[Photodynamic therapy for chronic central serous chorioretinopathy and diffuse retinal epitheliopathy].

Abstract

PURPOSE:

To report outcomes in patients with long-standing (more than 6 months) chronic central serous chorioretinopathy (CSC) treated with low-fluence Visudyne(®) photodynamic therapy (LFV-PDT).

PATIENTS AND METHODS:

The clinical, angiographic and optical coherence tomography (OCT) results of patients with long-standing chronic central serous chorioretinopathy (CCSC) treated with LFV-PDT in the Lyon Centre Rabelais between 2002 and 2008 were retrospectively analyzed. A comprehensive check-up (macular syndrome signs, ETDRS best-corrected visual acuity [BCVA], biomicroscopy, fluorescein [FA] and indocyanine green [ICGA] angiographies, OCT scans) was performed before LFV-PDT treatment and 3 months later. Patients were then followed regularly and retreated in case of recurrence. The LFV-PDT treatment, with a fluence of 25 J/cm(2) at an irradiance of 300 mW, was guided by ICGA.

RESULTS:

Forty-one eyes of 34 patients (27 males; mean age: 53 years) were included, of which 18 eyes had already been treated with laser photocoagulation. Several leaking points were visible on FA in most of the cases (n=38), mainly in the macula (35 cases). Before treatment, metamorphopsia was noted in 51% of the cases, intraretinal edema (IRE) was present on OCT scans in 71%, serous retinal detachment (SRD) in 85%, and pigment epithelial detachment (PED) in 10%. Thirty-nine eyes had only one treatment session and one eye was retreated once. At 3 months after LFV-PDT, IRE was present in 15% of the cases, SRD in 12%, and PED in 2%. At the end of the 20-month follow-up, IRE was present in 14% of the cases, SRD in 15%, and PED in 0%. Macular atrophy was observed on OCT in most of the cases at the end of the follow-up (mean central thickness, 144.5 μm). Compared to the initial BCVA, at 3 months after LFV-PDT, BCVA decreased in 22% of the cases, stabilized in 39%, and increased in 39%, while at the end of the follow-up, BCVA decreased in 12% of the cases, stabilized in 17%, and increased in 71%. No complication was observed.

DISCUSSION:

LFV-PDT treatment for patients with long-standing chronic central serous chorioretinopathy results in anatomical and functional improvement (sustained disappearance of the exudative phenomenon in most cases and increased BCVA in more than two-thirds of the cases). The macular atrophy observed may be due to the treatment or the natural course of the disease.

• Authors: P-L Cornut, M Quaranta-El Maftouhi, M Mauget-Faÿsse
• Journal: Journal francais d'ophtalmologie (J Fr Ophtalmol) Vol. 35 Issue 2 Pg. 82-7 (Feb 2012) ISSN: 1773-0597 [Electronic] France
• Vernacular Title: Intérêt de la photothérapie dynamique dans les choriorétinopathies séreuses centrales chroniques et les épithéliopathies rétiniennes diffuses exsudatives.
• PMID: 21889817 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Chemical References

• Photosensitizing Agents
• Porphyrins
• Verteporfin

Topics

• Adult
• Aged
• Central Serous Chorioretinopathy (drug therapy)
• Female
• Humans
• Male
• Middle Aged
• Photochemotherapy (methods)
• Photosensitizing Agents (administration & dosage, adverse effects, therapeutic use)
• Porphyrins (administration & dosage, adverse effects, therapeutic use)
• Retinal Diseases (drug therapy, pathology)
• Retinal Pigment Epithelium (pathology)
• Retrospective Studies
• Treatment Outcome
• Verteporfin
• Visual Acuity (drug effects, physiology)