Abstract
PurposeTo identify characteristics of Caucasian chronic central serous chorioretinopathy (cCSC) patients without a complete resolution of subretinal fluid (SRF) after reduced-settings photodynamic therapy (PDT), or with a recurrence of SRF after PDT.MethodsChronic CSC patients treated with reduced-settings PDT were divided into a successful PDT group and unsuccessful PDT group. Patients in the successful PDT group did not have any subretinal fluid (SRF) during follow-up after PDT, whereas the unsuccessful PDT group was categorized based on either persistence or recurrence of SRF after PDT treatment. Data on age, sex, best-corrected visual acuity (BCVA), PDT spot size, characteristics on fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) were obtained.ResultsTwenty-six patients in the successful PDT group (20 males, 6 females) had a mean age of 51 years (range, 25–78). In the unsuccessful PDT group, 20 males with a mean age of 60 years (range, 34–78) were included. At last visit before PDT, age, percentage of males, and percentage of patients with diffuse leakage > 1 optic disc diameter on FA were higher in the unsuccessful PDT group (p = 0.010, p = 0.029, and p = 0.008, respectively). At last visit before PDT, BCVA and the percentage of patients with intense hyperfluorescence on ICGA were lower in the unsuccessful group (p = 0.017 and p = 0.004, respectively). Patients with intense hyperfluorescence on ICGA were more likely (95% CI 1.3–333 times) to have a successful outcome (p = 0.045). A decrease in SFCT at final visit was observed in both groups (− 111 μm and p = 0.013, and − 141 μm and p = 0.007, respectively). BCVA only improved at final visit in the successful PDT group (5 Early Treatment of Diabetic Retinopathy Study letters, p < 0.001).ConclusionsChronic CSC patients with recurrent or persistent SRF after PDT are characterized by a higher percentage of males, more patients with diffuse leakage on FA, more patients without intense hyperfluorescence on ICGA, higher age, and lower pre-PDT and long-term BCVA than in the successful PDT group. A reduction in SFCT after PDT does not necessarily lead to complete resolution of SRF, while a resolution of SRF appears to be required to lead to a significant BCVA improvement in cCSC.
Highlights
Central serous chorioretinopathy (CSC) is a chorioretinal disease characterized by an accumulation of subretinal fluid (SRF), Graefes Arch Clin Exp Ophthalmol (2018) 256:1395–1402In acute CSC, SRF usually resolves spontaneously within a few months [2]
The aim of our study was to compare the characteristics of Caucasian patients with a successful Photodynamic therapy (PDT) response, defined as complete resolution of SRF on optical coherence tomography (OCT) after PDT, to characteristics of patients with an unsuccessful PDT response, defined as the presence of SRF within 2 months after PDT, or a recurrence of SRF after PDT
Based on the results of our study, we conclude that PDT treatment in Caucasian chronic central serous chorioretinopathy (cCSC) patients without hyperfluorescent areas on indocyanine green angiography (ICGA) is less likely to respond with a resolution of SRF, and that the rate of recurrence in these patients may be high
Summary
In acute CSC, SRF usually resolves spontaneously within a few months [2]. This is in contrast with the persistent SRF and often more extensive retinal and choroidal abnormalities in cCSC, which can lead to permanent photoreceptor damage and visual dysfunction [4]. Photodynamic therapy (PDT) has been shown to be an effective treatment option for cCSC, when using reduced settings in comparison with the original settings described for neovascular age-related macular degeneration [9,10,11,12]. The mechanism of action in PDT in CSC is thought to be short-term choriocapillaris hypoperfusion and subsequent choroidal vascular remodeling, with cessation of leakage to the subretinal area, despite the damaged outer blood-retinal barrier of the RPE [15, 16]. SRF resolves completely after PDT in a high percentage of cCSC patients (62–100%), the desired treatment effect of a complete SRF resolution will not be attained in every case [17,18,19], and some patients develop a recurrence of SRF after initial SRF resolution after PDT treatment [20]
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