all the relevant literature on the application of micropulse lasers in different retinal disorders. The efficacy of this treatment is analyzed on the basis of available studies and then placed in the perspective of other therapeutic methods that are used in retinal diseases.

Long-term Visual Outcomes and Causes of Vision Loss in Chronic Central Serous Chorioretinopathy

PURPOSE

To evaluate the long-term visual outcomes and causes of vision loss in chronic central serous chorioretinopathy (CSC).

DESIGN

Retrospective, longitudinal study.

PARTICIPANTS

A total of 133 participants (217 eyes) with chronic CSC.

METHODS

A retrospective review of clinical and multimodal imaging data of patients with chronic CSC managed by 3 of the authors between May 1977 and March 2018. Multimodal imaging comprised color photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence (FAF), and OCT.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA) at the final visit; change in BCVA between first visit and 1-, 5-, and 10-year follow-up visits; and causes of vision loss at final visit.

RESULTS

Data from 6228 individual clinic visits were analyzed. Mean age of patients at the first visit was 60.7 years, and mean period of follow-up from first to last visit was 11.3 years. The cohort included 101 male patients (75.9%). At the final visit, 106 patients (79.7%) maintained driving-standard vision with BCVA of 20/40 or better in at least 1 eye, and 17 patients (12.8%) were legally blind with BCVA of 20/200 or worse in both eyes. Mean BCVA at first visit was not significantly different from mean BCVA at 1- or 5-year follow-up visits (both P ≥ 0.65) but was significantly better than the mean BCVA at the 10-year follow-up visit (P = 0.04). Seventy-nine percent of eyes with 20/40 or better vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Ninety-two percent of eyes with 20/200 or worse vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Cystoid macular degeneration, choroidal neovascularization (CNV), outer retinal disruption on OCT, and FAF changes were associated with poorer vision at the final visit (all P ≤ 0.001). Multivariable analysis revealed that greater age at first visit was associated with greater BCVA change at the 10-year follow-up visit (P = 0.001).

CONCLUSIONS

Chronic CSC can be a sight-threatening disease leading to legal blindness. Age at presentation and outer retinal changes on multimodal imaging were associated with long-term BCVA changes and may be predictors of long-term visual outcomes.

Visual outcomes and anatomic changes after sub-threshold micropulse yellow laser (577-nm) treatment for chronic central serous chorioretinopathy: long-term follow-up

PurposeTo analyze the long-term efficacy of 577 nm sub-threshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC) and to evaluate the anatomic outcome, visual results and safety profile of the treatment.Patients and methodsThis prospective study assessed 39 eyes of 39 patients with non-resolving CCSC lasting more than three months. All eyes were treated by using 577 nm SMYL system with 5% duty cycle (DC) and each patients was monitored monthly. The main outcome measures were best-corrected visual acuity (BCVA), contrast sensitivity (CS) and subretinal fluid (SRF) height, central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), and subfoveal choroidal thickness (SFCT) measured by spectral domain optical coherence tomography (SD-OCT).ResultsThe median follow-up time period was 17.82±0.42 (13-23 months) months. The BCVA was improved significantly at final follow-up in comparison of baseline visit (P<0.01) in 35 eyes (89.7%) and in 4 eyes (10.3%) was stable. The median CMT, CMV, TMV before treatment was 369 μm, 0.30 mm3, and 9.86 mm3, in comparison to 250 μm, 0.19 mm3, and 8.76 mm3 at final follow-up, respectively (P<0.01 for all these parameters). Initial median SFCT was recorded as 364 μm and 342 μm at the final follow-up (P<0.001).DiscussionResults suggest that SMYL treatment is an effective method as response was rapid and procedure is safe to manage the non-resolving CCSC eyes.

Anatomical and Gene Expression Changes in the Retinal Pigmented Epithelium Atrophy 1 (rpea1) Mouse: A Potential Model of Serous Retinal Detachment

Purpose

The purpose of this study was to examine the rpea1 mouse whose retina spontaneously detaches from the underlying RPE as a potential model for studying the cellular effects of serous retinal detachment (SRD).

