Author: María Dolores Díaz Barreda (Spain)
Co-authors: Ana Boned Murillo, Guillermo Pérez Rivasés, Ismael Bakkali El Bakkali, Francisco Javier Ascaso Puyuelo, Ana Honrubia Grijalbo, Olivia Esteban Floría
To characterize the response to low-fluence photodynamic therapy (PDT) in patients with chronic central serous choroidopathy (CSC) in functional (visual acuity; VA) and anatomical terms using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCT-A).
Although the pathophysiology is not fully understood, central serous chorioretinopathy (CSC) has been linked to choroidal hyperpermeability typically resulting in neurosensory detachment and/or detachment of the retinal pigment epithelium at the posterior pole. Chronic cases must be treated to avoid visual impairment. In recent years, new therapeutic strategies have appeared in conjunction with improved diagnostics and the development of new imaging techniques. The most commonly used are photodynamic therapy with verteporfin, subthreshold micropulse laser, treatment with mineralocorticoid antagonists or intravitreal antiangiogenic drugs, the results and possible adverse effects of which are not yet well defined in these cases.
Retrospective study of 42 eyes with chronic CSC more than 8±1.2 months treated with low-fluence PDT and assessed at 1, 3, 6, 12 and 36 months after treatment by OCT and OCT-A. Patients with previous ocular pathologies, refractive errors greater than 3 dioptres or who had received any type of previous intraocular treatment were excluded.
Forty-two eyes with chronic CSC belonging to 38 patients (77.7% male and 22.3% female) with a mean age of 49.5 ± 8.0 years and a mean VA according to the decimal scale of 0.64 ± 0.22 were studied. Mean VA improved to 0.85 ± 1.2 after 1 month of treatment and remained stable until the end of the follow-up period (p<0.05). Foveal retinal thickness was significantly lower after 1 month of PDT treatment and remained stable until 36 months (p<0.05). Foveal choroidal thickness was reduced after one month of treatment and maintained similar values until the end of follow-up (p>0.05). Perifoveal macular retinal and choroidal macular sectors improved after PDT and remained stable until the end of follow-up. Only two patients needed a second PDT after 12 months. At 36 months, two patients (4.7%) presented choroidal neovascularization by OCT-A and two other patients had subretinal fluid again.
Low-fluence PDT showed a rapid (first month) and long-lasting (sustained 36 months follow-up) improvement in the treatment of chronic CSC, both in terms of VA and macular thickness (retinal and choroidal). Only 4.7% of the sample showed choroidal neovasularization with OCT-A after 36 months of follow-up.