Treatment Of Chronic Chronic Central Serous Chorioretinopathy Research Articles

Лазерная фотодинамическая терапия в лечении хронической центральной серозной хориоретинопатии без хориоидальной неоваскуляризации

Purpose. To estimate preliminary results of photodynamic therapy in patients with chronic central serous chorioretinopathy (CSCRP) without choroidal neovascularization. Relevance. Central serous chorioretinopathy, especially the chronic form, remains an urgent problem in ophthalmology. To date, various methods of treating this pathology have been proposed, the main of which are conservative therapy and laser treatment. The latter includes Transpupillary Thermotherapy (TTT), Micropulse Laser Treatment and Photodynamic Therapy (PDT). Unfortunately, not one technique today can claim the title of “method of the first choice”, because proven absolute superiority in treatment outcomes among these methods has not been identified. Nevertheless, PDT in recent years has shown fairly good results in the treatment of chronic CSCRP. Material and methods. We have treated 12 patients with chronic CSCRP without choroidal neovascularization (CN) by PDT with photolon. In this article, we presented all the initial data, as well as gave a detailed description of the applied parameters of laser exposure. Results. Our patients were followed up from 3 to 13 months, and the preliminary results of treatment are encouraging. In almost all cases, we received a positive trend in treatment without any formidable complications. Conclusions. Preliminary results show that PDT with photolon is not inferior in efficiency and is economically superior to other foreign analogues. Keywords: photodynamic therapy, photolon.

Анализ эффективности применения ингибитора ангиогенеза при лечении хориоидальной неоваскуляризации у пациентов с хронической формой центральной серозной хориоретинопатии

Purpose. To evaluate efficacy of angiogenesis inhibitor ranibizumab (Lucentis, Novartis, Switzerland) in treatment of choroidal neovascularization (CNV) in patients with chronic central serous chorioretinopathy (CSCR). Material and methods. The object of study was 11 patients (8 men and 3 women, 11 eyes) aged from 41 to 50 years with CNV on the background of chronic CSCR. All monitored patients underwent 3 consecutive “loading” intravitreal Lucentis injections is either 0.5 mg in 0.05 mL once a month. Results. After 3 months, all studied patients had complete obliteration of CNV. At the same time, the central retinal thickness was 224.5±13.3 µm, which did not differ significantly from norm (p<0.05). All 11 patients had stabilization of visual functions with average index of best corrected visual acuity of 0.9±0.13, exceeding the initial level by 0.15±0.04 (p<0.05), an increase in light sensitivity of central retinal zone was noted up to 22.41±1.2 dB. Conclusion. The data obtained allow us to state that timely use of angiogenesis inhibitor Lucentis in treatment of CNV in patients with the chronic CSCR is pathogenetically justified, effective and safe. Given frequency of recurrence, further studies of anti-VEGF therapy in treatment of chronic CSCR are needed to determine the need for repeated injections of anti-VEGF drugs. Key words: central serous chorioretinopathy, choroidal neovascularization, Lucentis.

Clinical observation on the efficacy of intravitreal injection of Ranibizumab for central serous chorioretinopathy

Objective To observe the efficacy of intravitreal injection of Ranibizumab for the treatment of chronic central serous chorioretinopathy(CSC). Methods Prospective cohort study. Forty-eight eyes of 45 cases with chronic CSC from Dec. 2015 to Jan. 2017 were recruited in this study. All cases received intravitreal injection of Ranibizumab. The visual acuities were recorded before and 2, 4, 8 weeks after injection. Subfoveal choroidal thickness (SFCT) and central macular choroidal thickness (CMCT) of 1 500 μm superior, inferior, nasal and temporal to the fovea were measured by OCT. Results The visual acuity (Log MAR) was 0.33±0.08, 0.24±0.19, 0.18±0.17 and 0.16±0.20 before and 2, 4, 8 weeks after injection. The visual acuities at different time point after injection were better than that before injection. The difference was significant between before and after injection(F=18.50, P=0.00). SFCT before injection was (443.63 ±98.32) μm, which decreased significantly to (393.55±97.66) μm, (379.53±93.55) μm, (388.30±96.52) μm at 2, 4, 8 weeks after treatment respectively(F=105.54, P<0.01). The changing trends of choroidal thickness measuring points were similar to the SFCT. Conclusion Intravitreal injection of Ranibizumab for the treatment of chronic CSC can reduce posterior choroidal thickness and improve vision. Key words: Chorioretinopathy, serous, central, chronic; Ranibizumab, intravitreal injection; Choroidal thickness

Half-fluence photodynamic therapy in chronic central serous chorioretinopathy

Purpose: The aim of this study is to investigate the effect of half-fluence photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSC). Materials and Methods: Forty-two eyes of 34 patients with chronic CSC and symptoms for at least 6 months were retrospectively reviewed. All eyes were treated with indocyanine green (ICG)-guided half-fluence PDT. The primary outcome measure was the proportion of eyes with complete resolution of subretinal fluid (SRF) on spectral domain-optical coherence tomography (SD-OCT). The secondary outcome measure was change in best corrected visual acuity (BCVA). SPSS v. 16 software was used for statistical analysis. Results: The mean follow-up period was 12.5 ± 4.3 months. Twenty six (78.78%) eyes showed complete resolution of SRF (P Conclusion: Half-fluence PDT is an effective and safe method in the treatment of chronic CSC with stabilization or improvement of anatomical and functional outcomes.

