Abstract
PurposeTo evaluate the clinical outcomes after half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSC) patients with pre-existent fovea-involving atrophy.MethodsIn this retrospective study, cCSC patients who had a window defect of the retinal pigment epithelium (RPE) on fluorescein angiography (FA), compatible with RPE atrophy, prior to half-dose PDT were included.ResultsThirty-four cCSC eyes with typical findings of cCSC on multimodal imaging, and fovea-involving RPE atrophy on FA, were included. At the first visit after PDT (at a median of 1.8 months after half-dose PDT), 20 eyes (59%) had a complete resolution of SRF (p < 0.001), while this was the case in 19 eyes (56%) at final visit (median of 11.3 months after half-dose PDT; p < 0.001). The mean BCVA in Early Treatment of Diabetic Retinopathy Study letters was 71. 2 ± 15.9 at last visit before PDT, which increased to 74.1 ± 14.1 at first visit after PDT (p = 0.093, compared with baseline), and changed to 73.0 ± 19.1 at final visit (p = 0.392, compared with baseline). Both at first visit after PDT and at final visit, a significant decrease in subfoveal choroidal thickness was observed (p = 0.032 and p = 0.004, respectively).ConclusionsHalf-dose PDT in cCSC patients with pre-existing fovea-involving atrophy may lead to anatomical changes, but not to functional improvements. Ideally, cCSC should be treated with half-dose PDT before the occurrence of such atrophy.
Highlights
Central serous chorioretinopathy (CSC) is a common macular disease in which a serous detachment of the neuroretina occurs, often in the macula, with subsequent vision loss [1]
Multimodal imaging consisting of optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), are pivotal for diagnosing CSC and OCT angiography can aid in detecting subretinal neovascularisation in cases of CSC or diseases mimicking CSC
The aim of this study is to report the outcome of photodynamic therapy (PDT) in chronic CSC (cCSC) patients with pre-existent fovea-involving retinal pigment epithelium (RPE) atrophy
Summary
Central serous chorioretinopathy (CSC) is a common macular disease in which a serous detachment of the neuroretina occurs, often in the macula, with subsequent vision loss [1]. The disease usually presents with visual symptoms including decreased visual acuity, diminished contrast vision and/or metamorphopsia. While OCT is important to detect SRF, FA is of additional value since it provides information on leakage sites and the extent of atrophic RPE alterations. While acute CSC usually resolves spontaneously within 4 months after the start of symptoms, cCSC can lead to irreversible visual impairment and a decreased quality of life [5, 6]. For cCSC, several subtypes have been described including for example cCSC with focal or diffuse leakage on FA, severe cCSC cases with diffuse atrophic RPE alterations and/ or cCSC with posterior cystoid retinal degeneration (PCRD) [7,8,9,10]. Most evidence on efficacy is available for half-dose (or halffluence) photodynamic therapy, which is considered to be the treatment of choice for cCSC [11]
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