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Danial Mohabati, Elon H.C. Van Dijk, Mays Talib, Eiko de Jong, Sascha Fauser, Carel C B Hoyng, Suzanne Yzer, Camiel J F Boon; Clinical characteristics and response to photodynamic therapy in severe phenotypes of chronic central serous chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5355.
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© ARVO (1962-2015); The Authors (2016-present)
To explore the clinical characteristics of severe cases of chronic central serous chorioretinopathy (cCSC) and to assess the outcome of photodynamic therapy (PDT) in these cases.
We retrospectively reviewed the medical records of 27 cCSC patients (35 eyes) treated with half-dose or half-time PDT between 2005 and 2015. Severe cCSC was defined as CSC existing for more than 6 months combined with at least one of the following findings: posterior cystoid retinal degeneration (PCRD) on optical coherence tomography (OCT), multiple hotspots or diffuse leakage on fluorescein angiography (FA), RPE atrophy larger than 5 optic disc diameters, an epiretinal membrane in the macula, and best corrected visual acuity (BCVA) less than 60 EDTRS letters. Eyes with suspected drusen-associated age-related macular degeneration, choroidal neovascularization, or polypoidal choroidal vasculopathy, were excluded. The main outcome measures included BCVA, reduction of central retinal thickness (CRT), and resolution of subretinal fluid (SRF) on OCT. Statistical analyses were performed using a paired samples t-test.
The mean age in this cohort was 57 years and 74% of cases were male. On inclusion PCRD was found in 16 eyes. Twenty-six eyes had multiple hotspots or diffuse leakage on FA. RPE atrophy was seen in 16 eyes. Three eyes had developed a macular epiretinal membrane, and 16 eyes had a BCVA of less than 60 ETDRS letters. The mean BCVA before therapy was 61 ETDRS letters, which significantly increased to 68 ETDRS letters at first post-therapy follow-up (mean= 7 weeks) (P= 0.002), and to 67 ETDRS letters at final visit (mean= 58 weeks post-therapy) (P= 0.011). The mean CRT reduction on OCT was 121 µm (±113 SD) at first follow-up post-therapy, and 105 µm (±114 SD) at final visit. In 23 cases (66%) there was a complete resolution of SRF at first follow-up. This number increased to 28 (80%) at the final visit. PCRD showed a complete resolution after PDT in 69% of these eyes.
A single PDT treatment with reduced settings appears to be an effective therapeutic intervention for short term and long term anatomical recovery in severe cCSC. Despite the significant improvement of visual acuity in these cases, the final BCVA did not rise above an average of 67 ETDRS letters. This may be caused by permanent photoreceptor damage due to a prolonged cCSC.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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