Czech and Slovak Ophthalmology 136 10.31348/2019/6/2 Original article Assessment of the Efficacy of Photodynamic Therapy in Patients with Chronic Central Serous Chorioretinopathy Manethová Kateřina Ernest Jan https://orcid.org/0009-0003-2775-7070 Hrevuš Michal https://orcid.org/0000-0002-6021-2270 Jirásková Naďa 9 6 2020 6 2

Purpose: The aim of this prospective clinical study was to evaluate the anatomical and functional results of the treatment of 54 eyes with chronic form of central serous chorioretinopathy (CSC) using photodynamic therapy in a reduced (half) verteporfin (HD-PDT) dosing regimen. Materials and Methods: Our prospective study included 54 eyes of 52 patients (40 males, 12 females) at an average age of 50.1 years (median 49.5, range 30–75 years) treated at the Ophthalmology Clinic of the First Faculty of Medicine and Military University Hospital in Prague from January 2012 to January 2018 for chronic form of CSC with a minimum disease duration of 3 months. In our study, we evaluated the improvement of the best corrected visual acuity (BCVA) and central retinal thickness (CRT) before treatment and at 1, 3, 6 and 12 months after HD-PDT. Results: The mean baseline BCVA was 68.91 ± 10.5 ETDRS letters (median 71; range 35–85) and the mean baseline CRT was 385.6 ± 118.5 µm (median 367, 5 µm; range 245–1000 µm). At the end of the follow-up period, the average BCVA was 79 ± 11 ETDRS letters (median 82; range 38–93). The improvement in BCVA before and after treatment was statistically significant in all measurements (p < 0.0001). The mean CRT at the end of the follow-up period was 263.5 ± 52 µm (median 258.5 µm; range 162–404 µm). The decrease in CRT at all timepoints was statistically significant compared to baseline (p < 0.0001). In our set of patients, at the end of the follow-up period, the retinal finding was improved or stabilized in 50 eyes (92.6 %). In this study, we observed in 2 cases the development of secondary choroidal neovascularization (CNV). Conclusion: HD-PDT is a long-term safe and effective method of treating chronic forms of CSC. However, despite a reduced dose of verteporfin, complications may occur.

 chronic central serous chorioretinopathy half-dose photodynamic therapy secondary choroidal neovascularization References Alkin, Z., Perente, I., Ozkaya, A. et al.: Comparison of efficacy between low-fluence and half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy. Clin Ophthalmol, 8; 2014: 685–690. Asahi, MG., Chon, AT., Gallemore, E. et al.: Photody - namic therapy combined with antivascular endothelial growth factor treatment for recalcitrant chronic central serous chorioretinopathy. Clin Ophthalmol, 11; 2017: 2051–2056. Bae, SH., Heo, J., Kim, C. et al.: Low-fluence photodynamic therapy versus ranibizumab for chronic central serous chorioretinopathy: one-year results of a randomized trial. Ophthalmology, 121; 2014: 558–565. Bonini Filho, MA., de Carlo, TE., Ferrara, D. et al.: Association of Choroidal Neovascularization and Central Serous Chorioretinopathy With Optical Coherence Tomography Angiography. JAMA Ophthalmol, 133; 2015: 899–906. Broadhead, GK., Chang, A.: Intravitreal aflibercept for cho - roidal neovascularisation complicating chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol, 253; 2015: 979–981. Cardillo Piccolino, F., Eandi, CM., Ventre, L. et al.: Photodynamic therapy for chronic central serous chorioretinopathy. Retina, 23; 2003: 752–763. Chan, WM., Lai, TY., Lai, RY. et al.: Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one- -year results of a prospective study. Retina, 28; 2008: 85–93. Chan, WM., Lai, TY., Liu, DT. et al.: Intravitreal bevacizumab (avastin) for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin. Am J Ophthalmol, 143; 2007: 977–983. Chan, WM., Lam, DS., Lai, TY. et al.: Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol, 87; 2003: 1453–1458. 