Methods

Optical coherence tomography (OCT) was performed immediately prior to euthanasia; retinal tissue was subsequently prepared for Western blotting, microarray analysis, immunocytochemistry, and light and electron microscopy (LM, EM).

Results

By postnatal day (P) 30, OCT, LM, and EM revealed the presence of small shallow detachments that increased in number and size over time. By P60 in regions of detachment, there was a dramatic loss of PNA binding around cones in the interphotoreceptor matrix and a concomitant increase in labeling of the outer nuclear layer and rod synaptic terminals. Retinal pigment epithelium wholemounts revealed a patchy loss in immunolabeling for both ezrin and aquaporin 1. Anti-ezrin labeling was lost from small regions of the RPE apical surface underlying detachments at P30. Labeling for tight-junction proteins provided a regular array of profiles outlining the periphery of RPE cells in wild-type tissue, however, this pattern was disrupted in the mutant as early as P30. Microarray analysis revealed a broad range of changes in genes involved in metabolism, signaling, cell polarity, and tight-junction organization.

Conclusions

These data indicate changes in this mutant mouse that may provide clues to the underlying mechanisms of SRD in humans. Importantly, these changes include the production of multiple spontaneous detachments without the presence of a retinal tear or significant degeneration of outer segments, changes in the expression of proteins involved in adhesion and fluid transport, and a disrupted organization of RPE tight junctions that may contribute to the formation of focal detachments.

Subthreshold micropulse yellow laser treatment for nonresolving central serous chorioretinopathy

Purpose

To report the efficacy and safety of micropulse 577 nm yellow laser in the treatment of nonresolving central serous chorioretinopathy (CSC) cases.

Patients and methods

The study included 15 eyes with nonresolving CSC lasting more than 3 months. All the patients were subjected to complete ophthalmic examination, in addition to contrast sensitivity measurement, fundus fluorescein angiography, and optical coherence tomography. All eyes were subjected to 577 nm subthreshold micropulse laser treatment, using the IQ 577 device, and followed up after 4 weeks, 2 months, 3 months, and 6 months. The outcome measures were change in best-corrected visual acuity, contrast sensitivity, subretinal fluid height, and change in macular thickness measured by optical coherence tomography.

Results

The average age of the patients was 36.4 years; eleven were males and four were females. Average duration of the leakage was 4.6 months. The mean best-corrected visual acuity measured 6 months after laser treatment was 0.85±0.097, in comparison to 0.67±0.097 before laser treatment (statistically significant [SS], P<0.05). The mean central macular thickness before laser was 389.6±46.4 µm, in comparison to 263.6±24 µm after 6 months (SS, P<0.05). The mean post-laser log contrast sensitivity measured using the Pelli–Robson contrast sensitivity chart was 1.73±0.14, while the initial log contrast sensitivity was 1.48±0.28 (SS, P<0.05).

Conclusion

Subthreshold micropulse laser treatment is an effective and safe treatment option for patients with nonresolving CSC.

Central Serous Chorioretinopathy Treatments: A Mini Review

Central serous chorioretinopathy (CSC) is a retinal disorder that primarily affects young (20- to 50-year-old) white men, although it is seen occasionally in older patients and females. CSC is characterized by avascular focal leakage through the retinal pigment epithelium (RPE), resulting in serous detachment of the neurosensory retina. The course is usually self-limiting and in most cases resolves spontaneously within a 3-month period, with visual acuity usually recovering to 20/30 or better. However, chronic CSC may develop as a consequence of recurrences or persistent neurosensory detachment, and can result in progressive RPE atrophy and permanent visual loss. A primary involvement of the RPE and choroidal vascularization play a significant role in the pathogenesis of CSC and the current treatment options attempt to restore the functions of the RPE and the normal choroidal vasculature. The aim of the current review is to provide an overview of the current therapeutical approaches to CSC, including observation, laser treatment, photodynamic therapy with verteporfin, intravitreal anti-vascular endothelial growth factor therapy and the mineralocorticoid receptor antagonists.

Loculation of Fluid in the Posterior Choroid in Eyes With Central Serous Chorioretinopathy

PURPOSE

To evaluate potential accumulation of fluid in the outer choroid in eyes with central serous chorioretinopathy.

