HALF-FLUENCE PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY

摘要

Purpose: To evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin (Visudyne?; Novartis Pharma, Switzerland) photodynamic therapy (PUT) with half-fluence rate in the treatment of chronic central serous chorioretinopathy. Methods: A retrospective review was conducted of 20 eyes of 19 consecutive patients with subfoveal fluid cause by chronic central serous chorioretinopathy with choroidal hyperpermeability on ICGA and symptoms of at least 6 months. ICGA-guided verteporfin (6 mg/m~2) PDT with half-fluence rate (25 J/cm2) was performed. ICGA findings were classified as intense, intermediate, or minimal hyperfluorescence depending on the degree of choroidal hyperpermeability. The resolution of the subretinal fluid and recurrence rates were assessed in relation to the different degrees of choroidal hyperfluorescence. Results: Best-corrected visual acuity at baseline was 40 letters (+-13; n = 20) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after PDT, the mean best-corrected visual acuity improved to 44 letters (P < 0.01). Pretreatment central foveal thickness 325mum and decreased by a mean of 103mum at Month 12 control (P < 0.05). At Month 1 after PDT, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in 100% of eyes regardless to their degree of choroidal hyperfluorescence. Two eyes of the intense hyperfluorescence group and 1 eye of the intermediate hyperfluorescence group developed recurrence of symptoms over 12 months and received another PDT with half-fluence rate within the 12-month control period. Treatment effect was not depending on the degree of choroidal hyperpermeability at baseline. No systemic side effects were observed during the 12-month follow-up. Conclusion: ICGA-guided half-fluence PDT with verteporfin is effective in treating chronic symptomatic central serous chorioretinopathy with choroidal hyperpermeability in ICGA, resulting in both visual improvement and reduction of central foveal thickness.