Abstract
PurposeTo evaluate the efficacy of half-dose photodynamic therapy (PDT) for the treatment of bullous retinal detachment.MethodsInterventional prospective case series in six eyes from six consecutive patients with bullous retinal detachment. The effected eyes were treated with indocyanine green angiography (ICGA)-guided half-dose PDT with multifocal and large laser spots. Clinical evaluations included best-corrected visual acuity (BCVA), ophthalmoscopy, ophthalmic B scan, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and ICGA at each scheduled visit at baseline; at 1, 3, and 6 months after PDT; and during follow-up after 6 months.ResultsAll six eyes received half-dose verteporfin PDT with a mean number of therapeutic spots 2.83 ± 1.47 and a mean spot size of 4647 ± 996 μm in diameter. Three months after PDT, retinal reattachment was observed on B scans and resolution of sub-retinal fluid (SRF) was observed in OCT images for five eyes. There was no significant difference in the mean logMAR BCVA between the baseline and the value at 1 month after PDT (P = 0.477). At 3 months after PDT, the mean logMAR BCVA improved significantly from a baseline value of 1.02 to 0.54 (P = 0.044). At 6 months after PDT, the mean logMAR BCVA further improved to 0.46 (P = 0.025) and remained stable. One affected eye received a second half-dose PDT for SRF not reduced until the second month after PDT. Retinal reattachment and SRF resolution were observed at 1 and 3 months after the second therapy, respectively. BCVA improved from a baseline value of 20/63 to 20/20 at 1 month after the second PDT and remained stable until the sixth month after the second PDT. During follow-up after more than 6 months, recurrence occurred in no cases.ConclusionsThis study demonstrated half-dose PDT with multifocal and large laser spots was an effective treatment for bullous retinal detachment contributing to the retinal reattachment, a resolution of SRF, and an improvement of BCVA. Thus, PDT for the treatment of bullous retinal detachment is considered to be a worthwhile endeavor.
Highlights
Chronic central serous chorioretinopathy (CSC) is a major threat to central vision in the working population and is mainly characterized by the serous detachment of the neurosensoryGraefes Arch Clin Exp Ophthalmol (2018) 256:1429–1439 most intriguing aspects of the disease
Two patients (33.3%) had bullous retinal detachment associated with systematic corticosteroid therapy for initial nephritic syndrome and intravitreal injection of triamcinolone acetonide (TA) for misdiagnosis of uveitis
There was no significant difference in the mean logMAR best-corrected visual acuity (BCVA) between the baseline and 1 month after photodynamic therapy (PDT) (P = 0.477)
Summary
Chronic central serous chorioretinopathy (CSC) is a major threat to central vision in the working population and is mainly characterized by the serous detachment of the neurosensoryGraefes Arch Clin Exp Ophthalmol (2018) 256:1429–1439 most intriguing aspects of the disease. Chronic central serous chorioretinopathy (CSC) is a major threat to central vision in the working population and is mainly characterized by the serous detachment of the neurosensory. A previous study reported that glucocorticoids can reduce macular edema and aggravate SRF accumulation in CSC patients [6]. In previous reports, the occurrence of bullous retinal detachment was associated with a history of glucocorticoids [7, 8]. Based on the currently available literature, the traditional treatment of CSC consists of photodynamic therapy (PDT) and laser photocoagulation. There are limited clinical data on the therapy of patients with bullous retinal detachment far. We present a series of cases of bullous retinal detachment that responded favorably to halfdose PDT without any additional complications during the follow-up period of more than 6 months
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