DESIGN

Retrospective observational case series.

METHODS

Patients in 2 community-based retinal practices were evaluated for hyporeflective areas in the outer choroid consistent with collections of fluid using enhanced depth imaging optical coherence tomography. Eligible patients were examined over the preceding 2 years, had a history of central serous chorioretinopathy, and did not have a history of choroidal neovascularization or photodynamic therapy.

RESULTS

In the New York group there were 131 eyes of 70 patients who had a mean age of 56.3 (± 12.5) years, and 88 (67.2%) had hyporeflective regions consistent with posterior loculation of fluid in the macular region. In the Minnesota data set there were 91 eyes of 48 patients who had a mean age of 47.9 (± 9.9) years and hyporeflective regions consistent with posterior loculation of fluid was present in 59 (64.8%). In the entire group the mean subfoveal choroidal thickness of those without loculated fluid was 344 μm, as compared with 498 μm with loculated fluid (P < .001). The areas of loculated fluid were hyporeflective, were larger topographically than the large choroidal vessels, had an angular inner border, and did not have a bounding vascular wall.

CONCLUSIONS

Posterior loculation of fluid is a common finding in central serous chorioretinopathy, but it has a different pattern and distribution than do collections of fluid in the outer choroid and suprachoroidal space as seen in other forms of choroidal effusion.

Photodynamic therapy and anti-vascular endothelial growth factor for acute central serous chorioretinopathy: a systematic review and meta-analysis

This systematic review aims to update current evidence on the efficacy and safety of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) injections for acute central serous chorioretinopathy (CSC). A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane Library. Studies comparing (1) PDT versus placebo, (2) anti-VEGF versus placebo, and (3) PDT versus anti-VEGF were included and meta-analyzes were performed when appropriate. Ocular and systemic adverse effects were also summarized. Literature search yielded six comparative studies, among which five were included for this review. Meta-analysis with three studies indicated that eyes treated with PDT achieved better best-corrected visual acuity (BCVA) and central macular thickness (CMT) than the placebo group throughout a follow-up of 12 months. Meta-analysis with another two studies comparing anti-VEGF injections and placebo showed that BCVA at first month was better in anti-VEGF group than in placebo group, though the differences of BCVA and CMT no longer existed at 3 and 6 months after injection. There was no report directly comparing PDT and anti-VEGF for acute CSC. No severe complications was reported in included studies. In this review, current evidence suggested that early treatment of acute CSC by PDT is valuable in improving visual acuity, reducing subretinal fluid, and maintaining long term effectiveness. Anti-VEGF injection could shorten the duration of symptoms and accelerate visual improvement at early stage of disease. Direct comparison between these two treatment will be needed in the future.

Subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy: safety profile and treatment outcome

PURPOSE

To assess the safety and efficacy of a single session of subthreshold micropulse (SM) yellow laser (577 nm) in the treatment of chronic central serous chorioretinopathy (CSCR).

METHODS

This was a retrospective analysis of 15 eyes of 13 patients with CSCR of >3 months duration who had been treated with SM yellow laser (577 nm). All patients had been treated using multiple spots of laser with a duty cycle of 10% over areas of focal and diffuse leak, as seen on fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Reduction in subretinal fluid height on spectral domain optical coherence tomography (SD-OCT) was used to measure the response to treatment.

RESULTS

The mean follow-up was at 8 weeks (4-19 weeks). All eyes responded to treatment. The mean subretinal fluid height pre and post treatment was 232 and 49 μm, respectively, showing a 79% average reduction (P<0.001) in fluid height. There was no evidence of retinal pigment epithelium or retinal damage on SD-OCT, FFA, or fundus autofluorescence. Median visual improvement was one line on Snellen's visual acuity chart (P=0.015). Microperimetry was performed in eight eyes of which six eyes (75%) showed an improvement in the threshold values post treatment.

CONCLUSION

SM yellow laser is an effective treatment option for chronic CSCR.

