Half-fluence Photodynamic Therapy Research Articles

Exogenous testosterone use and acute central serous chorioretinopathy in a transgender patient

Purpose: To describe the presentation and clinical course of a transgender patient with central serous chorioretinopathy (CSCR) and discuss the role of exogenous testosterone use in CSCR in this patient population. Method: Case report. Results: A 63-year-old transgender male with a history of exogenous testosterone use for over twenty years was referred to retina clinic for evaluation of macular pathology. The patient’s most recent total testosterone levels prior to presentation were 962 and 1,179 ng/dL (normal cisgender male levels for age 60+: 300-720 ng/dL). Fundus imaging revealed subretinal fluid involving the fovea without choroidal neovascularization in the right eye. There was no recent corticosteroid use. The patient’s dose of testosterone was reduced. After four months of observation, the subretinal fluid persisted and was successfully treated with half-fluence photodynamic therapy (PDT). At last follow-up, 15 months after PDT, the patient remained stable without recurrence and the best-corrected visual acuity was at baseline. Conclusion: Exogenous testosterone use with elevated serum testosterone levels may be associated with the development of central serous chorioretinopathy in the transgender patient population. CSCR in these patients might be effectively treated with PDT and testosterone dose reduction. Ophthalmologists should be aware of potential side effects of testosterone supplementation in this patient population, as well as the role of testosterone in CSCR pathophysiology.

Wide-Field Choroidal Thickness Analysis after Half-Fluence Photodynamic Therapy Combined with Intravitreal Aflibercept Injection in Pachychoroid Neovasculopathy.

Background: Pachychoroid neovasculopathy (PNV) is a pachychoroid-spectrum disease. As blood circulation throughout the choroid may be involved in PNV pathogenesis, analysis using ultra-wide-field (UWF) fundus imaging is crucial. We evaluated choroidal thickness after half-fluence photodynamic therapy (PDT) combined with intravitreal aflibercept injection for PNV using UWF swept-source optical coherence tomography. Methods: Seventeen eyes with PNV that underwent half-fluence PDT with an adjuvant single intravitreal aflibercept injection were analyzed. To compare choroidal thicknesses in the central and peripheral choroids, we set subfields <3, <9, and 9-18 mm from the fovea. The <9 and 9-18 mm subfields were divided into four quadrants. Results: Choroidal thickness in each subfield decreased significantly after half-fluence PDT (p < 0.001); this reduction was more pronounced in the central area. We also investigated the relationship between the dominant side of the deep choroidal veins that harbor choroidal vein efflux from the macula. When choroidal thickness in the supratemporal and infratemporal 9 mm subfields were evaluated, the ratio of choroidal thickness reduction was not significantly different between the dominant and non-dominant sides. The dominant side was not associated with the extent of choroidal thickness reduction in PNV. Conclusions: Half-fluence PDT caused thinning of the entire choroid, especially in the central area, in PNV.

Attenuation of irradiated choroid and its regional vortex veins in central serous chorioretinopathy after photodynamic therapy

We retrospectively studied 12 eyes of 12 patients with central serous chorioretinopathy (CSC) to investigate choroidal thickness changes following half-fluence photodynamic therapy (PDT) using widefield choroidal thickness maps obtained by optical coherence tomography (OCT). Additionally, we assessed the relationship between choroidal thickness changes and the regional vortex veins as visualized on widefield en face OCT of the choroid. Pre-treatment en face images of the choroidal vasculature were superimposed on subtracted choroidal thickness maps before and 3 months after half-fluence PDT. The choroidal thickness decreased mainly in the irradiated macular area and in the region of vortex veins which function as drainage for the macula in all eyes. Eleven eyes (91.7%) showed choroidal thinning in the nasal area which overlapped with the nasal vortex vein distribution. Moreover, in 10 (90.9%) of those eyes, we observed intervortex venous anastomosis across the vertical watershed zone. Quantitative analysis revealed that the reduction in choroidal thickness was most pronounced in the macular area. Furthermore, the choroidal thickness reduction in the area with macular drainage vortex veins was significantly greater than that in the area without such vortex veins. These results suggest that half-fluence PDT might decrease choroidal thickness due to choriocapillaris occlusion in the irradiated macula, possibly leading to diminished venous drainage from the macula to regional vortex veins. Moreover, venous blood flow through the anastomotic vessels from the macular drainage vortex veins into the nasal vortex veins might be reduced post-treatment.