2 out of 56 eyes (3.6 %) [48]. In our study we also recorded the progression of manifestly demonstrated complicating CNV in 2 eyes (3.7 %) within 1 month of the performance of treatment, in both cases this concerned CNV type II (thus minor classic CNV). The development of secondary CNV upon a background of cCSC has been described especially in connection with standard PDT or laser photocoagulation, though CNV may be a complication of cCSC itself [6,11,47]. On the assumption that only patients in whom the baseline examination (OCT/FAG/ICG) did not demonstrate the presence of CNV were included in our study, we consider the occurrence of CNV (type II) within one month of the performance of HD-PDT in our cohort to be a complication o Colucciello, M.: Choroidal neovascularization complicating photodynamic therapy for central serous retinopathy. Retina, 26; 2006: 239–242. Daruich, A., Matet, A., Dirani, A. et al.: Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res, 48; 2015: 82–118. Fujita, K., Imamura, Y., Shinoda, K. et al.: One-year outcomes with half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy. Ophthalmology, 122; 2015: 555–561. Gass, JDM.: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment. 4th edition. St. Louis, Mosby, 1997, 1061 p. Golshahi, A., Klingmuller, D., Holz, FG. et al.: Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study. Acta Ophthalmol, 88; 2010: 576–581. Haimovici, R., Rumelt, S., Melby, J.: Endocrine abnorma - lities in patients with central serous chorioretinopathy. Ophthalmology, 110; 2003: 698–703. Huang, WC., Chen ,WL., Tsai, YY. et al.: Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eye (Lond), 23; 2009: 488–489. Ie, D., Yannuzzi, LA., Spaide, RF. et al.: Subretinal exudative deposits in central serous chorioretinopathy. Br J Ophthalmol, 77; 1993: 349–353. Iida, T., Yannuzzi, LA., Spaide, RF. et al.: Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina, 23; 2003: 1–7; quiz 137–8. Imamura, Y., Fujiwara, T., Margolis, R. et al.: Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina, 29; 2009: 1469– 1473. Jalkh, AE., Jabbour, N., Avila, MP. et al.: Retinal pigment epithelium decompensation. I. Clinical features and natural course. Ophthalmology, 91; 1984: 1544–1548. Karakus, SH., Basarir, B., Pinarci, EY. et al.: Long-term results of half-dose photodynamic therapy for chronic central serous chorioretinopathy with contrast sensitivity changes. Eye (Lond), 27; 2013: 612–620. Kim, YK., Ryoo, NK., Woo, SJ. et al.: Comparison of visual and anatomical outcomes of half-fluence and half-dose photodynamic therapy in eyes with chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol, 253; 2015: 2063–2073. Konstantinidis, L., Mantel, I., Zografos, L. et al.: Intravitreal ranibizumab in the treatment of choroidal neovascularization associated with idiopathic central serous chorioretinopathy. Eur J Ophthalmol, 20; 2010: 955–958. Lai, TY., Chan, WM., Li, H. et al.: Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study. Br J Ophthalmol, 90; 2006: 869–874. Leaver, P., Williams, C.: Argon laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol, 63; 1979: 674–677. Lim, JI., Glassman, AR., Aiello, LP. et al.: Collaborative retrospective macula society study of photodynamic therapy for chronic central serous chorioretinopathy. Ophthalmology, 121; 2014: 1073–1078. Lim, JW., Kim, MU., Shin, MC.: Aqueous humor and plas - ma levels of vascular endothelial growth factor and interleukin-8 in patients with central serous chorioretinopathy. Retina, 30; 2010: 1465–1471. Lim, SJ., Roh, MI., Kwon, OW.: Intravitreal bevacizumab injection for central serous chorioretinopathy. Retina, 30; 2010: 100–106. L’Esperance, FA.: Ophthalmic lasers: Photocoagulation, photoradiation, and surgery. 