Abstract
Purpose :
To analyze the influence of retinal morphology on the outcome of therapy in patients with chronic central serous chorioretinopathy (CCSC) threated with subthreshold 577 nm micropulse (MP) and/or half-dose photodynamic therapy (PDT).
Methods :
This retrospective study included 95 patients with treatment-naive CCSC who were treated with only MP (n= 32), only PDT (n=37) or both (n= 26). Baseline subretinal fluid (SRF) and serous pigment epithelial detachment (sPED) on spectral-domain optical coherence tomography (SD-OCT) were volumetrically quantified using commercially available software (3D-Doctor). Further grading included baseline angiographic findings (point source leakage with/ without pigment epithelium atrophy, diffuse leakage), leakage size (<1 disc area (DA), 2-5 DA, ≥5 DA) and quantification of hyperreflective foci (HF). Logistic regression analysis was performed for evaluation of phenotypic risk factors for treatment success, defined as complete SRF absorption in all SD-OCT scans (‘’completely dry’’).
Results :
A completely dry status was reached in 66 cases (69.5%), 40 of them were dry after single therapy (42.1%). Dry status was reached after a mean of 5.36 (standard deviation (SD) ±4.41) months, whereas the patients who never reached dry status (referred as ‘’non-responders’’) were followed for a mean of 21.5 (SD±13.7) months and treated mean 3.28 (SD±2.51) times. No significant differences were observed between only MP and only PDT treatment regarding achievement of dry status (p=0.980). Although baseline HF number correlated significantly with total baseline SRF volume (p=8.95x10-6), none of the SD-OCT baseline features nor angiographic phenotypic features were associated with treatment success. Non-responders were associated with a combination of female gender (Odds Ratio (OR) [95%Confidence Interval]: 3.77 [1.03-13.77], p=0.045), higher age (OR: 1.08 [1.02-1.15], p=0.010) and current steroid use (OR: 6.64 [1.20-36.83], p=0.03).
Conclusions :
Presence of HF in CCSC patients correlates with disease activity but is not considered as a risk factor for treatment outcome. Further phenotypic features also do not seem to have a significant impact on treatment outcome. Besides steroid use, age and gender, other risk factors for non-response to therapy should be investigated in future studies.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.