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Study: PDT may be helpful for chronic central serous chorioretinopathy treatment
Early results suggest photodynamic therapy may treat chronic central serous chorioretinopathy, sustaining improvements for more than 6 months.
Patients with central serous chorioretinopathy reported subjective improvements 6 months after receiving photodynamic therapy treatments, in a small study presented at the American Academy of Ophthalmology meeting in New Orleans.
“All seven eyes in the study had at least two lines of visual improvement in Snellen acuity,” said John C. Chen, MD, an associate professor at McGill University in Montreal. “Effects have been maintained for more than 6 months, with just one patient receiving re-treatment due to persistence of subretinal fluid,” Dr. Chen said.
According to Dr. Chen, the etiology of central serous chorioretinopathy (CSC) is unclear. “It is well-known clinically, but the exact pathogenesis is a mystery,” he said. Often management of the disease is subjective, with disagreement among colleagues that can result in misdiagnosis and improper patient management.
Lawrence A. Yannuzzi, MD, a clinical professor at Columbia University in New York, N.Y., agreed with Dr. Chen that a larger prospective study is needed to establish the individual characteristics of CSC, as well as to assess the true efficacy of photodynamic therapy (PDT) on the condition.
Hypothesis
“Photodynamic therapy has been applied successfully in the treatment of choroidal neovascularization in a number of conditions,” Dr. Chen said, “Recently, a study reported that at least part of the PDT effect on the closure of the choroidal neovascular membrane may lead to decreased choroidal blood flow.”
By applying this knowledge, Dr. Chen and fellow researchers hypothesized that PDT may be effective in decreasing the state of hyperperfusion in affected areas of the choriocapillaris during the course of CSC.
Study selection and results
Dr. Chen’s study included seven eyes of five male patients between the ages of 35 and 65. Data were accrued retrospectively from chart reviews of patients who had been treated since September 2000. All patients had chronic CSC symptoms with either no improvement or a decline in status for more than 6 months.
“Within 3 weeks of treatment, patients reported improvements,” Dr. Chen said. In the first case, a patient with 1 year of decreased vision and a visual acuity of 20/60 experienced improvement to 20/20 at 12 months after treatment.
Additionally, a patient with chronic CSC for 30 years improved from a visual acuity of 20/60 to 20/25 at 2 months after PDT treatment. The third case improved from 20/70 in the right eye to 20/40 after treatment, and from 20/400 in the left eye to 20/200 after treatment. This patient improved his vision by nearly 50%, Dr. Chen said.
Case number four improved by nearly 50% as well, starting out with 20/70 visual acuity in the left eye and 20/100 in the right eye. Three months after PDT, vision was up to 20/40 in the left eye and 20/50 in the right eye.
The final case had lost central vision acuity a number of years before PDT treatment. The situation had worsened in recent months to 20/80. However, 6 months after PDT, the patient’s vision improved to 20/40. The condition continued to improve further and by the 1-year follow-up mark the patient could see at 20/20, with no recurrence, Dr. Chen said.
More testing needed
Dr. Chen said problems with the study design will be addressed in the next CSC study. “There is a lack of ICG documentation, and the retrospective nature of the study could be misleading,” he said.
“There are some problematic issues with the design of this study,” said Dr. Yannuzzi. He said that duration of the detachment would have been preferable as an outcome, particularly if confirmed with with optical coherence tomography. Indocyanine green angiography (ICG) is also needed to identify the choroidal leakage, he said.
Despite these study limitations, Dr. Yannuzzi said, “Five patients did well, which is encouraging.”
For future studies, Dr. Yannuzzi recommends the inclusion of more patients and the use of ICG documentation and OCT imaging. “The addition of these new components will give Dr. Chen the opportunity to confirm his diagnosis with certainty, to guide the laser treatments in a standardized fashion, and to assess the outcome with anatomical and functional correlation,” he added.
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For Your Information:
- John C. Chen, MD, can be reached at the Montreal Retina and Laser Institute, 2021 Union St., 1288 Montreal QC H3A 2S9, Canada; +(514) 285-8838; fax: +(514) 285-8897; e-mail: john.chen@mcgill.ca.
- Lawrence A. Yannuzzi, MD, can be reached at Vitreous-Retina-Macula Consultants of New York, 519 E. 72nd St., Suite 203, New York, NY 10021 U.S.A.; +(1) 212-861-9797; fax: +(1) 212-628-0698; e-mail: vrmny@aol.com; Web site: www.vrmny.com.