Prognostic factors related to photodynamic therapy for central serous chorioretinopathy

Abstract

To investigate the effects and prognostic factors related to photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). Retrospective medical record reviewing of consecutive CSC patients (chronic or persistent typical CSC) treated with conventional PDT (full-dose verteporfin, laser (689 nm) delivery for 83 s, total light energy of 50 J/cm(2)) was performed. Besides overall anatomic and functional outcomes, the prognostic influences of various baseline factors (sex, age, duration of symptoms, presence of focal leak and pigment epithelial detachment (PED), SRF size, confluent RPE atrophy, PDT spot size), disintegrity of the junction between foveal outer and inner photoreceptor layer (OS-IS) after resolution, and post-treatment RPE changes on outcomes were evaluated. Forty patients (41 eyes) were included. Anatomic success, defined as complete resolution of serous fluid on optical coherence tomography performed 4-6 weeks after PDT, was achieved in 87.8% of eyes, and visual acuity improved significantly (0.19 +/- 0.24 lines). Visual acuity had improved more than one line in 46.3% of the patients and decreased more than one line in 14.6% of patients at the 1-month follow-up visit. Prolonged symptom duration (> 9 months), PED, confluent RPE atrophy, foveal OS-IS disintegrity, and post-PDT RPE changes were associated significantly with visual loss of more than three lines and foveal atrophy. Central macular thickness was significantly reduced in patients treated with PDT compared to those treated with focal laser. PDT for CSC was effective with regard to anatomic and functional outcomes. However, visual improvement may be limited in patients with prolonged symptom duration, baseline confluent RPE atrophy, foveal OS-IS disintegrity, or progression of RPE atrophy after PDT and the risk of PDT-induced foveal injury should be considered.