Two-year Clinical Outcomes Following Photodynamic Acute Exudative Maculopathy in Patients with Chronic Central Serous Chorioretinopathy.

To analyze the two-year clinical outcomes following photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) in patients with chronic central serous chorioretinopathy (cCSCR). Prospective observational study that included 64 eyes of 64 patients with cCSCR who received half-fluence PDT and had a 2-year follow-up. Patients were classified into 2 groups based on whether they had had PAEM at 3 days after treatment (PAEM+, n=22; ≥50 µm increase in subretinal fluid (SRF) or not (PAEM-, n=42). Best-corrected visual acuity (BCVA) and SRF changes evaluated with optical coherence tomography (OCT) were registered at 3 days, 1 month, 3 months, 1 year and 2 years after PDT. The number of recurrences, the appearance of outer retinal atrophy (ORA) and choroidal neovascularization (CNV) were analyzed. BCVA was 75.9±13.6 (20/32) and 82.0±11.0 letters (20/25) at two years in the PAEM+ and PAEM- groups, respectively (p=0.055). There were no differences in the BCVA change (4.2±7.7 vs 3.3±7.1 letters; p=0.654) and the SRF decrease (-117.3±74.2 vs -138.5±83.6 µm; p=0.323) at 2 years between patients with and without PAEM. No differences in the number of recurrences (p=0.267), the appearance of CNV (p=0.155) or ORA (p=0.273) between both groups were noted. Patients with cCSCR with and without PAEM presented similar results at 2 years in terms of BCVA gain, SRF reduction and complication rate.

Serous Maculopathy Due to Aspecific Choroidopathy (SMACH).

Serous Maculopathy Due to Aspecific Choroidopathy (SMACH).

Three-Year Follow-Up Detecting Choroidal Neovascularization with Swept Source Optical Coherence Tomography Angiography (SS-OCTA) after Successful Half-Fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy.

Purpose: To assess the clinical course, structural changes, and choroidal neovascularization detection by SS-OCTA in long-standing and resolved patients with chronic central serous chorioretinopathy (cCSC) after successful half-fluence photodynamic therapy (hf-PDT) treatment. Methods: Twenty-four eyes presenting with cCSC were examined with SS-OCTA and were classified as choroidal neovascular (CNV) or non-choroidal neovascular (non-CNV) cCSC depending on the vascular pattern detected by SS-OCTA after one, two, and three years after hf-PDT. Two groups were compared based on the following clinical findings: demographic characteristics, time of clinical signs, best corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CFT), subretinal fluid (SRF), flat, irregular pigment epithelial detachment (FIPED), and features of fluorescein angiography (FA) and vascular pattern by SS-OCTA. Results: All patients showed resolved cCSC during follow-up after hf-PDT. A total of 5 of 24 (20.8%) eyes showed a neovascular pattern by SS-OCTA. No differences between BCVA, CRT, SRF, FIPED, or FA features were found between both groups (p > 0.05). However, CFT and older age were associated with a neovascular pattern by SS-OCTA (p < 0.05) in follow-up. No signs of neovascular activity were detected by SS-OCT during follow-up in CNV cCSC patients, and no antiVEGF treatment was required for three-year follow-ups. Conclusions: Despite patients with cCSC showing a favorable clinical response after hf-PDT, lower foveal thickness and older age were associated with CNV patterns by SS-OCTA during follow-up.

OCT-A in chronic central serous chorioretinopathy treated with oral eplerenone and half-fluence photodynamic therapy: A comparative study.

