Spektrum der Augenheilkunde

, Volume 32, Issue 6, pp 215–222 | Cite as

Long-term follow-up of half-fluence photodynamic therapy in acute central serous chorioretinopathy

  • Eva SmretschnigEmail author
  • Stefan Hagen
  • Jutta Gamper
  • Ilse Krebs
  • Susanne Binder
  • Siamak Ansari-Shahrezaei
original article



To evaluate the long-term results of indocyanine green angiography(ICGA)-guided verteporfin (Visudyne®, Novartis, Basel, Switzerland) photodynamic therapy (PDT) with half-fluence rate in the treatment of acute symptomatic central serous chorioretinopathy (CSC).

Material and methods

A retrospective review was performed of 12 patients with acute symptomatic CSC verified by spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA), treated with ICGA-guided verteporfin (6 mg/m2)-PDT with half-fluence rate (25 J/cm2). The vision-related quality of life (VR QOL) 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was completed by all patients and 82 controls.


Best corrected visual acuity (BCVA) at baseline was 77.5 (±10; n = 12) according to the Early Treatment Diabetic Retinopathy Study (EDTRS) letter score and changed to 89 letters (±9.9; p = 0.0003) at long-term follow-up (83.8 ± 4.8 months after PDT). Baseline contrast sensitivity (CS) was 29.5 ± 4.5 Pelli–Robson letters and increased to 34.5 ± 4.5 letters at long term (p < 0.0006). Baseline central foveal thickness (CFT) was 419 μm and decreased to 242 µm at long term (p < 0.0001). The long-term vision-related quality of life of patients was similar to that of controls.


ICGA-guided half-fluence PDT with verteporfin results in excellent long-term visual improvement in BCVA and CS, a significant reduction of CFT, and high levels of VR QOL.


Central serous chorioretinopathy Indocyanine green angiography Photodynamic therapy National Eye Institute Visual Function Questionnaire Long term outcome 

Langzeitergebnisse nach photodynamischer Therapie mit reduzierter Lichtdosis bei akuter Chorioretinopathia centralis serosa



Langzeitergebnisse der mittels Indozyaningrünangiographie (ICGA) gesteuerten photodynamischen Therapie (PDT) mit reduzierter Lichtdosis und Gabe von Verteporfin (Visudyne®, Novartis, Basel, Schweiz) zur Behandlung der akuten symptomatischen Chorioretinopathia centralis serosa (CSC) werden präsentiert.

Material und Methode

Retrospektiv wurden Daten von 12 Patienten ausgewertet, bei denen aufgrund einer akuten symptomatischen CSC, die mittels Fluoreszeinangiographie (FA) und ICGA diagnostiziert worden war, eine ICGA-gesteuerte PDT unter Gabe von Verteporfin (6 mg/m2) mit reduzierter Lichtdosis (25 J/cm2) erfolgte. Die Ergebnisse des 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) wurden ebenfalls ausgewertet und mit den Ergebnissen von 82 gesunden Kontrollen verglichen.


Die bestkorrigierte Sehschärfe (BCVA) vor PDT betrug 77,5 (±10; n = 12) Buchstaben auf der Tafel gemäß Early Treatment Diabetic Retinopathy Study (ETDRS) und steigerte sich auf 89 Buchstaben (±9,9; p = 0,0003) am Ende der Follow-up-Periode (83,8 ± 4,8 Monate nach PDT). Für die Kontrastsensitivität (CS) betrug der Ausgangswert 29,5 ± 4,5 Pelli-Robson-Buchstaben, er stieg auf 34,5 ± 4,5 Buchstaben am Ende der Langzeitnachbeobachtung(p < 0,0006). Vor PDT betrug die zentrale foveale Dicke (CFT) 419 μm und am Ende der Follow-up-Periode 242 µm (p < 0,0001). Die auf den Langzeitvisus bezogene Lebensqualität war auf einem vergleichbaren Niveau wie bei der gesunden Kontrollgruppe.


Die ICGA-gesteuerte Verteporfin-PDT mit reduzierter Lichtdosis erzielt hervorragende Langzeitergebnisse hinsichtlich BCVA, CS und Reduktion der CFT sowie gute Resultate bei der visusbezogenen Lebensqualität.


