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Erfahrungen mit „half-dose“ photodynamischer Therapie mittels Verteporfin bei Chorioretinopathia centralis serosa

Experiences with chronic central serous chorioretinopathy treated with half-dose photodynamic therapy and verteporfin

Der Ophthalmologe volume 108, pages 947–951 (2011)Cite this article

Zusammenfassung

Hintergrund

Chorioretinopathia centralis serosa (CCS) ist eine idiopathische, meist selbstlimitierende Erkrankung gewöhnlich jüngerer Patienten. Charakteristisches Zeichen ist eine seröse Abhebung der neurosensorischen Retina. Die Visusprognose ist gut. In bis zu 30% der Fälle kann die Erkrankung chronisch oder rezidivierend sein. Es gibt das Risiko der Entwicklung einer sekundären choroidalen Neovaskularisation. Therapeutische Optionen sind Laserphotokoagulation oder photodynamische Therapie mit Verteporfin (PDT). In den letzten Jahren ist zur Minimierung von Nebenwirkungen der PDT das Behandlungsprotokoll modifiziert worden. Diese Protokolle werden als „Half-dose-“ oder „Reduce-fluence-“ bzw. „Low-fluence-PDT“ bezeichnet.

Patienten und Methoden

Retrospektiv wurden 7 Augen von 6 konsekutiven männlichen Patienten mit chronischer CCS ausgewertet. Vor „Half-dose-PDT“ und am Ende des Follow-up wurden der bestkorrigierte Visus sowie die Netzhautdicke mittels „spectral-domain“ optischer Kohärenztomographie bestimmt.

Ergebnisse

Das Durchschnittsalter lag bei 40,7 ± 10,3 Jahren. Fünf Augen erhielten 1, 1 Auge 2 und 1 Auge 3 „Half-dose-PDT“. Das durchschnittliche Follow-up lag bei 79,8 ± 104,5 Monaten. Der Visus (Snellen) war vor PDT bei 0,4 ± 0,2 und nach PDT bei 0,4 ± 0,3 (p = 0,49). Die Netzhautdicke nahm von 479 μm ± 233 auf 242 μm ± 60 ab (p = 0,08).

Fazit

„Half-dose-PDT“ ist eine sichere Behandlungsoption für Patienten mit chronischer CCS. Alle Patienten zeigten eine Abnahme der Netzhautdicke mit zum Teil vollständiger Resorption von subretinaler Flüssigkeit in 6 Augen. Fünf Augen zeigten zusätzlich sowohl eine funktionelle als auch eine anatomische Verbesserung durch die Behandlung.

Abstract

Background

Chronic central serous chorioretinopathy (CSR) is an idiopathic, often self-limiting disease usually occurring in younger patients. A characteristic sign of CSR is a serous detachment of the neurosensory retina. Prognosis with regard to visual acuity is generally good. The disease is chronic or recurrent in up to 30% of cases. There is a risk for the development of secondary choroidal neovascularization. Therapeutic options include photocoagulation or photodynamic therapy (PDT) with verteporfin. In recent years there have been several approaches aiming to minimize the side-effects of PDT and the treatment protocols were designated half-dose, reduced fluence or low fluence PDT.

Patients and Methods

A total of 7 eyes from 6 male patients with CSR were analyzed retrospectively. Beforehalf-dose PDT and at the end of follow-up best corrected visual acuity and retinal thickness were measured by spectral domain-optical coherence tomography.

Results

The mean age of the patients was 40.7 ± 10.3 years, 5 eyes were treated with a single session of half-dose PDT (25 J / cm2), 1 with 2 PDTs and 1 with a total of 3 PDTs. Mean follow-up was 79.8 ± 104.5 months. Mean visual acuity (Snellen) before PDT was 0.4 ± 0.2 and 0.4 ± 0.3 after PDT (p = 0.49). During the observation period the mean retinal thickness (RT) decreased from 479 μm ± 233 to 242 μm ± 60 (p = 0.08).

Conclusions

Half-dose PDT is a safe option for patients with long-standing CSR. All patients showed a decrease of retinal thickness, 6 eyes showed a total resolution of subretinal fluid and 5 eyes also showed functional improvement.

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Affiliations

  1. Augenklinik, UniversitätsSpital Zürich, Frauenklinikstr. 24, 8091, Zürich, Schweiz

    M. Töteberg-Harms, M. Kurz-Levin, J. Fleischhauer & R. Windisch

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  1. M. Töteberg-Harms
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  2. M. Kurz-Levin
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  3. J. Fleischhauer
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  4. R. Windisch
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Correspondence to M. Töteberg-Harms.

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Töteberg-Harms, M., Kurz-Levin, M., Fleischhauer, J. et al. Erfahrungen mit „half-dose“ photodynamischer Therapie mittels Verteporfin bei Chorioretinopathia centralis serosa. Ophthalmologe 108, 947–951 (2011). https://doi.org/10.1007/s00347-011-2423-9

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Schlüsselwörter

  • Retinopathia centralis serosa
  • Chorioretinopathia centralis serosa
  • Retinopathie
  • Photodynamische Therapie
  • Verteporfin

Keywords

  • Central serous retinopathy
  • Central serous chorioretinopathy
  • Retinopathy
  • Photodynamic therapy
  • Verteporfin