Recent developments in retinal lasers and delivery systems

Photocoagulation is the standard of care for several ocular disorders and in particular retinal conditions. Technology has offered us newer lasing mediums, wavelengths and delivery systems. Pattern scan laser in proliferative diabetic retinopathy and diabetic macular edema allows laser treatment that is less time consuming and less painful. Now, it is possible to deliver a subthreshold micropulse laser that is above the threshold of biochemical effect but below the threshold of a visible, destructive lesion thereby preventing collateral damage. The advent of solid-state diode yellow laser allows us to treat closer to the fovea, is more effective for vascular structures and offers a more uniform effect in patients with light or irregular fundus pigmentation. Newer retinal photocoagulation options along with their advantages is discussed in this review.

Effects of photodynamic therapy with verteporfin for the treatment of chronic central serous chorioretinopathy: An uncontrolled, open-label, observational study

BACKGROUND

Central serous chorioretinopathy is an idiopathic disorder that leads to serous neurosensory retinal detachment. The disorder is usually self-limited and resolves spontaneously; however, sometimes neurosensory retinal detachment persists. This form of the disorder is called chronic central serous chorioretinopathy (CCSC).

OBJECTIVE

The aim of this study was to assess the effects of photodynamic therapy (PDT) on visual acuity with full-dose verteporfin for CCSC.

METHODS

The eyes of patients with CCSC were included in the study. Ophthalmic examination including best-corrected visual acuity (BCVA), fundus examination, fluorescein angiography, and optical coherence tomography was performed before treatment and at 1, 3, 6, 9, and 12 months. PDT with full-dose verteporfin (6 μ/m(2) of body surface area) was applied only to areas of active leakage. BCVA was converted to a log of the minimum angle of resolution (logMAR) equivalent for statistical analysis. Central foveal thickness and BCVA between baseline and follow-up were compared.

RESULTS

Seventeen eyes of 16 patients (13 males, 3 females; mean [SD] age, 39.75 [7.51] years; mean duration of follow-up, 13.06 [1.82] months) were used in the study. The mean (SEM) logMAR BCVA was 0.26 (0.07) at baseline and 0.04 (0.02) at 12 months. Mean logMAR BCVA values at baseline (0.259) and after treatment (0.112, 0.053, 0.047, 0.041, and 0.041 at 1, 3, 6, 9, and 12 months, respectively) differed significantly (P = 0.006, P = 0.005, P = 0.005, P = 0.005, and P = 0.005). There was a significant difference in the mean central foveal thickness at the final visit (169 μm) compared with the baseline value (383 μm; P < 0.001). BCVA decreased in one eye (20/20 vs 20/25) and persisted during follow-up; in the other 16 eyes, BCVA either increased (n = 10) or remained stable (n = 6).

CONCLUSIONS

In this small, open-label study, patients with CCSC treated with a single course of PDT with full-dose verteporfin had significant improvement from baseline in BCVA and resolution of subretinal fluid accumulation and active leakage. Treatment was generally well tolerated, but one patient had worsening in BCVA.

Half-dose photodynamic therapy targeting the leakage point on the fluorescein angiography in acute central serous chorioretinopathy: a pilot study

PURPOSE

To evaluate the efficacy of half-dose photodynamic therapy (PDT) targeting only the focal leakage point on fluorescein angiography for acute central serous chorioretinopathy.

DESIGN

Nonrandomized, retrospective, comparative, interventional case series.

METHODS

Ten consecutive eyes with acute central serous chorioretinopathy underwent PDT, and later, 11 eyes were observed without treatment. Main outcome measures included achievement of complete resolution of subretinal fluid, change in best-corrected visual acuity, and central retinal sensitivity.

RESULTS

Complete resolution of subretinal fluid was achieved in 80.0% and 18.2% of eyes in the PDT group and the observation group at 1 month (P = .009), 100% and 27.3% at 3 months (P = .001), and 90% and 63.6% at 12 months (P = .311), respectively. At 12 months, 3 eyes (27%) in the observation group had a persistent lesion, whereas no such lesions were observed in the eyes in the PDT group. One eye in each group showed recurrence during the 12-month follow-up period. Visual acuity improved significantly in both groups at each time point, and the differences between groups were not significant. The mean central retinal sensitivity at 3 months was significantly higher in the PDT group compared with the observation group.

