Abstract
Background
To report the anatomic and functional outcomes of a single-session combined photodynamic therapy with verteporfin (PDT) and intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) in patients with chronic central serous chorioretinopathy (CCSCR).
Methods
Retrospective interventional comparative case series of eyes with symptomatic CCSCR (duration ≥4 months) and macular neurosensory retinal detachment (MNSRD). The study group, eight eyes (six patients), received a single session of combined full-fluence PDT and IVT anti-VEGF [bevacizumab (2.5 mg), four eyes; pegaptanib sodium [0.3 mg], four eyes). A matched control group, ten eyes (seven patients), treated with full-fluence PDT alone, was included. All patients had 12 months of follow-up.
Results
The mean CCSCR duration was 12.5 ± 14.2 months (range: 4–47 months) in the study group. In the control group, the mean CCSCR duration was 15.3 ± 7.5 months (range: 4–24 months). In the study group, the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 0.6 (20/80) to 0.2 (20/30) (P = 0.011). Central macular thickness (CMT) measured by optical coherence tomography (OCT) decreased from 288.4 μ (range: 165–375 μ) at baseline to a CMT of 163.1 μ (range: 120–200 μ) (P = 0.005) at 12 months. In the control group, the mean logMAR BCVA improved from 0.7 (20/100) to 0.6 (20/80) (P = 0.43). CMT decreased from 332.9 μ (range: 171–495 μ) at baseline to a CMT of 213.1 μ (range: 133–307 μ) (P = 0.002) at 12 months. At 12 months, MNSRD resolved completely in eight eyes (100%) and in seven eyes (70%), in the study group and the control group respectively. In the control group, four eyes (40%) required more than one PDT session (mean: 2.6 sessions; range: 2–4) due to persistent MNSRD. Retinal pigment epithelium (RPE) atrophy changes but no leakage were seen by fluorescein angiography in all eight eyes (100%) in the study group, and in three out of ten eyes (30%) in the control group. No systemic adverse events were observed.
Conclusions
Combined PDT and IVT anti-VEGF therapy seems to aid in the resolution of MNSRD in patients with CCSCR. Combination therapy was associated with a rapid reduction in MNSRD and improvement in BCVA with no recurrences at 12 months. However, combination therapy with full-fluence PDT has the potential to accelerate RPE atrophy, and this needs further study.
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References
Bujarborua D, Chatterjee S, Choudhury A, Bori G, Sarma AK (2005) Fluorescein angiographic features of asymptomatic eyes in central serous chorioretinopathy. Retina 25:422–429
Wang M, Munch IC, Hasler PW, Prünte C, Larsen M (2008) Central serous chorioretinopathy. Review article. Acta Ophthalmol 86:126–145
Yannuzzi LA (1987) Type A behavior and central serous chorioretinopathy. Retina 7:111–131
Loo RH, Scott IU, Flynn HW Jr, Gass JDM, Murray TG, Lewis ML, Rosenfeld PJ, Smiddy WE (2002) Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina 22:19–24
Taban M, Boyer DS, Thomas EL (2004) Chronic central serous chorioretinopathy: photodynamic therapy. Am J Ophthalmol 137:1073–1080
Gass JDM (1997) Stereoscopic atlas of macular diseases: diagnosis and treatment, 4th edn. Mosby, St. Louis, pp 52–70
Cardillo F, Rigault R, Ravera G, Eandi CM, Ventre L, Abdollahi A, Manea M (2005) The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol 139:87–99
Ergun E, Tittl M, Stur M (2004) Photodynamic therapy with verteporfin in subfoveal choroidal neovascularization secondary to central serous chorioretinopathy. Arch Ophthalmol 122:37–41
Chan W-M, Lai TYY, Lai RYK, Tang EWH, Liu DTL, Lam DSC (2008) Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy. Retina 28:85–93
Battaglia PM, Da Pozzo S, Ravalico G (2003) Photodynamic therapy in chronic central serous chorioretinopathy. Retina 23:235–237
Bressler NM (1999) 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 trial-TAP report no. 1. Arch Ophthalmol 117:1329–1345
