Short-Term Choriocapillaris Changes in Patients with Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy.

Marco Nassisi,Chiara Eandi,Luca Musso,Camilla Alovisi,Carlo Lavia

doi:10.3390/ijms18112468

Marco Nassisi, Chiara Eandi + Show 3 more

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https://doi.org/10.3390/ijms18112468

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Abstract

Background: Although photodynamic therapy (PDT) has become the standard treatment for central serous chorioretinopathy (CSC), its mechanism of action remains unclear. It is assumed that PDT induces short-term choriocapillaris (CC) occlusion and long-term choroidal vascular remodeling. In this paper, we describe the short-term CC changes induced by Half-Dose PDT (HD-PDT) in chronic CSC using optical coherence tomography-angiography (OCTA). Methods: This is a prospective interventional case series. Chronic CSC eyes underwent Spectral-Domain OCT, Fundus Autofluorescence, FA, ICGA (Heidelberg Spectralis, Heidelberg, Germany) and OCTA (RTVue XR Avanti with AngioVue; Optovue Inc., Fremont, CA, USA) before HD-PDT, with follow-up after one hour, one week, and one month. Vascular changes after PDT were analyzed within the CC layer. The CC vessel density was defined as the percentage of an area occupied by flow pixels, using Image J software to obtain measurements by applying a grey level threshold. All pixels with a grey level above the threshold were considered as indicators of blood flow. Results: 20 eyes of 19 patients were included. At baseline the mean CC vessel density was 94.87 ± 2.32%. It significantly differed from the density at 1 week and 1 month (92.79 ± 3.16% and 95.55 ± 2.05%, p < 0.001, respectively), but not with values at 1 h (94.8 ± 2.28%, p = 0.516). Conclusions: CC vessel density was significantly reduced at 1 week as compared with baseline, suggesting a possible short-term effect of PDT on CC perfusion. After 1 month however, the CC vessel density was even higher than the baseline, probably due to a CC recovery. OCTA seems to be useful in the visualization of CC vessels and in confirming the mechanism of action of PDT treatment in eyes with chronic CSC.

Highlights

Central serous chorioretinopathy (CSC) is a posterior segment disease that represents a common cause of vision threat in the middle-aged population
It is characterized by the presence of a localized and limited accumulation of fluid under the neurosensory retina through a defect of the retinal pigment epithelium (RPE) [1,2]
The aim of our study is to describe the short-term CC changes induced by Half-Dose photodynamic therapy (PDT) (HD-PDT) in the treatment of chronic central serous chorioretinopathy (CSC) using optical coherence tomography-angiography (OCTA)

Summary

Introduction

Central serous chorioretinopathy (CSC) is a posterior segment disease that represents a common cause of vision threat in the middle-aged population It is characterized by the presence of a localized and limited accumulation of fluid under the neurosensory retina through a defect of the retinal pigment epithelium (RPE) [1,2]. The distinction between acute and chronic forms relies on the presence of persistent serous retinal detachment, extended RPE and photoreceptor atrophic changes correlated with a progressive visual loss over a period of 3–6 months [4,5,6]. This arbitrary demarcation has therapeutic implications as it usually determines the timing for intervention.

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