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J. E. Kempton, R. A. Adelman; Modified Photodynamic Therapy for the Treatment of Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3277.
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To study the therapeutic effects of low dose verteporfin and delayed activation photodynamic therapy for patients with central serous chorioretinopathy (CSCR).
Two patients presented with chronic CSCR without spontaneous resolution of symptoms or subretinal fluid (SRF). Patient 1 was a 45 year-old Caucasian male with metamorphopsia and Patient 2 was a 51year-old African-American female with decreased vision who was on oral steroids for chronic lymphocytic leukemia. Fundus photography, fluoroscein angiography (FA), and optical coherence tomography (OCT) were obtained at baseline in both patients. Based on their calculated body surface area (BSA), both patients received half of the standard verteporfin dose (1.5xBSA vs. 3xBSA) in mL. Given the leakage time is delayed in CSCR, the activation time was increased from the standard 15 minutes to 30 minutes. Fundus photography, FA, and OCT were followed.
At baseline, Patient 1 had pinpoint leakage on FA, SRF on OCT inferior to the fovea with retinal elevation to 340 microns. Patient 2 had pinpoint leakage on FA, SRF nasal to the fovea with elevation to 290 microns. At 1 week, leakage from the treated eyes of both patients had resolved on FA. The SRF had completely resolved on OCT with a decrease in elevation to 280 microns in Patient 1 and 275 microns in Patient 2. At 1 month, Patient 1 continued to have no leakage on FA, no SRF on OCT, and 280 microns of elevation. Patient 2 showed complete resolution of SRF on OCT with an elevation of 270 microns at this time. At 3 months post treatment, the FA of Patient 2 showed pinpoint leakage consistent with baseline and re-accumulation of SRF on OCT with retinal elevation up to 380 microns.
The use of PDT with half dose verteporfin and delayed activation time for the treatment of CSCR may to be beneficial. Our patients had fast and significant improvement on clinical exam, OCT, and FA. The recurrence of SRF in Patient 2 may be due to her continued use of oral steroids or may suggest the need for repeat treatment. Further study addressing these questions is warranted.
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