J Korean Ophthalmol Soc.  2015 Feb;56(2):205-212. 10.3341/jkos.2015.56.2.205.

Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy

• Kim JA
• Shin JY
• Bae SH
• Ahn JY
• Chung H
• Heo JW

• KMID: 2216003
• DOI: http://doi.org/10.3341/jkos.2015.56.2.205

Abstract

PURPOSE
To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC).
METHODS
Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumab for chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessful at 3 months. A commercially available image analysis program (Adobe(R) Photoshop(R) CS6 [Adobe Systems, Inc., San Jose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energy PDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatment images after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability.
RESULTS
The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 +/- 8.74) than in the ranibizumab group (6.78 +/- 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolution of subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energy PDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5 eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showing poor response (10.31 +/- 4.00 vs. 2.74 +/- 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significant difference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124).
CONCLUSIONS
Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC, greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may be attributed to greater influence on choroidal hyperpermeability.

Keyword

Choroidal hyperpermeability; Chronic central serous chorioretinopathy; Half-energy photodynamic therapy; Intravitreal ranibizumab injection

MeSH Terms

Angiography
Central Serous Chorioretinopathy*
Choroid*
Indocyanine Green
Intravitreal Injections
Photochemotherapy*
Subretinal Fluid
Ranibizumab
Indocyanine Green

Figure

• 

  Figure 1. The method of calculating choroidal hyperpermeability changes after treatment of chronic central serous chorioretinopathy. A 47-year-old female treated with half energy photodynamic therapy (HE-PDT) for chronic central serous chorioretinopathy (CSC). Hyperfluorescent dilated choroidal vessels seen before treatment (A) was disappeared after half-energy PDT (B). The dashed ovoid lines (A, B, and C) indicate the area with choroidal hypermeabity at pretreatment. We quantified the change in choroidal hyper-permeability after treatment for chronic central serous chorioretinopathy using commercially available image analysis software (Adobe® Photoshop® CS6 [Adobe Systems, Inc., San Jose, CA]). By this software, we calculated the mean gray scale in the reference area (circled area in A, B, and C) for correction the contrast difference between pretreatment indocyanine green angiography (ICGA) image and post-treatment ICGA image. We subtracted post-treatment ICGA image from pre-treatment ICGA image to make the subtracted image representing the change in choroidal hyperpermeability after treatment for chronic CSC (C). We calculate in-tegrated gray scale value per area in subtracted image for analysis of change in choroidal hyperpermeability.

• 

  Figure 2. Flow chart of treatment progress. CSC = central serous chorioretinopathy; HE-PDT = half energy photo-dynamic therapy.

• 

  Figure 3. The calculated changes in choroidal hyperpermeability after treatment for chronic central serous chorioretinopathy according to primary treatment methods (HE-PDT versus 3 consecutive intravitreal ranibizumab injections). HE-PDT = half * Between-group comparison energy photodynamic therapy. was evaluated by Mann-Whitney U-test.

• 

  Figure 4. The comparison of change of choroidal hyper-permeability after treatment in the successfully treated eyes for chronic central serous chorioretinopathy (HE-PDT versus 3 consecutive intravitreal ranibizumab injections). HE-PDT = half energy photodynamic therapy. * Between-group comparison was evaluated by Mann-Whitney U-test.

• 

  Figure 5. The comparison of change of choroidal hyper-permeability after treatment in the eyes treated with 3 consecutive intravitreal ranibizumab injections for chronic central serous chorioretinopathy. * Between-group comparison was evaluated by Mann-Whitney U-test.

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  Figure 6. The association of the change in choroidal hyper-permeability with decrease in central forveal thickness. HE-PDT = half energy photodynamic therapy.

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