Zentrale seröse Chorioretinopathie Indozyaningrünangiographie Photodynamische Therapie National Eye Institute Visual Function Questionnaire Langzeitresultate 


Compliance with ethical guidelines

Conflict of interest

E. Smretschnig, S. Hagen, J. Gamper, I. Krebs, S. Binder, and S. Ansari-Shahrezaei declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Chan WM, Lai TY, Lai RY, Tang EW, Liu DT, Lam DS. Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study. Retina. 2008;28:85–93.CrossRefPubMedGoogle Scholar
  2. 2.
    Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol. 1967;63:1–139.Google Scholar
  3. 3.
    Fok AC, Chan PP, Lam DS, Lai TY. Risk factors for recurrence of serous macular detachment in untreated patients with central serous chorioretinopathy. Ophthalmic Res. 2011;46:160–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Gass JD. Stereoscopic atlas of macular diseases: diagnosis and treatment. 4th ed. Vol. 1. St.Louis: Mosby; 1997. pp. 52–70.Google Scholar
  5. 5.
    Han DP, Thompson HS, Folk JC. Differentiation between recently resolved optic neuritis and central serous retinopathy. Use of tests of visual function. Arch Ophthalmol. 1985;103:394–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Ozkaya A, Alkin Z, Ozveren M, Yazici AT, Taskapili M. The time of resolution and the rate of recurrence in acute central serous chorioretinopathy following spontaneous resolution and low-fluence photodynamic therapy: a case-control study. Eye (Lond). 2016;30:1005–10.CrossRefGoogle Scholar
  7. 7.
    Piccolino FC, Borgia L. Central serous chorioretinopathy and indocyanine green angiography. Retina. 1994;14:231–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology. 2008;115:1756–65.CrossRefPubMedGoogle Scholar
  9. 9.
    Ober MD, Yannuzzi LA, Do DV, Spaide RF, Bressler NM, Jampol LM, et al. Photodynamic therapy for focal retinal pigment epithelial leaks secondary to central serous chorioretinopathy. Ophthalmology. 2005;112:2088–94.CrossRefPubMedGoogle Scholar
  10. 10.
    Wu ZH, Lai RY, Yip YW, Chan WM, Lam DS, Lai TY. Improvement in multifocal electroretinography after half-dose verteporfin photodynamic therapy for central serous chorioretinopathy. A randomized placebo-controlled trial. Retina. 2011;31:1378–86.CrossRefPubMedGoogle Scholar
  11. 11.
    Zhao MW, Zhou P, Xiao HX, Lv YS, Li CA, Liu GD, et al. Photodynamic therapy for acute central serous chorioretinopathy: the safe effective lowest dose of verteporfin. Retina. 2009;29:1155–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Reibaldi M, Cardascia N, Longo A, Furino C, Avitabile T, Faro S, et al. Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol. 2010;149:307–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Smretschnig E, Ansari-Shahrezaei S, Moussa S, Glittenberg C, Krebs I, Binder S. Half-fluence photodynamic therapy in acute central serous chorioretinopathy. Retina. 2012;32:2014–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Hagen S, Ansari-Shahrezaei S, Smretschnig E, Glittenberg C, Krebs I, Steiner I, et al. Effect of photodynamic therapy on short-wavelength fundus autofluorescence in eyes with acute central serous chorioretinopathy. Retina. 2015;35:223–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Hagen S, Ansari-Shahrezaei S, Smretschnig E, Glittenberg C, Krebs I, Graf A, et al. The effect of photodynamic therapy on macular sensitivity in eyes with acute central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol. 2013;251:1081–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Ferris FL III, Bailey I. Standardizing the measurement of visual acuity for clinical research studies: guidelines from the Eye Care Technology Forum. Ophthalmology. 1996;103:181–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD, National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item national eye institute visual function questionnaire. Arch Ophthalmol. 2001;119:1050–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Maaranen T, Mäntyjärvi M. Contrast sensitivity in patients recovered from central serous chorioretinopathy. Int Ophthalmol. 1999;23:31–5.CrossRefGoogle Scholar
  19. 19.
    Rubin GS, Bandeen-Roche K, Huang GH, Muñoz B, Schein OD, Fried LP, et al. The association of multiple visual impairments with self report visual disability: SEE project. Invest Ophthalmol Vis Sci. 2001;42:64–72.Google Scholar
  20. 20.
    Owsley C. Contrast sensitivity. Ophthalmol Clin North Am. 2003;16:171–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Rubin GS. Reliability and sensitivity of clinical contrast sensitivity tests. Clin Vis Sci. 1988;2:169–77.Google Scholar
  22. 22.
