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Photodynamische Therapie mit halber Verteporfindosis bei chronischer Chorioretinopathia centralis serosa

Photodynamic therapy with half dose of verteporfin in patients with chronic central serous chorioretinopathy

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Zusammenfassung

Hintergrund

Die photodynamische Therapie (PDT) mit Verteporfin in der Behandlung der Chorioretinopathie centralis serosa (CCS) hat sich in einigen Studien als wirksam erwiesen. Wir untersuchten in der vorliegenden Studie, ob eine Halbierung der Verteporfindosis in der Behandlung der chronischen Form der CCS genauso effektiv ist.

Patienten und Methode

Siebzehn Patienten mit chronischer CCS wurden einer PDT mit einer Verteporfindosis von 3 mg/m2 Körperoberfläche unterzogen. Als Zielkriterien wurden Sehschärfe, Resorption der subretinalen Flüssigkeit in der optischer Kohärenztomografie (OCT) und Verschwinden der Quellpunkte in der Fluoreszeinangiographie (FA) gewählt.

Ergebnisse

Die mittlere Beschwerdedauer war 15 Monate (3–84 Monate; Median: 12 Monate) und die Nachbeobachtungszeit lag zwischen 6 und 17 Monate (Median: 9,7 Monate). Der Visus verbesserte sich um zwei oder mehr Zeilen bei 9 Patienten (53%), blieb unverändert bei 7 (41%) und verschlechterte sich bei einem Patienten (6%) durch eine verstärkte Atrophie des retinalen Pigmentepithels. Der durchschnittliche Visus verbesserte sich statistisch signifikant um 1,1 Zeilen (p < 0,01). Bei 11 Patienten (65%) resorbierte sich die subretinale Flüssigkeit im OCT vollständig, bei 6 (35%) unvollständig. Die Quellpunkte in der FA verschwanden vollständig bei 12 Patienten (71%), Restleckagen waren noch bei 3 Augen (17%) und aktive Quellpunkte bei 2 (12%) zu finden.

Schlussfolgerung

Nach unserer Pilotstudie ist die PDT mit halber Verteporfindosis in der Behandlung der chronischen CCS wirksam mit Resorption der subretinalen Flüssigkeit und Verschwinden der Quellpunkte. Als Wirkmechanismus kann eine Beeinflussung des choroidalen Blutflusses durch die PDT angenommen werden.

Summary

Background

In several studies photodynamic therapy (PDT) with verteporfin has shown to be effective in the treatment of chronic central serous chorioretinopathy (CCSC). Aim of this study was to investigate the efficacy of photodynamic therapy (PDT) in this subset of patients using a reduced dose of verteporfin.

Patients and methods

Seventeen eyes of 17 consecutive patients with CCSC received PDT with a reduced dose of verteporfin (3 mg/m2 body surface area followed by application of 50 J/cm2 laser at 689 run). Main outcome measures were best-corrected visual acuity, resolution of subretinal fluid on optical coherence tomography (OCT) and disappearence of fluorescein leakage.

Results

The mean duration of symptoms was 15 months (3–84 months; median: 12 months) and the followup ranged between 6 and 27 months (median: 10 months). The visual acuity improved two or more lines in 9 eyes (53%), remained stable in 7 eyes (41%) and decreased in one patient (6%) due to retinal pigment epthelium (RPE) atrophy. The mean visual acuity improved statistical significantly by 1.1 lines (p < 0.01). Eleven (65%) had a complete and 6 (35%) an incomplete anatomic resolution of the subretinal fluid on OCT. Fluorescein leakage disappeared completely in 12 eyes (71%). Residual leakage was found in 3 patients (17%) and persistent active leaks in 2 (12%).

Conclusion

Our pilot study demonstrates that photodynamic therapy with a low dose of verteporfin appears to have a beneficial effect in treating patients with CCSC by reducing fluid leakage and subretinal fluid accumulation. PDT with half dose of verteporfin seems to be sufficient to affect the choroidal blood flow and to decrease fluid passage towards the retina.

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Literatur

  1. Spaide RF, Hall L, Haas A, Campeas L, Yannuzzi LA, Fisher YL, Guyer DR, Slakter JS, Sorenson JA, Orlock DA (1996) Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina 16: 203–213

    Article  PubMed  CAS  Google Scholar 

  2. Gass JDM (1973) Bullous retinal detachment. An unusual manifestation of idiopathic central serous choroidopathy. Am J Ophthalmol 75: 810–821

    PubMed  CAS  Google Scholar 

  3. Gass JDM (1991) Central serous chorioretinopathy and white subretinal exudation during pregnancy. Arch Ophthalmol 109: 677–681

    PubMed  CAS  Google Scholar 

  4. Ie D, Yannuzi LA, Spaide RF, Rabb MF, Blair NP, Daily MJ (1993) Subretinal exudative deposits in central serous chorioretinopathy. Br J Ophthalmol 77: 349–353

    Article  PubMed  CAS  Google Scholar 

  5. Iida T, Yannuzzi LA, Spaide RF, Borodoker N, Carvalho CA, Negrao S (2003) Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina 23 (1): 1–7

