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Low-fluence PDT improves macular sensitivity best in eyes with chronic serous chorioretinopathy

Am J Ophthalmol. 2011;151(6):953-960.

Issue: August 25, 2011

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Low-fluence photodynamic therapy yielded higher macular sensitivity than did standard-fluence laser therapy in eyes with chronic central serous chorioretinopathy, a study found.

“This, as well as its efficacy in improving visual acuity and resolving subretinal fluid and its lower rate of side effects, suggests that low-fluence PDT may be a good treatment option in patients with chronic [central serous chorioretinopathy],” the study authors said.

The prospective clinical study included 42 eyes of 42 patients with chronic central serous chorioretinopathy; 19 eyes underwent standard-fluence PDT and 23 eyes underwent low-fluence PDT. The MP-1 microperimeter (Nidek) was used to localize and quantify retinal sensitivity and fixation at baseline and 3 and 12 months after treatment.

Modified ETDRS charts were used to measure best corrected visual acuity; results were converted to logMAR values. Optical coherence tomography (Status, Carl Zeiss Meditec) was used to measure central foveal thickness.

BCVA and central foveal thickness were assessed at baseline and 1, 3, 6, 9 and 12 months. Parameters at baseline and 3 and 12 months were analyzed.

At 12 months after treatment, mean central retinal sensitivity improved from 11.9 to 14.4 in the standard fluence PDT group and from 11.8 to 16.3 in the low-fluence PDT group. The between-group difference was statistically significant (P = .04).

Retinal sensitivity correlated strongly with BCVA in both groups at 12 months.

Both groups had similar gains in BCVA and reductions in central foveal thickness at 12 months. In addition, neither group had significant changes in fixation stability, the authors reported.

The concept of using low-fluence PDT is to achieve the same desirable effects of standard-fluence PDT but with less damaging effects to normal tissue and, therefore, lower rates of any associated visual loss. The literature suggests that low-fluence PDT has lower rates of severe visual acuity loss when used to treat neovascular AMD. There is evidence in the literature for the efficacy of PDT to treat chronic central serous chorioretinopathy (CSC). This prospective study strengthens that evidence and also indicates that visual function outcomes expressed as macular sensitivity by microperimetry may be better with low-fluence PDT. Based on this study, it may be best to consider starting with low-fluence PDT when treating chronic CSC.

– Carl D. Regillo, MD
Retina Service, Wills Eye Institute, Philadelphia
Disclosure: Dr. Regillo reported no relevant financial relationships.