    Kyo T, Yuzawa M, Tochigi K, Yamaguchi T, Shimozuma K, Fukuhara S, et al. Assessment of the quality of life in patients with age-related macular degeneration 1 year after photodynamic therapy. Nippon Ganka Gakkai Zasshi. 2007;111:315–21.PubMedGoogle Scholar
  23. 23.
    Mozaffarieh M, Krepler K, Heinzl H, Sacu S, Wedrich A. Visual function, quality of life and patient satisfaction after ophthalmic surgery: a comparative study. Ophthalmologica. 2004;218:26–30.CrossRefPubMedGoogle Scholar
  24. 24.
    Türkcü FM, Sahin A, Bez Y, Yüksel H, Cinar Y, Kürşat, et al. Vision-related quality of life in patients with chronic central serous chorioretinopathy. Semin Ophthalmol. 2015;30:272–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Smretschnig E, Falkner-Radler CI, Binder S, Spörl J, Ristl R, Glittenberg C, et al. Vision-related quality of life and visual function after retinal detachment surgery. Retina. 2016;36:967–73.CrossRefPubMedGoogle Scholar
  26. 26.
    Okamoto F, Okamoto Y, Fukuda S, Hiraoka T, Oshika T. Vision-related quality of life and visual function after vitrectomy for various vitreoretinal disorders. Invest Ophthalmol Vis Sci. 2010;51:744–51.CrossRefPubMedGoogle Scholar
  27. 27.
    Okamoto F, Okamoto Y, Hiraoka T, Hiraoka T, Oshika T. Vision-related quality of life and visual function after retinal detachment surgery. Am J Ophthalmol. 2008;146:85–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Mason JO, Neimkin MG, Mason JO, Friedman DA, Feist RM, Thomley ML, et al. Safety, efficacy, and quality of life following sutureless vitrectomy for symptomatic vitreous floaters. Retina. 2014;34:1055–61.CrossRefPubMedGoogle Scholar
  29. 29.
    Okamoto F, Okamoto Y, Fukuda S, Hiraoka T, Oshika T. Vision-related quality of life and visual function following vitrectomy for proliferative diabetic retinopathy. Am J Ophthalmol. 2008;145:1031–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Fukuda S, Okamoto F, Yuasa M, Kunikata T, Okamoto Y, Hiraoka T, et al. Vision-related quality of life and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole. J Ophthalmol. 2009;93:1595–9.Google Scholar
  31. 31.
    Okamoto Y, Okamoto F, Hiraoka T, Oshika T. Vision-related quality of life and visual function following intravitreal bevacizumab injection for persistent diabetic macular edema after vitrectomy. Jpn J Ophthalmol. 2014;58:369–74.CrossRefPubMedGoogle Scholar
  32. 32.
    Aydin Kurna S, Altun A, Gencaga T, Akkaya S, Sengor T. Vision related quality of life in patients with keratoconus. J Ophthalmol. 2014; Scholar
  33. 33.
    Zou H, Zhang X, Xu X, Liu H, Bai L, Xu X. Vision-related quality of life and self-rated satisfaction outcomes of rhegmatogenous retinal detachment surgery: three-year prospective study. PLoS ONE. 2011;6:e28597.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ghazi-Nouri SM, Tranos PG, Rubin GS, Adams ZC, Charteris DG. Visual function and quality of life following vitrectomy and epiretinal membrane peel surgery. Br J Ophthalmol. 2006;90:559–62.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Tranos PG, Ghazi-Nouri SM, Rubin GS, Adams ZC, Charteris DG. Visual function and subjective perception of visual ability after macular hole surgery. Am J Ophthalmol. 2004;138:995–1002.CrossRefPubMedGoogle Scholar
  36. 36.
    Okamoto F, Okamoto Y, Hiraoka T, Oshika T. Effect of vitrectomy for epiretinal membrane on visual function and vision-related quality of life. Am J Ophthalmol. 2009;147:869–74.CrossRefPubMedGoogle Scholar
  37. 37.
    Lahousen T, Painold A, Luxenberger W, Schienle A, Kapfhammer HP, Ille R. Psychological factors associated with acute and chronic central serous chorioretinopathy. Nord J Psychiatry. 2016;70:24–30.CrossRefPubMedGoogle Scholar
  38. 38.
    Lai TY, Wong RL, Chan WM. Long-term outcome of half-dose Verteporfin photodynamic therapy for the treatment of central serous chorioretinopathy (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2015;113:T81–T827.Google Scholar
  39. 39.
    Kitzmann AS, Pulido JS, Diehl NN, Hodge DO, Burke JP. The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980–2002. Ophthalmology. 2008;115:169–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Eva Smretschnig
    • 1
    • 2
    Email author
  • Stefan Hagen
    • 1
    • 2
  • Jutta Gamper
    • 5
  • Ilse Krebs
    • 1
    • 2
  • Susanne Binder
    • 1
    • 2
    • 4
  • Siamak Ansari-Shahrezaei
    • 1
    • 2
    • 3
    • 4
  1. 1.Karl Landsteiner Institute for Retinal Research and ImagingViennaAustria
  2. 2.Department of OphthalmologyRudolf Foundation HospitalViennaAustria
  3. 3.Department of OphthalmologyMedical University of GrazGrazAustria
  4. 4.Retina Center ViennaViennaAustria
  5. 5.Institute for Medical StatisticsMedical University of ViennaViennaAustria

Personalised recommendations