Abstract
To quantify the structural and perfusion changes in choriocapillaris in chronic central serous chorioretinopathy after half-dose photodynamic therapy by using spectral-domain optical coherence tomography and optical coherence tomography angiography. This retrospective interventional case series examined the eyes of patients with central serous chorioretinopathy. Patients underwent full ophthalmic examinations, including spectral-domain optical coherence tomography and angiography, prior to and 1, 3, and 6 months after the treatment. Clinical and tomographic features of the choriocapillaris and choroidal thickness and vascular changes were evaluated by assessing flow signal voids. All 56 eyes of 56 patients showed complete resolution of subretinal fluid at 3 months after photodynamic therapy. The best-corrected visual acuity significantly improved at 6 months (p<0.001). The central subfield thickness, subfoveal choroidal thickness, subfoveal choroidal large vessel layer thickness, and mean total area of flow signal voids decreased significantly at 6 months (all p values < 0.001), but the subfoveal choriocapillaris layer thickness did not change significantly at 6 months (p≥0.16). Multivariate analysis revealed positive linear correlations of the central subfield thickness and subfoveal choroidal large vessel layer thickness with the mean total area of flow signal voids at 6 months (p<0.001). There was a negative linear correlation between the subfoveal choriocapillaris layer and the mean total area of flow signal voids at 6 months (p = 0.013). Half-dose photodynamic therapy improved the anatomic and functional outcomes of central serous chorioretinopathy, induced subfoveal choroidal thickness thinning, and increased choriocapillaris perfusion. In addition, the recovery of the subfoveal choriocapillaris layer thickness and improved choriocapillaris perfusion were closely associated.
Highlights
Central serous chorioretinopathy (CSC) is a well-known vision-threatening disease that occurs in relatively young patients [1,2]
Subjects were excluded if their symptoms lasted fewer than six months; exhibited any sign of choroidal neovascularization with fluorescein angiography, indocyanine green angiography or optical coherence tomography angiography (OCTA); previously underwent photodynamic therapy (PDT), focal laser photocoagulation, or antiVEGF treatment; had evidence of choroidal atrophy; had high myopia defined as a refractive error < −6.0 diopters or an axial length > 26.5 mm; underwent continuous corticosteroid therapy; or had intraocular surgeries, poor signal strength, or severe artifacts due to saccadic eye movement
This study demonstrated that PDT leads to improved Central subfield thickness (CST) and best-corrected visual acuity (BCVA) in chronic CSC patients, as reported previously [2,19,20,21]
Summary
Central serous chorioretinopathy (CSC) is a well-known vision-threatening disease that occurs in relatively young patients [1,2]. It is characterized by localized serous detachment of the retina that mainly involves the macular area, and predominantly affects males. There are many treatment options for CSC, including steroid discontinuation [3], anti-VEGF therapy [4], focal laser treatment [5], subthreshold micropulse laser [6,7,8], mineralocorticoid receptor antagonist therapy [9] and diuretics, photodynamic therapy (PDT) is believed to be the most effective and permanent treatment [10].
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