To evaluate retinal and choriocapillary vessel density (VD) changes in patients with chronic central serous chorioretinopathy (CSC) treated with half-fluence verteporfin photodynamic therapy (vPDT) or eplerenone, using optical coherence tomography angiography (OCTA). Patients affected by CSC and treated with vPDT and eplerenone were retrospectively studied. At baseline and 3 months after each treatment, all patients underwent a complete ophthalmological examination, including an evaluation of best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT) and OCTA. Forty-eight eyes of patients with CSC were analysed. Twenty-four eyes were placed in the vPDT group, and 24 eyes formed the eplerenone group. In both groups, OCTA showed a significant improvement in the VD of deep capillary plexus (DCP) and choriocapillaris (CC) after treatments with respect to baseline (p < 0.001), whereas the VD of superficial capillary plexus (SCP) did not show significant differences (p > 0.05). The PDT group demonstrated a statistically significant increase in the VD of DCP and CC with respect to the eplerenone group (DCP p = 0.012; CC p = 0.004). A statistically significant reduction with respect to baseline in subfoveal choroidal thickness (SFCT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) and in central foveal thickness (CFT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) was also found. The SFCT was significantly thinnest in the PDT group with respect to the eplerenone group (p = 0.021). OCTA allowed us to study retinal and choriocapillary vascular changes in patients with CSC treated with vPDT and eplerenone.

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta-analyses.

Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short-term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta-analyses to compare to non-treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half-dose or half-fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half-dose or half-fluence PDT (OR: 20.6; 95% CI: 6.3-66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0-655.7; p=0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7-6.8; p=0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best-corrected visual acuity was only obtained by half-dose/-fluence PDT (-0.13 logMAR; 95% CI: -0.20 to -0.06 logMAR; p=0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half-dose/-fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long-term data available for PDT-based treatments finding persisting treatment results, half-dose or half-fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.

Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning

To assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL). Retrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n=100); Group 2, partial SRF resorption (n=66); and Group 3, absence of any SRF resorption (n=50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1vs. 2 and 3 together; 3rd compares groups 2vs. 3. The mean age was 55.6±10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529±0.035. In the second model, the mean accuracy was higher (0.670±0.046). In the third approach, the algorithm showed a precision of 0.74±0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69±0.15 in group 3 (absence of SRF resolution). Despite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.

A Comparative Study of Short-Term Vascular and Stromal Alterations of the Choroid Following Half-Fluence Photodynamic Therapy in Pachychoroid Neovasculopathy and Chronic Central Serous Chorioretinopathy.

Background: Central serous chorioretinopathy (CSCR) and pachychoroid neovasculopathy (PNV) are among the pachychoroid spectrum diseases (PSDs). Half-fluence photodynamic therapy (hf-PDT) is one of the effective treatment methods for both diseases. The aim of this study was to compare the effect of hf-PDT on the choroidal structure in CSCR and PNV. Methods: This study included 35 patients with chronic CSCR and 18 patients with PNV. The hf-PDT protocol was applied to all eyes. Before and 3 months after hf-PDT, enhanced-depth optical coherence tomography images were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Results: Compared with baseline values, 3 months after hf-PDT, the mean CA reduced from 1.398 to 1.197 mm2 (p < 0.001) in the CSCR group and the total CA reduced from 1.050 to 1.000 mm2 (p < 0.021) in the PNV group. The mean percentage changes in CA, LA, and SA values were statistically higher in the chronic CSCR group (13.86%, 13.53%, and 14.11%, respectively) than those in the PNV group (4.61%, 4.02%, and 5.74%; p = 0.001, p = 0.002, and p = 0.031, respectively). Conclusion: CSCR and PNV are thought to be PSDs. However, they differ in choroidal morphological response after hf-PDT, which might be a result of the different structural components of the PNV lesions.

