PDT USEFUL FOR CSC

Half-fluence verteporfin photodynamic therapy (PDT) is a useful treatment option for the treatment of central serous chorioretinopathy (CSC), the 2015 Irish College of Ophthalmologists annual conference in Westport, Ireland heard.

Christine Goodchild MD, University Hospital Galway, Ireland, reported positive results on optical coherence tomography (OCT) imaging following the procedure from a small-scale Irish study. She explained that CSC is characterised by neurosensory detachment and choriocapillaris leakage through the retinal pigment epithelium (RPE). While it usually resolves spontaneously, some patients experience persistent or recurrent leakage, so treatment is considered, usually after three months of acute CSC, she said.

“What you find with CSC is that these eyes have a very characteristic appearance in OCT and fundus fluorescein angiography (FFA) – you get this neurosensory retinal detachment on OCT and this smoke stack appearance, ink blot, or diffuse leakage on FFA,” said Dr Goodchild.

Dr Goodchild and colleagues carried out a study to determine the outcomes of patients who underwent half-fluence PDT treatment for CSC in University Hospital Galway over a four-year period.

Eleven patients (11 eyes) with chronic (unresponsive to other treatment) or persistent CSC after three months were involved in the study. The patients, with a mean age of 57 years, underwent a visual acuity check, a dilated fundal examination, OCT and FFA assessment at baseline, three months and six months follow-up. Investigators set out to determine if intraretinal and subretinal fluid resolved in the majority of cases, and if visual acuity was maintained, following half-fluence PDT treatment.

Patients were treated with half-fluence verteporfin PDT. Intravenous verteporfin was given at a dose of 3mg/m2 over 10 minutes and the delivered laser energy was half of the standard dose (half-fluence PDT), ie 25mj/cm2 over 83 seconds. The study outcome measures were best corrected visual acuity (BCVA), subretinal fluid thickness and central macular thickness. The baseline mean BCVA was LogMAR 0.4+/-0.21 (range 0.1-0.8) and at three months post-treatment was LogMAR 0.31+/-0.26 (range 0.1-1.7). Mean pre-PDT subretinal fluid thickness was 114+/-57µm, and post-PDT the mean was 41+/-57µm. Final visual acuity improved in seven cases, stabilised in two cases, and worsened in two cases. There was one post-PDT choroidal neovascular membrane (CNVM), a rare complication.

In all cases there was either resolution or improvement in subretinal fluid thickness. Dr Goodchild concluded that the study results were encouraging and, including the post-PDT CNVM, were in line with the published results to date internationally of using of half-fluence PDT for the treatment of active CSC.

Christine Goodchild: christine_siew88@yahoo.com