Long-term prognostic factors of chronic central serous chorioretinopathy after half-dose photodynamic therapy: A 3-year follow-up study.

Fuminori Haga,Yasuki Ito,Hiroko Terasaki,Ruka Maruko,Keiko Kataoka,Chiaki Sato,Demetrios G Vavvas

doi:10.1371/journal.pone.0181479

Fuminori Haga, Yasuki Ito + Show 5 more

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https://doi.org/10.1371/journal.pone.0181479

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Journal: PloS one	Publication Date: Jul 24, 2017
Citations: 44	License type: CC BY 4.0

Affiliation: Nagoya University

Abstract

PurposeTo evaluate the long-term efficacy and factors involved in the recurrence and persistence of subretinal fluid (SRF) after half-dose photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC).MethodsIn this retrospective observational case series, 79 eyes (73 patients) with chronic CSC were treated with half-dose PDT and followed up for at least 3 years. They were divided into successful (64 eyes) and unsuccessful (15 eyes) groups based on SRF absorption and disease recurrence after one PDT session. Age, best-corrected visual acuity (BCVA), central foveal thickness, neuroretinal thickness, height of SRF, subfoveal choroidal thickness, window defect area detected by fluorescein angiography, and PDT spot area were compared between the groups. Factors associated with PDT success and BCVA at 3 years were investigated.ResultsLogMAR BCVA improved from 0.21±0.24 to 0.08±0.16 (P<0.001) at 3 years after PDT. Compared with the unsuccessful group, the successful group had a significantly younger mean age (50.5±9.7 vs. 56.5±9.1 years, P = 0.032) and better baseline BCVA (0.18±0.23 vs. 0.32±0.25, P = 0.034). Other parameters were not significantly different. Multivariate analyses showed that unsuccessful PDT was significantly associated with lower baseline BCVA (P = 0.026) and older age (P = 0.029) and that BCVA at 3 years after PDT was positively associated with baseline BCVA (P<0.001).ConclusionsHalf-dose PDT has a long-term efficacy in chronic CSC. Relatively early PDT may improve anatomic and functional outcomes of chronic CSC.

Highlights

Central serous chorioretinopathy (CSC) is characterized by the accumulation of subretinal fluid (SRF) in the macula, and it frequently affects young-to-middle-aged men.[1]
Multivariate analyses showed that unsuccessful photodynamic therapy (PDT) was significantly associated with lower baseline best-corrected visual acuity (BCVA) (P = 0.026) and older age (P = 0.029) and that BCVA at 3 years after PDT was positively associated with baseline BCVA (P
Indocyanine green angiography (ICGA) has shown the hyperpermeability of choroidal vessels in eyes with CSC,[9] and optical coherence tomography (OCT) has shown that the choroid is thicker in eyes with CSC than in normal eyes.[10]

Summary

Introduction

Central serous chorioretinopathy (CSC) is characterized by the accumulation of subretinal fluid (SRF) in the macula, and it frequently affects young-to-middle-aged men.[1] The risk factors of CSC include the use of corticosteroid medications,[2, 3] pregnancy,[4] psychological stress,[1, 5] type A personality,[6] smoking,[7] and male gender.[8] Indocyanine green angiography (ICGA) has shown the hyperpermeability of choroidal vessels in eyes with CSC,[9] and optical coherence tomography (OCT) has shown that the choroid is thicker in eyes with CSC than in normal eyes.[10] The exact etiology of CSC is unknown, disturbances in choroidal circulation are suggested to be related to CSC. In the long term, approximately half of the patients experience persistent or recurrent SRF.[11, 12] In these patients, the prognosis can be poor due to complications such as diffuse atrophy of the retinal pigment epithelium (RPE), subretinal fibrosis, and thinning of the outer sensory retina.[13]

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