Utility of an additional photodynamic therapy session after multiple failed PDT treatments in chronic central serous chorioretinopathy

PurposeTo assess the efficacy of an additional photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSCR) patients who have two or more previous failed PDTs. MethodsTen eyes of 10 patients with cCSCR who had received two or more PDTs without complete resolution of the subretinal fluid (SRF) or with early recurrence (before 3 months) were included. An additional half-fluence PDT was performed. Swept-source optical coherence tomography (OCT) and OCT angiography were performed before, 3 days, 1 month, 3 months, 6 months and 12 months after treatment. Age, gender, best-corrected visual acuity (BCVA), subfoveal choroidal thickness, SRF and vessel occlusion in the choriocapillaris (CC) were collected. ResultsThe median number of previous PDTs was 3 (range 2 to 4). BCVA before and 12 months after treatment was 72 letters (50 to 95) and 78 letters (55 to 100) (p=0.094). Median initial SRF was 94 µm (50 to 306), being 0 µm (range 0 to 81) at the end of the follow-up (p=0.007). After the additional PDT, 8 out of 10 patients had a complete SRF resorption. All the patients except one who had a complete response (7/8) had an occlusion in the CC 3 days after PDT. ConclusionDespite previous failed PDTs in cCSCR, good anatomical results can be achieved, this being more likely if an early vessel occlusion in the CC is observed. Even when the BCVA did not improve, the high rate of fluid resolution could justify the additional PDT treatment in order to maintain visual function.

ACUTE EXUDATIVE MACULOPATHY AND BACILLARY LAYER DETACHMENT IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY AFTER PHOTODYNAMIC THERAPY.

To describe the incidence and characteristics of photodynamic therapy-induced acute exudative maculopathy (PAEM) and bacillary layer detachment in patients with chronic central serous chorioretinopathy. This was a prospective observational case series including 92 eyes of 75 patients who underwent photodynamic therapy. Best-corrected visual acuity, optical coherence tomography, and optical coherence tomography angiography were performed before, 3 days, 1 month, and 3 months after half-fluence photodynamic therapy. Two groups were established depending on the presence or absence (N = 28 and N = 64, respectively) of PAEM. Choriocapillaris flow voids increase, subfoveal choroidal thickness, and the presence of choroidal neovascularization were collected. The incidence of PAEM was 28/92 (30.4%). There was no difference in the age, sex, baseline subretinal fluid, subfoveal choroidal thickness, or the presence of choroidal neovascularization between groups (P ≥ 0.094). No differences emerged in the subretinal fluid at 1 and 3 months after photodynamic therapy between groups (P ≥ 0.524), nor in the mean best-corrected visual acuity gain at 3 months (4.1 ± 7.6 vs. 3.6 ± 6.4 letters; P = 0.773). A bacillary layer detachment was observed in 13 patients with PAEM (46.4%). Photodynamic therapy-induced acute exudative maculopathy is frequent in patients with chronic central serous chorioretinopathy but has a favorable prognosis. There was no association between PAEM and age, sex, subfoveal choroidal thickness, or choroidal neovascularization; however, it was related to choriocapillaris flow voids increase.

Early changes in choriocapillaris flow voids as an efficacy biomarker of photodynamic therapy in central serous chorioretinopathy

PurposeTo assess the early changes produced in the choriocapillaris (CC) and choroidal vasculature using swept-source optical coherence tomography angiography (SS-OCTA) in patients with persistent central serous chorioretinopathy (CSCR) as predictors of the efficacy after photodynamic therapy (PDT). MethodsProspective observational study in 52 eyes of 52 patients with persistent subretinal fluid (SRF). SS-OCTA scans of the 6 × 6 mm macular region were assessed before; 2–3 days, one month and three months after half-fluence PDT. Vessel occlusion in the CC and choroid was measured as flow signal voids (FSV). ResultsA 3.67 ± 4.12 and 2.76 ± 3.63 fold increase in CC and CH FSV, due to vessel occlusion, was observed at 2–3 days after PDT versus baseline. There was less SRF at 3 months in patients with an increase in FSV (≥1-fold) compared to those without this increase (<1-fold) after PDT (p ≤ 0.003). An association between the increase in CC and choroidal FSV at the early control (2–3 days) and the height of SRF at 1 month was found (R=-0.405; p = 0.002 and R=-0.356; p = 0.008 respectively). In a multivariate model, the SRF at one month was not associated with age, gender, visual acuity, or FSV (p ≥ 0.288). At 3 months, flow restoration was achieved in the choroid versus the baseline (p = 0.619), but there was a persistent increase in the CC FSV (p = 0.008). ConclusionsEarly vessel occlusion by OCTA after PDT in CSCR was associated with good treatment response. Therefore, an increase in FSV immediately after PDT could be a biomarker to predict SRF resorption.

