COMMENTARY

Refining the Treatment for Acute Central Serous Chorioretinopathy

C. Robert Bernardino, MD

Disclosures

November 10, 2008

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

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....