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Jennifer Lim, Adam Glassman, Lloyd Aiello, Usha Chakravarthy, Christina Flaxel, Richard Spaide, ; Visual and Anatomic Results of the Macula Society Photodynamic Therapy (PDT) for Central Serous Chorioretinopathy (CSC) Retrospective Study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2798.
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To assess the visual and anatomic outcomes after verteporfin photodynamic therapy (PDT) for central serous chorioretinopathy (CSC).
The Macula Society Research and Education Committee electronically surveyed the membership to retrospectively collect data on PDT treatment for CSC. Patient demographic information, PDT treatment parameters, fluorescein angiographic information, OCT metrics, visual acuity pre and post-treatment and adverse outcomes were collected using standardized forms.
Data were submitted on 237 CSC patients from 11 countries by 37 Macula Society members. The mean age was 52+/- 11 years; 74 % were men. Patients were 69 % Caucasian, 18% Asian and 12% Hispanic. CSC was treated bilaterally in 11.8%. A history of systemic steroid exposure was present in 13%. Baseline visual acuities (VAs) were 20/32 or better in 43%, 20/40 to 20/80 in 37%, and 20/100 or worse in 18% of eyes. Subretinal fluid was seen by biomicroscopy in 83% (versus 85% by OCT); PED was seen by biomicroscopy in 28% (versus 32% on OCT). PDT treatment parameters: 49 % normal fluence, 46 % half-fluence, 3% low fluence PDT. The number of PDT treatments was 1 in 90%, 2 in 7% and 3 in 3%. Post-PDT follow-up ranged from 1 month to greater than 1 year. At the last post-PDT visit VA was improved >2 lines in 26%, 55% and 59% of eyes with baseline VA 20/32 or better, 20/40 to 20/80 and 20/100 or worse respectively. VA improved >3 lines in <1%, 29% and 48% of eyes with baseline VA 20/32 or better, 20/40 to 20/80 and 20/100 or worse respectively. Only 4% lost > 4 lines. There was no difference in the response to PDT when analyzed by age, race, fluence, FA leakage type, steroid exposure or fluid location (subretinal or PED) (p>0.01). Post-PDT central subfield measurements on OCT improved by > 25µ in 75% , 82% and 86% of eyes with baseline VA of 20/32 or better, 20/40 to 20/80 and 20/100 or worse respectively. Complications were rare: RPE atrophy was seen in 4% and acute severe visual decrease in 2%.
PDT for CSC eyes with decreased vision results in visual acuity gains in a majority of eyes and only a small number with significant visual loss.
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