Optical coherence tomography angiography quantification of choriocapillaris blood-flow after half-fluence photodynamic therapy for chronic central serous chorioretinopathy.

To quantitatively analyze characteristics of choriocapillaris flow using spectral domain optical coherence tomography angiography (SD-OCTA) in eyes with chronic central serous chorioretinopathy (CSC) before and after treatment by photodynamic therapy (PDT). Retrospective interventional study. Macular 3X3 SD-OCT scans were analyzed in eyes diagnosed with chronic CSC before and after treatment with half-fluence PDT. The choriocapillaris en face slabs were extracted from the SD-OCTA device after manual segmentation. En face choriocapillaris flow images were compensated with en face choriocapillaris structure images. Phansalkar local thresholding method was then used with a radius of 4 and 8 pixels. Percentage of flow deficits (FD%), number, size, and total area of FDs were computed for comparison, before and after treatment by half-fluence PDT. Mean choriocapillaris FD% before PDT was of 58.36 + / - 11.88 and of 60.82 + / - 11.08 after PDT using radius 4 pixels with no significant difference (p = 0.140). Mean choriocapillaris FD% was of 58.63 + / - 11.08 before PDT and of 60.87 + / - 10.36 after PDT using radius 8 pixels with no significant difference (p = 0.200). Similarly, no significative difference was found in number, size, and total area of FDs, before and after half-fluence PDT, using radius 4 and 8 pixels in patients with chronic CSC. Using Phansalkar local thresholding method, quantitative analysis of choriocapillaris with SD-OCTA found no significant change in choriocapillaris flow deficits before and after successful half-fluence PDT in patients with chronic CSC. Therefore, it seems that half-fluence PDT may not alter choriocapillaris perfusion, at least on a relative short-term basis.

Comparison of Retinochoroidal Vascular and Structural Changes after Half-Dose Photodynamic Therapy versus Half-Fluence Photodynamic Therapy Based on Optical Coherence Tomography Angiography in Eyes with Chronic Central Serous Chorioretinopathy

Purpose: The aim of this study is to compare the efficacy of half-fluence photodynamic therapy (PDT) and half-dose PDT on the choroidal structure via perfusion of the retinal plexus and choriocapillaris in eyes with chronic central serous chorioretinopathy (cCSCR). Materials and Methods: This retrospective study included 43 eyes in 43 patients with cCSCR. Patients in group 1 received half-fluence (verteporfin 6 mg m⁻²) PDT and those in group 2 received half-dose (verteporfin 3 mg m⁻²) PDT. Enhanced depth imaging optical coherence tomography and optical coherence tomography angiography (OCTA) images were recorded 1 day before and 3 months after PDT. Total choroidal area (TCA), luminal area (LA), and stromal area (SA) were calculated using Image J software. Results: From baseline to 3 months post PDT TCA decreased from 2.43 ± 0.47 mm² to 2.08 ± 0.59 mm² (p < 0.001), LA decreased from 1.78 ± 0.11 mm² to 1.54 ± 0.26 mm² (p < 0.001), and SA decreased from 0.76 ± 0.33 mm² to 0.53 ± 0.37 mm² (p < 0.001) in group 1. Choriocapillaris vascular density measured via OCTA increased from 37.82 ± 10.99 at the initial visit to 44.96 ± 15.34 at month 3 after half-fluence PDT administered to the fovea (p < 0.001). Deep capillary plexus vessel density was 32.49 ± 11.36 at baseline and increased to 43.27 ± 11.40 at month 3 after half-fluence PDT administered to the fovea (p < 0.001) in group 1. TCA decreased to 2.00 mm² ± 0.51 mm² from 2.39 mm² ± 0.43 mm² (p < 0.001), LA decreased to 1.53 ± 0.29 mm² from 1.74 ± 0.16 mm² (p = 0.019). Although SA decreased from 0.76 ± 0.33 mm² to 0.53 ± 0.37 mm² in group 2, the difference was not significant (p = 0.07). Based on OCTA, choriocapillaris vascular density increased from 43.68 ± 10.38 mm² at baseline to 47.46 ± 6.42 mm² at 3 months after half-dose PDT onto the fovea (p = 0.049). Deep capillary plexus vessel density increased from 34.37 ± 9.36 mm² at the initial visit to 38.17 ± 8.81 mm² 3 months after half-dose PDT onto the fovea (p = 0.046) in group 2. At 3 months, post-PDT subretinal fluid (SRF) was significantly higher resolution in group 1 than in group 2 (p = 0.021). Conclusions: OCTA shows there is a significant increase in deep capillary plexus and choriocapillaris perfusion 3 months after both half-fluence PDT and half-dose PDT. Although there was a significant decrease in LA in both groups, based on OCTA there was a significant decrease in SA, a significant increase in choriocapillaris and deep capillary perfusion in group 1; therefore, the level of SRF resolution at month 3 post PDT might explain its higher incidence in group 1.

