Refining the Treatment for Acute Central Serous Chorioretinopathy

Introduction

Central serous chorioretinopathy (CSC) is characterized by macular subretinal fluid; it typically affects young men with a 'type A' personality.^[1] Although most fluid and visual changes resolve spontaneously within 3 months, up to 50% of patients can have persistent vision loss. Although "full-dose" photodynamic therapy (PDT) has been efficacious, side effects can include retinal pigment epithelium (RPE) atrophy, choroidal ischemia, and choroidal neovascularization.^[2,3] This study looked at the efficacy and safety of half-dose verteporfin PDT for CSC.

Summary

Patients with CSC were randomized to receive either half-dose PDT or placebo. Verteporfin was given at half-dose (3 mg/m²) and infused over 8 minutes. Ten minutes after commencement of infusion, a 689-nm laser was delivered to areas of choroidal dilation and hyperpermeability.

A total of 42 eyes received half-dose PDT and 21 eyes received placebo; 5 patients were eventually lost to follow-up (3 in the PDT group). At 12 months, 37 of 39 patients who received PDT had complete resolution of fluid compared with 11 of 19 patients in the placebo group. At 3 months, there was no difference in visual acuity change between the two groups. However at 1 year, patients who received half-dose PDT had a mean improvement of 1.8 lines of vision compared with 0.6 lines in the placebo group. No complications were seen in the half-dose PDT group.

Comment

This study demonstrated efficacy and safety in the use of half-dose verteporfin/PDT for CSC. Halving the dose of verteporfin and shortening the interval between infusion and laser application seemed to prevent complications associated with full-strength PDT. Although there was no apparent benefit at 3 months, there was significant improvement of vision compared with placebo at 1 year follow-up.

Abstract

Chan WM, Lai TY, Lai RY, Liu DT, Lam DS
Ophthalmology. 2008;115:1756-1765

Medscape Ophthalmology © 2008  Medscape

Cite this: Refining the Treatment for Acute Central Serous Chorioretinopathy - Medscape - Nov 10, 2008.