Author: José Ignacio Fernandez-Vigo (Spain)
Co-authors: Francisco Javier Moreno-Morillo, Emilio López-Varela, Jorge Novo-Bujan, Marcos Ortega-Hortas, Barbara Burgos-Blasco, Juan Donate-López
Purpose
To assess the early changes produced in the choriocapillaris (CC) and choroidal (CH) vasculature using swept-source optical coherence tomography angiography (SS-OCTA) in patients with chronic central serous chorioretinopathy (CSCR) as predictors of the efficacy after photodynamic therapy (PDT).
Setting/Venue
Hospital Clínico San Carlos, Madrid, Spain
Methods
Prospective observational study. A cohort of 52 eyes of 52 patients with chronic CSCR and persistent subretinal fluid (SRF) was included. SS-OCTA scans of the 6x6mm macular region were assessed before; and 2-3 days, one month and three months after half-fluence PDT. Best-corrected visual acuity (BCVA), height of SRF and vessel occlusion in the CC and CH was measured as flow signal voids (FSV). Main Outcome Measures were early increase in FSV in the CC and CH after PDT, and the recanalization after treatment.
Results
BCVA before PDT was 75.3 ±12.0 letters in the ETDRS scale, which improved to 81.3 ±11.0 after 3 months (p<0.001). A 3.67 ±4.12 and 2.76 ±3.63 fold increase in CC and CH FV, due to vessel occlusion, was observed at 2-3 days after PDT versus baseline. There was less SRF at 3 months in patients with an increase in FSV (≥1-fold) compared to those without this increase (<1-fold) after PDT (p≤0.003). An association between the increase in CC and CH FSV at the early control (2-3 days) and the amount of SRF at 1 month was found (R= -0.405; p=0.002 and R= -0.356; p=0.008 respectively). In a multivariate model, the amount of SRF at one month was not associated with age, gender, axial length, baseline BCVA, baseline CC or CH FSV (p≥0.288). However, there was an association with the increase in CC and CH FSV after PDT (p=0.007). At 3 months, recanalization was achieved in the CH versus the baseline (p=0.619), but there was a persistent increase in the CC FSV (p=0.008).
Conlusions
Early vessel occlusion by OCTA after PDT in CSCR was associated with an excellent treatment response. Therefore, an increase in FSV immediately after PDT could be a robust biomarker to predict SRF resorption.
Financial Disclosure
Not applicable
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