Half-fluence photodynamic therapy in peripapillary circumscribed choroidal haemangiomas.

To evaluate the safety and efficacy of half-fluence photodynamic therapy (PDT) as treatment for symptomatic peripapillary circumscribed choroidal haemangiomas (CCHs). In this prospective, interventional case series; 11 patients with symptomatic peripapillary CCHs presenting to a single centre were treated with half-fluence PDT using verteporfin 6mg/m2 with fluence of 25mJ/cm2 (standard is 50mJ/cm2) and other standard settings. Patients were evaluated at baseline, four weeks, twelve weeks and twenty-four weeks post-PDT treatment with best corrected visual acuity (BCVA), ultrasonography, spectral domain optical coherence tomography (SD-OCT), visual evoked potential and angiographic studies. Eleven patients with peripapillary CCHs received half-fluence PDT. The BCVA significantly improved to 0.558 ± 0.118 at four weeks post-treatment (P = 0.014), to 0.494 ± 0.114 at twelve weeks (P = 0.006) and 0.441 ± 0.125 at twenty-four weeks (P = 0.007) from baseline levels of 1.017 ± 0.075 on log MAR scales. Similar improvement was observed in central macular thickness (CMT) of 78.50 ± 13.73 μm (P = 0.001) at four weeks; 114.70 ± 27.73 μm (P = 0.003) at twelve weeks and 174.60 ± 23.13 μm (P = 0.001) at twenty-four weeks post-treatment. A single session of re-treatment was required in 18% (n = 2) of patients which also showed complete resolution at last follow-up. No complications were observed without any significant change in retinal nerve fibre layer (RNFL) thickness at six months follow-up. Half-fluence PDT can be an effective and safe treatment option for peripapillary CCHs which results in both anatomical and functional improvements with no observable complications.

Short term effects of half-fluence photodynamic therapy on retinal vessels and choroid in chronic central serous chorioretinopathy

Short term effects of half-fluence photodynamic therapy on retinal vessels and choroid in chronic central serous chorioretinopathy

Treatment outcomes of photodynamic therapy and findings predicting treatment success in pachychoroid-associated neovascularization.

To investigate the treatment outcomes and predictive factors affecting treatment success of half-fluence photodynamic therapy (hf-PDT) in pachychoroid-associated neovascularization (PNV). Twenty-four eyes of 23 PNV patients who underwent hf-PDT were included in this study. The results of optical coherence tomography (OCT) and OCT-angiography imaging were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Baseline characteristics of the eyes showing complete response (group 1) and the eyes with partial response or unresponsive to hf-PDT (group 2) were compared. The mean age of the patients was 54.2±9.6 years. The mean follow-up time after hf-PDT was 20.7 ± 13.6 months. Three months after hf-PDT, the subretinal fluid had completely regressed in 18 eyes (75.0%), partial resolution was observed in 3 eyes (12.5%), and 3 eyes (12.5%) were unresponsive to hf-PDT. When the baseline characteristics before hf-PDT were evaluated between the groups, the mean central choroidal thickness (411.5 ± 115.1 µm vs 284.8 ± 69.4 µm), the mean CA (1.082 ± 0.315 mm2 vs 0.795 ± 0.242 mm2) and the mean LA (0.795 ± 0.234 mm2 vs 0.578 ± 0.200 mm2) was significantly higher in group 1 compared to group 2 (p = 0.019, p = 0.018, p = 0.018, respectively). Hf-PDT is an effective treatment method usually providing total resolution of subretinal fluid in PNV cases. A high baseline central choroidal thickness and large luminal area may be positive predictive factors in terms of full anatomical response to hf-PDT. It may be possible to plan a more effective treatment strategy by keeping these factors in mind.