CONCLUSIONS

Fluorescein angiography-guided half-dose PDT seems to facilitate faster resolution of subretinal fluid in acute central serous chorioretinopathy without, however, convincing long-term anatomic and functional benefits. This protocol may enhance the safety of PDT further.

[Treatment of central serous chorioretinopathy: MicroPulse photocoagulation versus bevacizumab]

PURPOSE

The aim of this study was to evaluate the treatment of central serous chorioretinopathy (CSC) with either subthreshold diode-laser MicroPulse (MP) or intravitreal bevacizumab (BCZ) using the Pro Re Nata (PRN) scheme.

METHODS

This comparative, controlled, prospective study over 10 months examined 52 eyes of 52 patients with either (a) treatment with MP at the active leakage site guided by fluorescein angiography (FA) (n=16 eyes), (b) intravitreal injection of 1.25 mg BCZ (n=10 eyes) or (c) passive observation (n=26 eyes). Outcome measures included changes in retinal pigment epithelium (RPE) leakage at FA, central macular thickness (CMT), best corrected visual acuity (BCVA) and 10° macular perimetry.

RESULTS

At the end of the study there was a 12.5 % persistent leakage in the MP group compared to 60 % in the BCZ group and 92 % in the control group. Mean CMT decreased by 94 µm in the MP, 38 µm in the BCZ and did not change in the control group. Mean BCVA improved by six ETDRS letters in the MP, decreased by one letter in the BCZ and by 2 letters in the control group. In the MP group mean perimetric deficit improved by 1.5 decibels and corrected lost variance by 2.6. In the BCZ it improved by 0.6 and by 0.5 in the control group. Retreatment was required in 7 out of 16 eyes of the SDM (43.75 %), and in 5 out of 10 eyes of the BCZ group (50 %).

CONCLUSIONS

MP photocoagulation was superior to intravitreal injections of 1.25 mg BCZ in the treatment of CSC which resulted in enhanced visual acuity and macular perimetry.

Central Serous Chorioretinopathy: A Review of the Literature

Central serous chorioretinopathy (CSCR) is an incompletely understood multifactorial disease of those who are middle aged characterized by the collection of fluid between the retinal pigment epithelium and the neurosensory retina. The exact etiology of CSCR and the reason of its predominance in middle-aged males are still unknown. Many pharmacologic modalities are suggested for CSCR with no proven efficacy. So this article was written to give a review of the relevant and recent literature on CSCR and to summarize the etiology, clinical features, and diagnostic modalities for CSCR with special emphasis on the treatment options available and those that are still under trial and can be of help in the future to fasten the recovery and reduce the recurrences.

Photoreceptor disruption in central serous chorioretinopathy treated by half-dose photodynamic therapy

BACKGROUND

To evaluate photoreceptor disruption in patients with central serous chorioretinopathy (CSC) treated by half-dose photodynamic therapy (PDT).

METHODS

A total of 29 patients with symptomatic CSC were recruited and underwent half-dose verteporfin PDT covering the leakage sites as observed via fundus fluorescein angiography. The primary outcome was the percentage of patients with the presence of photoreceptor disruption, and the secondary outcome was the correlation between photoreceptor disruption and visual results at the 1-year follow-up.

RESULTS

Photoreceptor disruption was identified in 13 eyes (44.8%) 12 months after treatment. Twenty-seven patients experienced best-corrected visual acuity (BCVA) improvement after PDT, while two patients showed stable BCVA. The mean BCVA in patients with photoreceptor disruption at the baseline and every follow-up visit was significantly lower than that of patients without photoreceptor disruption. However, there was no correlation between the presence or absence of photoreceptor disruption and the improvement of visual acuity because the BCVA gain at the last follow-up visit between the two groups was not significant (P = 0.69). No potential ocular complication was encountered in the study.

CONCLUSION

Photoreceptor disruption was found in about 45% of CSC patients treated by PDT, which ultimately resulted in poor visual outcomes. However, a half-dose PDT might not affect or modify the photoreceptor function because it gave the same pattern of visual recovery in patients with and without photoreceptor cell loss.

