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R. Kim, T. Wong, R. Fish, D. Brown; Photodynamic Therapy Using Low–Dose Verteporfin for Chronic Central Serous Retinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):305.
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Purpose: In central serous retinopathy (CSR), most patients have spontaneous resolution of subretinal fluid and have a good visual prognosis. However, a small percentage of patients develop chronic and, at times, progressive disease with widespread involvement of the retinal pigment epithelium and subsequent loss of vision. Although there is no proven effective therapy for this variant of CSR, a recent pilot study has shown that indocyanine green angiography–guided photodynamic therapy (PDT) with verteporfin results in complete resolution of exudative macular detachment in 12 out of 20 eyes and incomplete resolution in the remaining 8 eyes (Yannuzzi et al., Retina 2003). However, in this study, only 6 of the 20 eyes showed improved vision. Therefore, in this case report, we evaluated the effect of PDT wth verteporfin in visual recovery and optical coherence tomography (OCT) using half the standard dose (3 mg per meter squared of body surface area) in a patient with long–standing CSR. Methods: The patient had had central serous retinopathy for 12 months. Optical coherence tomography showed the foveal thickness to be 394 microns with subretinal fluid as well as mutiple intraretinal cysts. After obtaining appropriate consent for the off–label usage of photodynamic therapy, the affected eye was treated using verteporfin at a dose of 3 mg per square meter of body surface area. Results: Two months following treatment, the foveal thickness had decreased from 394 microns to 135 microns. Furthermore, the visual acuity had improved from counting fingers (1.5 logMAR) to 20/100 (0.7 logMAR). The patient had RPE clumping and atrophy as expected in chronic CSR, which is the likely explanation for his final visual outcome. Conclusions: Photodynamic therapy using the half the standard dose of verteporfin resulted in anatomical improvement by OCT with complete resolution of subretinal fluid and intraretinal cysts as well as improved visual acuity in a single patient. This encouraging result suggests that 50% of the currently recommended dose may be sufficient in future clinical studies involving PDT for chronic CSR.
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