Transient accumulation of subretinal fluid after half-fluence photodynamic therapy in neovascular age-related macular degeneration

BackgroundPhotodynamic therapy (PDT) is known to occlude choroidal neovascularisation selectively, and there have been several reports on its adverse effects on the normal choroid and retinal pigment epithelium, resulting in decreased vision.MethodsThis retrospective interventional case series aimed to investigate the changes in visual acuity and retinal thickness in the immediate post-treatment period after half-fluence PDT, administered alone or with anti-vascular endothelial growth factor and steroids, in 29 eyes (26 patients) with neovascular age-related macular degeneration. The patients’ best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography images were measured 1 day, 1 week, and 1 month post-treatment.ResultsCompared to the pre-treatment CFT (270.38 μm), the mean CFT was significantly increased 1 day post-treatment (387.07 μm, P = 0.001), which then started to decrease, with a mean CFT of 269.32 μm (P = 0.516) at 1 week, and of 240.66 μm (P = 0.066) at 1 month post-treatment. All CFT increases were due to the accumulation of subretinal fluid (SRF), rather than the intraretinal or subretinal pigment epithelium fluid. Relative to the pre-treatment BCVA (0.59 logMAR), the mean BCVA at 1 day (0.74 logMAR, P = 0.005) and 1 week (0.75 logMAR, P = 0.002) post-treatment was significantly deteriorated; however, it recovered to 0.62 logMAR at 1 month. The patterns of change in CFT and BCVA did not differ according to treatment modality.ConclusionsHalf-fluence PDT resulted in accumulation of SRF in the immediate post-treatment period; this damage mostly recovered within a week, and the BCVA was restored within a month.

Long-term outcomes of half-fluence photodynamic therapy and eplerenone in chronic central serous chorioretinopathy: A comparative study

To compare the long-term outcomes in chronic central serous chorioretinopathy (cCSC) following half-fluence photodynamic therapy (HF-PDT) and oral eplerenone treatment. This retrospective comparative study included consecutive patients of cCSC treated with either HF-PDT or eplerenone. The treatment outcomes of the two groups were analyzed at 3-month, 6-month, and 12-month post-treatment. This study included 20 eyes (20 patients) in HF-PDT group, and 18 eyes (18 patients) in eplerenone group. All baseline parameters in HF-PDT and eplerenone groups were comparable including neurosensory detachment height (217.05 ± 140.25 µm vs 178.05 ± 164.24 µm respectively, p = 0.09), best-corrected visual acuity (BCVA) (logMAR 0.24 ± 0.13 vs logMAR 0.46 ± 0.37 respectively, p = 0.1), and subfoveal choroidal thickness (SFCT) [427.4 ± 117.4 µm vs 456.38 ± 119.25 µm respectively, p = 0.45]. HF-PDT resulted in complete resolution of neurosensory detachment in higher proportion of eyes compared to eplerenone at each follow-up visits (3 months: 90% vs 27.7%, p = 0; 6 months: 100% vs 61.1%, p = 0.003; and 12 months: 100% vs 70%, p = 0.03) with a significantly shorter duration to resolution (3.3 ± 0.9 months vs 5.8 ± 3.3 months respectively, p = 0.02). Intergroup comparison showed no significant difference between mean BCVA (p = 0.38 at 3 months, p = 0.14 at 6 months, and p = 0.19 at 12 months). Mean SFCT at 12 months of the two groups differed significantly (p = 0.003) due to increased choroidal thickness of eplerenone group. HF-PDT has a superior efficacy to achieve faster, greater and long-lasting resolution of subretinal fluid in cCSC compared to eplerenone therapy.