Multiple spots of photodynamic therapy for the treatment of severe chronic central serous chorioretinopathy

PURPOSE

To evaluate the efficacy and safety of fluorescein angiography (FA)-guided photodynamic therapy (PDT) for the treatment of severe chronic central serous chorioretinopathy (CSC).

METHODS

Patients presenting with chronic CSC with multiple areas of retinal pigment epithelium decompensation, with or without focal leaks, were treated with FA-guided full-fluence PDT. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), FA, indocyanine green angiography, and fundus autofluorescence were used to determine functional and anatomic outcomes.

RESULTS

Twenty-one eyes (17 patients) were treated with PDT and followed for a median of 24 months (range, 12-73). In fourteen eyes (66.66%), two PDT spots were performed within the same session. In three eyes (14.28%), three PDT spots were performed, in two eyes (9.52%) four spots, and in two eyes (9.52%) five spots. In 17 eyes (80.95%), the leakage in FA and the subretinal fluid in OCT disappeared after only one session of PDT. In four eyes (19.05%), a second session - with only one spot - of PDT was required due to persistent or recurrent leakage and subfoveal SRF. Median BCVA improved significantly from 20/63 at baseline to 20/40 at 3 months (P = 0.0002) and 20/32 at 6 months (P < 0.0001), and remained improved until the last examination (20/25, P < 0.0001). Two patients complained of a transient central scotoma after the treatment.

CONCLUSION

FA-guided full-fluence PDT with multiple PDT spots within the same session seems to be effective and safe for the treatment of chronic CSC cases with multiple areas of retinal pigment epithelium decompensation.

The efficacy of intravitreal bevacizumab for acute central serous chorioretinopathy

PURPOSE

To investigate the efficacy of intravitreal bevacizumab injection in patients with acute central serous chorioretinopathy (CSCR).

METHODS

Between 6 weeks and 3 months, 13 eyes of 22 patients with acute CSCR received an intravitreal bevacizumab injection (2 mg/0.08 mL), 9 eyes had no medical treatment as a control. At baseline and follow-up visits patients had best corrected visual acuity (BCVA), intraocular pressure assessment, dilated fundus examination, and spectral optical coherence tomography imaging. Outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and symptoms.

RESULTS

All patients showed prompt improvements of visual acuity and symptoms until the 3rd month and recovered from neurosensory detachment gradually following treatment in the study group. The vision of control subjects recovered later and the regression of serous retinal detachments were fairly slow. The mean BCVA improved from 0.39±0.16 at first visit (at baseline) to 0.73±0.17 at the 6th month in the study group; and, from 0.25±0.17 at first visit (at baseline) to 0.67±0.13 at the 6th month in the control group that was statistically significant (P=0.0001; P=0.0001, respectively). Mean retinal thickness for the study group was decreased from 414.38±102.79 at first visit (at baseline) to 256.46±84.77 at the 3rd month and 198.30±29.81 at the 6th month (P=0.0001, P=0.0001); and that for the control group was decreased from 510.33±80.59 at first visit (at baseline) to 336.33±127.83 at the 3rd month and 205.66±19.65 at the 6th month (P=0.004, P=0.0001, respectively). One of the patients in the control group revealed recurrence at the 6th month and the patient was given intravitreal injection of bevacizumab.

CONCLUSION

Intravitreal bevacizumab injection for acute CSCR can lead to remarkable improvements of visual acuity within 3 months follow-up compared with controls. These results demonstrated that intravitreal bevacizumab injection may be a promising option for selected patients in the treatment of acute CSCR.

Evaluation of verteporfin pharmakokinetics--redefining the need of photosensitizers in ophthalmology

INTRODUCTION

The benzoporphyrine derivative verteporfin has lost its importance to the treatment of the most frequent neovascular eye diseases. Nevertheless, it is still mandatory to define the remaining applications, role, and potential of verteporfin in ocular photodynamic therapy (PDT), including the dosages of administration, effectiveness, and safety profile.

