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Elodie Setrouk, Tony Garcia, Alain Ducasse, carl Arndt; Circadien Cycle And Chronic Idiopathic Central Serous Chorioretinopathy Treated With Low Dose Verteporfin. Invest. Ophthalmol. Vis. Sci. 2012;53(14):975.
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Chronic Central Serous Chorioretinopathie(CRSC) is a multifocal disease. Photodynamic therapy(PDT)with vertepofin (3mg/m2) is a symptomatic treatment. A further reduction to 1,5mg/m2 could reduce potential side and thus improve safety of this off label treatment. The present study was designed to evaluate circadian disturbance and corticosteroid in patients treated with chronic CRSC in an ongoing trial comparing the effect of 3mg/m2 verteporfin with 1,5mg/m2.
In all patients with chronic CRSC between 01/01/2009 to 11/31/2011, a history of corticosteroid treatment, sleep disturbance and irregular working hours was noted. If visual acuity was less than 20/40 for more than three months without any tendency of improvement,PDT was performed. The patients were randomly assigned to either treatment group,3mg/m2 or 1,5mg/m2. A mesure of visual acuity, an optical coherence tomography (OCT), angiography(fluorescein and indocyanine green) was performed at baseline, with evaluation at 12 months.
During the period of inclusion,43 patients were examined, 19 were trated with PDT. 11 patients completed a follow-up of 12 months, 3 patients (27%) had a history of corticosteroid, 5 patients (45%) had sleep disturbances and 6 (54%) worked at night.On case of improvement of visual acuity >5 ETDRS letters was observed in group 1 against 2 in group 2. The macular thickness was reduced > 100 microns in two patients in group 2,no such improvement were observed in group 1.
On this preliminary study of photodynamic therapy with chonic CRSC, functional and morphological improvement is inconstant. It is likely that other factors such as existance of a corticosteroid treatment or a disruption of the circadian cycle is involved in the spontaneous evolution or the reponse to treatment.
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