Abstract
BackgroundThe effect of various reduced doses of verteporfin photodynamic therapy (PDT) on choroidal blood flow in chronic central serous chorioretinopathy (CSC) remains unclear. Therefore, this study aimed to evaluate choroidal blood flow after half-dose PDT (1/2PDT) and one-third dose PDT (1/3PDT) with verteporfin for chronic CSC using laser speckle flowgraphy and spectral-domain optical coherence tomography.MethodsTwenty-seven eyes of 27 patients with serous retinal detachment (SRD) caused by chronic CSC for more than 6 months were included in this study. Patients were divided into the 1/2PDT (n = 12; January 2018 to July 2019) and 1/3PDT (n = 15; August 2016 to December 2017) groups based on the treatment period. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), and mean blur rate in the macular area (m-MBR) and optic nerve head (ONH-MBR) were obtained using laser speckle flowgraphy and evaluated at baseline (pre-treatment), and 2 weeks, 1 month, 3 months, and 6 months after treatment.ResultsWe found that SRD disappeared after 1 month in 92 and 93% of patients’ eyes in the 1/2PDT and 1/3PDT groups, respectively. Recurrence of SRD was observed in one eye at the 6-month follow-up after 1/2PDT and two eyes at the 3-month follow-up after 1/3PDT. No significant improvement was observed in baseline BCVA in the 1/3PDT and 1/2PDT groups. The average m-MBR against baseline significantly decreased at 2 weeks and 1, 3, and 6 months in the 1/2PDT group. The average m-MBR against baseline decreased significantly only at the 2 weeks follow-up in the 1/3PDT group. The average rate of change in the CCT against baseline decreased significantly throughout for up to 6 months in the 1/2PDT group and for up to 3 months in the 1/3PDT group. No significant fluctuation was observed in the ONH-MBR.Conclusions: Here, PDT significantly affected choroidal blood flow depending on the verteporfin dose in chronic CSC.Trial registrationThis trial was retrospectively registered (UMIN000026850; Approval date 03/04/2017).
Highlights
The effect of various reduced doses of verteporfin photodynamic therapy (PDT) on choroidal blood flow in chronic central serous chorioretinopathy (CSC) remains unclear
Central serous chorioretinopathy (CSC) is one of the most common retinal diseases, which presents with central serous chorioretinopathy, serous retinal detachment (SRD) at the posterior pole, and causes blue vision and metamorphopsia, and micropsia [2]. the clinical course of CSC is usually benign, 30 to 50% of patients experience repeated recurrence, and some of these patients develop chronic CSC, which results in poor visual acuity [3, 4].The pathophysiology of acute and chronic CSC is not fully understood, several studies have revealed that retinal pigment epithelium (RPE) and choroidal dysfunction could play an important role [5, 6] Gass suggested that a focal increase in the permeability of the choriocapillaris layer was the primary cause of damage to the overlying RPE in patients with CSC [6]
No significant differences were found in the sex (p = 0.78), baseline bestcorrected visual acuity (BCVA) (1/Half-dose photodynamic therapy (2PDT), 0.13 ± 0.25; One-third dose photodynamic therapy (1/3PDT), 0.21 ± 0.25; p = 0.35), duration of symptoms (1/3PDT, 18.4 ± 16.4; 1/ 2PDT, 18.8 ± 12.2; p = 0.59), central retinal thickness (CRT) at baseline (1/2PDT, 334.2 ± 94.5; 1/3PDT, 275.1 ± 94.5; p = 0.06), central choroidal thickness (CCT) at baseline (1/2PDT, 451.2 ± 132.5; 1/3PDT, 452.2 ± 85.1; p = 0.88), and PDT spot size (1/2PDT, 2888.3 ± 550.5; 1/ 3PDT, 2558.9 ± 710.7; p = 0.22), except for age (1/2PDT, 51.5 ± 5.7; 1/3PDT, 46.3 ± 7.2; p = 0.04) between the two treatment groups
Summary
The effect of various reduced doses of verteporfin photodynamic therapy (PDT) on choroidal blood flow in chronic central serous chorioretinopathy (CSC) remains unclear. Photodynamic therapy (PDT) with verteporfin, which was introduced as a promising therapeutic approach for CSC, is based on occlusion and remodelling of the choroidal capillaries and choroidal vascular, which decreases the hyperpermeability of the dilated choroidal vessels [8, 9]. These treatments yielded good results, complications such as RPE atrophy, RPE tear, secondary choroidal neovascularization (CNV), and choriocapillaris ischemia occurred after PDT [10,11,12]
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