AREAS COVERED

Although verteporfin PDT has forfeited the first-line status and value of treating subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration or pathologic myopia, the treatment remains the standard of care for choroidal haemangioma and polypoidal choroidal vasculopathy. PDT is effective in less pigmented choroidal melanoma as well as in retinal vascular proliferations and retinal angioma. Verteporfin was granted the orphan drug designation for the treatment of chronic or recurrent central serous chorioretinopathy (CSC).

EXPERT OPINION

Evidence-based data regarding optimized parameters (low fluence, reduced dose, fractionated irradiation) adapted to the treated diseases (target structure, dosimetry, blood supply) are scarce. Prospective and large clinical trials are missing, although the scientific community agrees on the fact that the standard treatment protocol does not necessarily provide the optimal efficacy to the specific disease or individual patient. Within the reviewed indications, the adverse effect profile is favorable compared with other therapies.

Intravitreal bevacizumab for treatment of refractory central serous choroidoretinopathy

In a clinical case series, 5 patients with not-resolved central serous choroidoretinopathy (CSC) lasting more than 1 year received one intravitreal bevacizumab injection (IVB, 1.25 mg) injection. All patients underwent a through ophthalmic examination 1 day, 1 week, and 1, 2, and 6 months after the injection. Best corrected visual acuity (BCVA) and central macular thickness were compared before and after treatment by optical coherence tomography. Mean BCVA was improved significantly (p = 0.020) from 0.60 ± 0.25 to 0.50 ± 0.18 and 0.29 ± 0.19 logarithm of minimum angle of resolution at 6 and 18 weeks, respectively. Central macular thickness was also decreased significantly (p = 0.010) from 370 ± 65 to 208 ± 23 µm at 4 months. No recurrence was occurred during follow-up. IVB injection may have beneficial effect in the treatment of refractory CSC.

Diffuse retinal capillary leakage in coats disease

PURPOSE

Coats disease is a rare condition characterized by retinal vascular telangiectasia, aneurysms, and leakage from these abnormal blood vessels. We report the phenomenon and treatment of Coats disease with diffuse hyperpermeability from angiographically normal retinal capillaries.

METHODS

This case series describes two patients with Coats disease, diagnosed based on fundus photography and fluorescein angiography. The first patient was treated with intravitreal bevacizumab and limited laser photocoagulation. The second patient was treated only with limited photocoagulation.

RESULTS

The diffuse exudation from normal retinal capillaries resolved with treatment of the focal primary vascular Coats lesions.

CONCLUSION

Vasculopathies such as Coats disease may produce diffuse hyperpermeability of otherwise normal capillaries in the fundus. Limiting treatment only to the primary Coats lesions is a minimally invasive strategy that preserves normal capillaries.

Retinal sensitivity after photodynamic therapy with half-dose verteporfin for chronic central serous chorioretinopathy: short-term results

BACKGROUND

To assess retinal sensitivity after photodynamic therapy (PDT) with half-dose verteporfin in patients with chronic central serous chorioretinopathy.

METHODS

Sixteen eyes with chronic chorioretinopathy treated using PDT with half-dose verteporfin were enrolled. Microperimetry covering the central area 12 degrees in diameter was performed before and at 1 month and 3 months after PDT. Retinal sensitivities within the retinal serous detachment before PDT, the PDT spot area, and the central area 2 degrees in diameter were evaluated.

RESULTS

Fourteen of 16 eyes showed complete resolution of retinal detachment at 3 months after PDT. Mean retinal sensitivities within the retinal serous detachment before and at 1 month and 3 months after PDT were 8.9 dB, 12.1 dB, and 14.7 dB, respectively. Mean retinal sensitivities within the PDT spot area were 11.0 dB, 14.2 dB, and 15.7 dB, respectively. Mean retinal sensitivities in the central area 2 degrees in diameter were 6.0 dB, 9.9 dB, and 12.5 dB, respectively. Mean retinal sensitivities at both 1 month and 3 months after PDT showed statistically significant improvements as compared with before PDT (both, P < 0.05).

CONCLUSION

Photodynamic therapy with half-dose verteporfin appears to be an effective and safe treatment for patients with chronic chorioretinopathy, improving retinal sensitivity for at least 3 months.