J Korean Ophthalmol Soc.  2012 Feb;53(2):268-275.

Photodynamic Therapy for Chronic Central Serous Chorioretinopathy According to Degree of Choroidal Hyperfluorescence

• Lim SH
• Chang WH
• Sagong M

Abstract

PURPOSE
To compare the efficacy of photodynamic therapy (PDT) depending on the degree of hyperfluorescence based on indocyanine green angiography (ICGA) for treating chronic central serous chorioretinopathy (CSC).
METHODS
Twenty-three eyes of 23 patients with chronic CSC were recruited for the present study. The minimum follow-up period was six months. The total energy of PDT was reduced to 25 J/cm2 for 83 seconds. The baseline middle-phase ICGA findings were classified as intense or low hyperfluorescence depending on the degree of hyperpermeability from choriocapillaris. The change in mean best-corrected visual acuity, the resolution of subretinal fluid, recurrence rate, and complication were analyzed in relation to each ICGA finding at baseline.
RESULTS
The baseline ICGA findings showed intense hyperfluorescence in 11 eyes (47.8%) and low hyperfluorescence in 12 eyes (52.2%). The subretinal fluid resolved completely one month after a single application of low-fluence PDT in both groups. The subretinal fluid recurred in one of 12 eyes (8.3%) with low hyperfluorescence and in no eyes (0%) with intense hyperfluorescence. There was no statistically significant difference in the rate of recurrence between the two groups.
CONCLUSIONS
Low-fluence PDT appears to be an effective and safe treatment option for long-standing chronic CSC regardless of the degree of hyperfluorescence based on the ICGA.

Keyword

Chronic central serous chorioretinopathy; Indocyanine green angiography; Photodynamic therapy

MeSH Terms

Angiography
Central Serous Chorioretinopathy
Choroid
Eye
Follow-Up Studies
Humans
Indocyanine Green
Photochemotherapy
Recurrence
Subretinal Fluid
Triazenes
Visual Acuity
Indocyanine Green
Triazenes

Figure

• 

  Figure 1 Classification of indocyanine green angiography (ICGA) findings at baseline. The ICGA findings before PDT was applied to overlying areas of RPE leakage on FA, ICGA findings during the middle phase were classified as intense or low hyperfluorescence. First row demonstrates intense hyperfluorescence (A, B, C, D) and second row demonstrates low hyperfluorescence (E, F, G, H). M iddle phase of fluorescein angiography (A, E), early phase of ICGA (B, F), middle phase of ICGA (C, G) and late phase of ICGA (D, H).

Reference

1. Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol. 1967. 63:1–139.

2. Spaide RF, Campeas L, Haas A, et al. Central serous chorioretinopathy in younger and older adults. Ophthalmology. 1996. 103:2070–2079.

3. Spitznas M. Pathogenesis of central serous retinopathy: a new working hypothesis. Graefes Arch Clin Exp Ophthalmol. 1986. 224:321–324.

4. Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol. 1996. 121:26–34.

5. Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina. 1996. 16:203–213.

6. Jalkh AE, Jabbour N, Avila MP, et al. Retinal pigment epithelium decompensation. I. Clinical features and natural course. Ophthalmology. 1984. 91:1544–1548.

7. Ie D, Yannuzzi LA, Spaide RF, et al. Subretinal exudative deposits in central serous chorioretinopathy. Br J Ophthalmol. 1993. 77:349–353.

8. Iida T, Yannuzzi LA, Spaide RF, et al. Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina. 2003. 23:1–7.

9. Ficker L, Vafidis G, While A, Leaver P. Long-term follow-up of a prospective trial of argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1988. 72:829–834.

10. Piccolino FC. Laser treatment of eccentric leaks in central serous chorioretinopathy resulting in disappearance of untreated juxtafoveal leaks. Retina. 1992. 12:96–102.

11. Robertson DM. Argon laser photocoagulation treatment in central serous chorioretinopathy. Ophthalmology. 1986. 93:972–974.

12. Lim SJ, Roh MI, Kwon OW. Intravitreal bevacizumab injection for central serous chorioretinopathy. Retina. 2010. 30:100–106.

13. Schaal KB, Hoeh AE, Scheuerle A, et al. Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol. 2009. 19:613–617.

14. Cardillo Piccolino F, Eandi CM, Ventre L, et al. Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003. 23:752–763.

15. Yannuzzi LA, Slakter JS, Gross NE, et al. Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina. 2003. 23:288–298.

16. Chan WM, Lam DS, Lai TY, et al. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003. 87:1453–1458.

17. Schlötzer-Schrehardt U, Viestenz A, Naumann GO, et al. Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes. Graefes Arch Clin Exp Ophthalmol. 2002. 240:748–757.

18. Schmidt-Erfurth U, Laqua H, Schlötzer-Schrehard U, et al. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol. 2002. 120:835–844.

19. Chan WM, Lai TY, Lai RY, et al. Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study. Retina. 2008. 28:85–93.

20. Reibaldi M, Cardascia N, Longo A, et al. Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol. 2010. 149:307–315.

21. Chang MH, Kim SW, Oh JR, Huh K. Photodynamic therapy with verteporfin using half fluence for chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2009. 50:1326–1333.

22. Kim JL, Kim HW, Yoon IH. Photodynamic therapy with verteporfin for short time for chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2008. 49:1078–1086.

23. Piccolino FC, Borgia L, Zinicola E, Zingirian M. Indocyanine green angiographic findings in central serous chorioretinopathy. Eye (Lond). 1995. 9:324–332.

24. Inoue R, Sawa M, Tsujikawa M, Gomi F. Association between the efficacy of photodynamic therapy and indocyanine green angiography findings for central serous chorioretinopathy. Am J Ophthalmol. 2010. 149:441–446.

25. Arnold J, Kilmartin D, Olson J, et al. Verteporfin in Photodynamic Therapy Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin: 1-year results of a randomized clinical trial-VIP report no. 1. Ophthalmology. 2001. 108:841–852.

26. Schmidt-Erfurth U, Miller JW, Sickenberg M, et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of retreatments in a phase 1 and 2 study. Arch Ophthalmol. 1999. 117:1177–1187.

27. Miller JW, Schmidt-Erfurth U, Sickenberg M, et al. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of a single treatment in a phase 1 and 2 study. Arch Ophthalmol. 1999. 117:1161–1173.

28. Michels S, Hansmann F, Geitzenauer W, Schmidt-Erfurth U. Influence of treatment parameters on selectivity of verteporfin therapy. Invest Ophthalmol Vis Sci. 2006. 47:371–376.

29. Gilbert CM, Owens SL, Smith PD, Fine SL. Long-term follow-up of central serous chorioretinopathy. Br J Ophthalmol. 1984. 68:815–820.

30. Wang MS, Sander B, Larsen M. Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2002. 133:787–793.

31. Costa RA, Scapucin L, Moraes NS, et al. Indocyanine green-mediated photothrombosis as a new technique of treatment for persistent central serous chorioretinopathy. Curr Eye Res. 2002. 25:287–297.

32. Kim M, Chung H. The result of photodynamic therapy in chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2009. 50:1035–1043.

33. Song MH, Lee PY, Kim KS, Lee WK. The effect of photodynamic therapy in chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2007. 48:1048–1056.

34. Feigl B, Brown B, Lovie-Kitchin J, Lee L. Dynamics of retinal function after multiple photodynamic therapies in age-related macular degeneration: a report of cases. Doc Ophthalmol. 2005. 111:135–148.

35. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials--TAP report. Arch Ophthalmol. 1999. 117:1329–1345.

36. Verteporfin In Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization--verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 2001. 131:541–560.