Low-Fluence Photodynamic Therapy versus Subthreshold Micropulse Yellow Wavelength Laser in the Treatment of Chronic Central Serous Chorioretinopathy.

Purpose. To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC). Methods. Thirty-three eyes of 30 patients with chronic CSC received either PDT (18 eyes) or SMYL (15 eyes) therapy. Best corrected visual acuity (BCVA), subretinal fluid (SRF) height, and central macular thickness (CMT) were evaluated at the baseline visit and one, three, six, nine, and 12 months after the therapy. Results. After 12 months, mean BCVA improved from 67.3 ± 14.2 to 71.5 ± 21.4 ETDRS letters in SMYL group and from 60.7 ± 16.3 to 64.4 ± 24.9 ETDRS letters in PDT group (p = 0.285 and p = 0.440, resp.). Mean CMT decreased from 242.8 ± 80 μm to 156.9 ± 60 μm in the PDT group and from 287.3 ± 126 μm to 138.0 ± 40 μm in the SMYL group (p = 0.098 and p = 0.003, resp.). SRF resolved completely in 72.2% and 80.0% of the eyes in the PDT and SMYL groups, respectively. Mean SRF height decreased from 117.2 ± 58 μm to 31.3 ± 56 μm in the PDT group and from 130.0 ± 104 μm to 12.5 ± 21 μm in the SMYL group (p = 0.031 and p = 0.014, resp.). Conclusions. Subthreshold micropulse yellow wavelength laser seems to be effective in the treatment of chronic CSC without any side effect and results in the resorption of SRF without causing visible retinal scarring.

Our experience with anti‐VEGF treatment on central serous retinopathy

PurposeTo evaluate the short‐term efficacy of intravitreal anti‐VEGF for the treatment of subretinal fluid (SRF) and/or pigment epithelium detachment (PED) secondary to chronic central serous chorioretinopathy (CSR).MethodsSixteen patients were treated with intravitreal injections of anti‐VEGF at 6‐ to 8‐week intervals until SRF and/or PED resolved. Main outcomes were Best‐Corrected Visual Acuity (BCVA), central retinal thickness (CRT) measured with optical coherence tomography (OCT), performed at 6‐ to 8‐week intervals and number of injections. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings.ResultsPatients received 3.16 (range: 1–15) intravitreal injections of anti‐VEGF on average during a follow‐up of 22 +/‐ 2 weeks. Mean BCVA increased by 11.2 letters and mean CRT decreased significantly over follow‐up from 396.68 µm at baseline to 250.36 µm on last visit. 5 patients (31.25%) showed complete resolution of subretinal fluid and PED, 6 patients (37.5%) had persistent SRF and 5 patients (31.25%) had persistent PED.ConclusionsAnatomic and functional improvement following intravitreal anti‐VEGF injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSR. The results suggest a possible role for anti‐VEGF agents in the treatment of chronic CSR.

Therapeutic benefit of melatonin in refractory central serous chorioretinopathy.

To evaluate the efficacy and safety of melatonin for the treatment of chronic central serous chorioretinopathy (CSCR). Prospective comparative case series. A total of 13 patients with chronic CSCR were treated for 1 month: 8 patients were treated orally with 3 mg melatonin t.i.d., and 5 with placebo. All patients had 20/40 or worse Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) in the affected eye or presented an incapacitating scotoma. Most of the patients had previous failed treatments for their condition. Observational procedures included ETDRS BCVA, and complete ophthalmic examination. Optical coherence tomography (OCT) was performed at day 1 and week 4. Fluorescein angiography was performed at baseline only for diagnostic purposes. Data were subjected to two-sample t-test statistical analysis. P-values of <0.05 were considered statistically significant. At 1-month follow-up, BCVA significantly improved in 87.5% of patients treated with melatonin (7 of 8 patients, P<0.05). All patients showed a mean significant reduction (P<0.01) of central macular thickness (CMT) when compared with the baseline, with 3 patients (37.5%) exhibiting complete resolution of subretinal fluid at 1-month follow-up. No significant side effects were observed. No changes in BCVA or CMT were noted in the control group. These results suggest that melatonin is safe, well tolerated, and effective in the treatment of chronic CSCR, as it significantly improved BCVA and CMT in patients with this pathology. Further evaluations with longer follow-up and a larger patient population are desirable.