2nd edition. St. Louis, Mosby, 1983, 606 p. Manayath, GJ., Shah, VS., Saravanan, VR. et al.: Polypoidal choroidal vasculopathy associated with central serous chorioretinopathy: Pachychoroid Spectrum of Diseases. Retina, 38; 2018: 1195–1204. Maruko, I., Iida, T., Sekiryu, T. et al.: Morphologic changes in the outer layer of the detached retina in rhegmatogenous retinal detachment and central serous chorioretinopathy. Am J Ophthalmol, 147; 2009: 489–494. Michels, S., Hansmann, F., Geitzenauer, W. et al.: Influence of treatment parameters on selectivity of verteporfin therapy. Invest Ophthalmol Vis Sci, 47; 2006: 371–376. Moon, JW., Yu, HG., Kim, TW. et al.: Prognostic factors related to photodynamic therapy for central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol, 247; 2009: 1315–1323. Mudvari, SS., Goff, MJ., Fu, AD. et al.: The natural history of pigment epithelial detachment associated with central serous chorioretinopathy. Retina, 27; 2007: 1168–1173. Naseripour, M., Falavarjani, KG., Sedaghat, A. et al.: Half- -dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy. J Ophthalmic Vis Res, 11; 2016: 66–69. Nicholson, B., Noble, J., Forooghian, F. et al.: Central serous chorioretinopathy: update on pathophysiology and treatment. Surv Ophthalmol, 58; 2013: 103–126. Nicolo, M., Eandi, CM., Alovisi, C. et al.: Half-fluence ver - sus half-dose photodynamic therapy in chronic central serous chorioretinopathy. Am J Ophthalmol, 157; 2014: 1033–1037. Nicolo, M., Zoli, D., Musolino, M. et al.: Association between the efficacy of half-dose photodynamic therapy with indocyanine green angiography and optical coherence tomography findings in the treatment of central serous chorioretinopathy. Am J Ophthalmol, 153; 2012: 474–480. Obana, A., Gohto, Y., Kaneda, K. et al.: Selective occlusion of choroidal neovascularization by photodynamic therapy with a water-soluble photosensitizer, ATX-S10. Lasers Surg Med, 24; 1999: 209–222. Piccolino, FC., de la Longrais, RR., Ravera, G. et al.: The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol, 139; 2005: 87–99. Pikkel, J., Beiran, I., Ophir, A. et al.: Acetazolamide for central serous retinopathy. Ophthalmology, 109; 2002: 1723–1725. Prunte, C., Flammer, J.: Choroidal capillary and venous con - gestion in central serous chorioretinopathy. Am J Ophthalmol, 121; 1996: 26–34. Reibaldi, M., Cardascia, N., Longo, A. et al.: Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol. 149; 2010: 307–315. Robertson, DM.: Argon laser photocoagulation treatment in central serous chorioretinopathy. Ophthalmology, 93; 1986: 972–974. Rouvas, A., Stavrakas, P., Theodossiadis, PG. et al.: Long- -term results of half-fluence photodynamic therapy for chronic central serous chorioretinopathy. Eur J Ophthalmol, 22; 2012: 417–422. Smretschnig, E., Ansari-Shahrezaei, S., Hagen, S. et al.: Half- -fluence photodynamic therapy in chronic central serous chorioretinopathy. Retina, 33; 2013: 316–323. Spaide, RF., Campeas, L., Haas, A. et al.: Central serous chorioretinopathy in younger and older adults. Ophthalmology, 103; 1996: 2070–2079. Tseng, CC., Chen, SN.: Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy. Br J Ophthalmol, 99; 2015: 1070–1077. Uetani, R., Ito, Y., Oiwa, K. et al.: Half-dose vs one-third-do - se photodynamic therapy for chronic central serous chorioretinopathy. Eye (Lond), 26; 2012: 640–649. Yannuzzi, LA., Slakter, JS., Gross, NE. et al.: Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina, 23; 2003: 288–298.