Schlotzer-Schrehardt U, Viestenz A, Naumann GO et al (2002) Dose-related structural effects of photodynamic therapy in human eyes. Arch Ophthalmol 240:748–757
Chan W-M, Lai TYY, Liu DTL, Lam DSC (2007) Intravitreal bevacizumab (Avastin) for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin. Am J Ophthalmol 143:977–983
Lee PY, Kim KS, Lee WK (2009) Severe choroidal ischemia following photodynamic therapy for pigment epithelial detachment and chronic central serous chorioretinopathy. Jpn J Ophthalmol 53:52–56
Chan W-M, Lam DSC, Lai TYY, Tam BSM, LIU DTL, Chan CKM (2003) Choroidal vascular remodeling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol 87:1453–1458
Cardillo F, Eandi CM, Ventre L, De la Longrais R, Grignolo FM (2003) Photodynamic therapy for central serous chorioretinopathy. Retina 23:752–763
Yannuzzi LA, Slakter JS, Gross NE, Spaide RF, Costa DLL, Huang SJ, Klancnik JM Jr, Aizman A (2003) Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy. A pilot study. Retina 23:288–298
Parodi MB, Pozzo SDA, Ravalico G (2003) Photodynamic therapy in chronic central serous chorioretinopathy. Retina 23:235–237
Schmidt-Erfurth U, Hasan T (2000) Mechanism of action of photodynamic therapy with verteporfin for the treatment of age-related macular degeneration. Surv Ophthalmol 45:195–214
Niegel MF, Schrage NF, Christmann S, Degenring RF (2008) Intravitreal bevacizumab for chronic central serous chorioretinopathy. Ophthalmologe 105:943–945
Torres-Soriano ME, García-Aguirre G, Kon-Jara V, Ustariz-Gonzáles O, Abraham-Marín M, Ober MD, Quiroz-Mercado H (2008) A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports). Graefes Arch Clin Exp Ophthalmol 246:1235–1239
Schaal KB, Hoeh AE, Scheuerle A, Schuett F, Dithmar S (2009) Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol 19:613–617
Lim SJ, Roh MI, Kwon OW (2010) Intravitreal bevacizumab injection for central serous chorioretinopathy. Retina 30:100–106
Spitzer MS, Yoeruek E, Sierra A, Wallenfels-Thilo B, Schraermeyer U, Spitzer B et al (2007) Comparative antiproliferative and cytotoxic profile of bevacizumab (Avastin), pegaptanib (Macugen) and ranibizumab (lucentis) on different ocular cells. Graefes Arch Clin Exp Ophthalmol 245:1837–1842
Hatta Y, Ishikawa K, Nishihara H, Ozawa S, Ito Y, Terasaki H (2010) Effect of photodynamic therapy alone or combined with posterior subtenon triamcinolone acetonide or intravitreal bevacizumab on choroidal hypofluorescence by indocyanine green angiography. Retina 30:495–502
Chan WM, Lai TY, Lai RY, Liu DT, Lam DS (2008) Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology 115:1756–1765
Stewart JM (2006) Half dose verteporfin PDT for central serous chorioretinopathy. Br J Ophthalmol 90:805–806
Reibaldi M, Cardascia N, Longo A, Furino C, Avitabile T, Faro S, Sanfilippo M, Russo A, Uva MG, Munno F, Cannemi V, Zagari M, Boscia F (2010) Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol 149:307.e2–315.e2
Shin JY, Woo SJ, Yu HG, Park KH (2011) Comparison of efficacy and safety between half-fluence and full-fluence photodynamic therapy for chronic central serous chorioretinopathy. Retina 31:119–126
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The authors have no financial or proprietary interest in any of the products or techniques mentioned in this article.
Supported in part by the Arevalo–Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela.
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Arevalo, J.F., Espinoza, J.V. Single-session combined photodynamic therapy with verteporfin and intravitreal anti-vascular endothelial growth factor therapy for chronic central serous chorioretinopathy: a pilot study at 12-month follow-up. Graefes Arch Clin Exp Ophthalmol 249, 1159–1166 (2011). https://doi.org/10.1007/s00417-011-1651-7
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DOI: https://doi.org/10.1007/s00417-011-1651-7