Low-Fluence Photodynamic Therapy versus Ranibizumab for Chronic Central Serous Chorioretinopathy: One-Year Results of a Randomized Trial

To compare the efficacy and safety between low-fluence photodynamic therapy (PDT) and the intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). Prospective, randomized, single-center, parallel-arm, controlled trial. Thirty-four eyes of 32 patients with chronic CSC with >6 months' duration of symptoms or recurrent CSC were randomly placed into the low-fluence PDT group (n = 18) or the ranibizumab group (n = 16). The patients underwent a single session of low-fluence PDT or 3 consecutive monthly injections of ranibizumab. Rescue treatment was available from month 3 if the subretinal fluid (SRF) persisted or recurred after primary treatment; low-fluence PDT was given to the ranibizumab group and intravitreal ranibizumab to the low-fluence PDT group. The primary outcome was the proportion of eyes with complete resolution of SRF without rescue treatment. Secondary outcomes included the mean changes in logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA), central retinal thickness (CRT), and angiographic findings from baseline to 12 months. At month 12, 16 eyes (88.9%) of the low-fluence PDT group maintained complete resolution of SRF without rescue treatment versus 2 eyes (12.5%) in the ranibizumab group (P <0.001). Two eyes (11.1%) in the low-fluence PDT group and 11 eyes (68.8%) in the ranibizumab group met the criteria for rescue treatment (P = 0.001). In the low-fluence PDT group, the mean decrease in CRT from baseline was significantly greater than that in the ranibizumab group until month 6 (P <0.05), but the differences became insignificant thereafter. The improvement in BCVA from baseline was superior in the low-fluence PDT group to that in the ranibizumab group, but the differences were not statistically significant except at month 3 (P = 0.025). On indocyanine green angiography, a significantly greater proportion of the low-fluence PDT group (16 eyes; 88.9%) showed a marked reduction in choroidal hyperpermeability after primary treatment than that of the ranibizumab group (0 eyes; P <0.001). No serious adverse events related to the drugs or procedures were observed. This study represents the overall superiority of low-fluence PDT compared with intravitreal ranibizumab in the treatment of chronic CSC.

LOW-DOSE METHOTREXATE FOR THE TREATMENT OF CHRONIC CENTRAL SEROUS CHORIORETINOPATHY

To evaluate the utility of oral methotrexate (MTX) for the treatment of chronic central serous chorioretinopathy (CSCR). Retrospective review of all eyes of patients on oral MTX as treatment for chronic CSCR in three different centers. Visual acuity as well as optical coherence tomography central macular thickness and total volume parameters were analyzed. Complete blood count and serum chemistry results were monitored. Nine eyes of 9 patients treated with MTX for chronic CSCR met the criteria for analysis. Mean duration of CSCR was 28 months (range, 3-94 months). Mean starting dose of oral MTX was 7.04 mg (range, 5-10 mg), and mean final dose was 7.27 mg (range, 5-10 mg). The mean duration of treatment was 89 days. Mean visual acuity improved from 20/67 at baseline to 20/35 at 8 weeks (P < 0.01, paired t-test). Mean central macular thickness improved from 309 μm to 213 μm at 8 weeks (P < 0.01, paired t-test). Mean total macular volume improved from 8.14 to 7.21 at 8 weeks (P ≤ 0.02, paired t-test). Eighty-three percent of the patients achieved total resolution of subretinal fluid. No MTX-associated toxicity was evident. Methotrexate may have a role in the treatment of chronic CSCR as evidenced by these results. A randomized controlled clinical trial is warranted to better understand the effects of MTX in these patients.

Intravitreal Bevacizumab for Treatment of Chronic Central Serous Chorioretinopathy

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to chronic central serous chorioretinopathy (CSC). Twelve patients were treated with intravitreal injections of 2.5 mg bevacizumab at 6- to 8-week intervals until intraretinal or subretinal fluid resolved. Observation procedures were Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT), performed at 6- to 8-week intervals. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Multivariate analysis of variance with repeated measures was used to calculate a statistical significance of change in BCVA and mean central retinal thickness, which were the main outcome measures. SAS statistical software was used for analyses. Patients received 2-/+1 intravitreal injections of bevacizumab on average during a follow-up of 24-/+14 weeks. Mean BCVA increased by 2-/+2 lines; the change in BCVA (logMAR) was significant (p<0.02). Mean central retinal thickness decreased significantly over follow-up (p<0.05), with 6 patients (50%) showing complete resolution of subretinal fluid. Anatomic and functional improvement following intravitreal bevacizumab injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSC. The results suggest a possible role for anti-VEGF agents in the treatment of chronic CSC. Further evaluation of intravitreal bevacizumab for chronic CSC in controlled randomized studies is warranted.