    Article  PubMed  Google Scholar 

  6. Schatz H, McDonald R, Johnson RN, Chan CK, Irvine AR, Berger AR, Folk JC, Robertson DM (1995) Subretinal fibrosis in central serous chorioretinopathy. Ophthalmology 102: 1077–1088

    PubMed  CAS  Google Scholar 

  7. Yannuzzi LA, Shakin JL, Fisher YL, Altomonte MA (1984) Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigmentepitheliopathy. Ophthalmology 91: 1554–1571

    PubMed  CAS  Google Scholar 

  8. Spaide RF, Campeas L, Haas A, Yannuzzi LA, Fisher YL, Guyer DR, Slakter JS, Sorenson JA, Orlock DA (1996) Central serous chorioretinopathy in younger and older adults. Ophthalmology 103: 2070–2079

    PubMed  CAS  Google Scholar 

  9. Jampol LM, Weinreb R, Yannuzzi L (2002) Involvement of corticosteroids and catecholamines in the pathogenesis of central serous chorioretinopathy: a rationale for new treatment strategies. Ophthalmology 109 (10): 1765–1766. Review

    Article  PubMed  Google Scholar 

  10. Burumcek E, Mudun A, Karacorlu S, Arslan MO (1997) Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up. Ophthalmology 104: 616–622

    PubMed  CAS  Google Scholar 

  11. Cardillo Piccolino F, Eandi CM, Ventre L, Rigault de la Longrais RC, Grignolo FM (2003) Photodynamic therapy for chronic central serous chorioretinopathy. Retina 23: 752–763

    Article  Google Scholar 

  12. Taban M, Boyer DS, Thomas EL, Taban M (2004) Chronic central serous chorioretinopathy: photodynamic therapy. Am J Ophthalmol 137 (6): 1073–1080

    Article  PubMed  Google Scholar 

  13. Yannuzzi LA, Slakter JS, Gross NE, Spaide RF, Costa DL, 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

    Article  PubMed  Google Scholar 

  14. Bressler NM (2001) 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: two-year results of 2 randomized clinical trials-tap report 2. Arch Ophthalmol 119: 198–207

    PubMed  CAS  Google Scholar 

  15. Kitaya N, Nagaoka T, Hikichi T, Sugawara R, Fukui K, Ishiko S, Yoshida A (2003) Features of abnormal choroidal circulation in central serous chorioretinopathy. Br J Ophthalmol 87: 709–712

    Article  PubMed  CAS  Google Scholar 

  16. Prunte C, Flammer J (1996) Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol 121: 26–34

    PubMed  CAS  Google Scholar 

  17. Guyer DR, Yannuzzi LA, Slakter JS, Sorenson JA, Ho A, Orlock D (1994) Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol 112: 1057–1062

    PubMed  CAS  Google Scholar 

  18. Tittl M, Maar N, Polska E, Weigert G, Stur M, Schmetterer L (2005) Choroidal hemodynamic changes during isometric exercise in patients with inactive central serous chorioretinopathy. Invest Ophthalmol Vis Sci 46 (12): 4717–4721

    Article  PubMed  Google Scholar 

  19. Schmidt-Erfurth U, Michels S, Barbazetto I, Laqua H (2002) Photodynamic effects on choroidal neovascularization and physiological choroid. Invest Ophthalmol Vis Sci 43: 830–841

    PubMed  Google Scholar 

  20. Schmidt-Erfurth U, Schlotzer-Schrehard U, Cursiefen C, Michels S, Beckendorf A, Naumann GO (2003) Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF), VEGF receptor 3, and pigment epithelium-derived factor. Invest Ophthalmol Vis Sci 44 (10): 4473–4480

    Article  PubMed  Google Scholar 

  21. Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, Chan CK (2003) 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 87 (12): 1453–1458

    Article  PubMed  Google Scholar 

  22. Lai TY, Chan WM, Li H, Lai RY, Liu DT, Lam DS (2006) Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study. Br J Ophthalmol 50: 161–169

    Google Scholar 

  23. Postelmans L, Pasteels B, Coquelet P, El Ouardighi H, Verougstraete C, Schmidt-Erfurth U (2004) Severe pigment epithelial alterations in the treatment area following photodynamic therapy for classic choroidal neovascularization in young females. Am J Ophthalmol 138 (5): 803–808

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Univ.-Augenklinik, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich

    A. Haas, G. Mossböck, C. Stangl, C. Wohlfart, M. Bachernegg, P. Fürschuss-Wolff & M. Weger

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  1. A. Haas
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  2. G. Mossböck
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  3. C. Stangl
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  4. C. Wohlfart
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  5. M. Bachernegg
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  6. P. Fürschuss-Wolff
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  7. M. Weger
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Correspondence to A. Haas.

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Haas, A., Mossböck, G., Stangl, C. et al. Photodynamische Therapie mit halber Verteporfindosis bei chronischer Chorioretinopathia centralis serosa. Spektrum Augeheilkd 20, 227–230 (2006). https://doi.org/10.1007/BF03163805

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