PDT should be considered for chronic central serous chorioretinopathy

Issue: February 25, 2015

WAILEA, Hawaii — Retina specialists should consider photodynamic therapy as an adjunctive treatment for chronic central serous chorioretinopathy, according to a study presented here.

Perspective from Pravin U. Dugel, MD

“PDT has been impressively good,” Rishi P. Singh, MD, said at Retina 2015. “It’s really something to consider in those patients who have chronic CSR.”

According to results of the American Society of Retina Specialists’ PAT Survey, 64% of U.S. respondents used reduced-fluence PDT and 3.5% used standard-fluence PDT.

Additionally, 13.5% used intravitreal Avastin (bevacizumab, Genentech) and 3.8% used thermal laser. Small percentages of U.S. respondents used rifampin, finasteride, aspirin, RU486 or mifepristone or resorted to observation.

These agents increase cytochrome P450 enzymes in the liver, reduce cortisol levels in the body, and may block mineralocorticoid or glucocorticoid receptors, Singh said.

Verteporfin selectively occludes choroidal neovascularization and superficial choroidal vessels and has a minimal effect on overlying and deeper choroidal layers, Singh said.

Ninety percent of patients in the study had one PDT treatment, 7% had two and 3% had three; 51% underwent PDT with indocyanine green guidance.

Among eyes with baseline visual acuity of 20/32 or better, 26% gained two or more lines and 1% gained three or more lines.

Among eyes with baseline visual acuity of 20/40 to 20/80, 55% gained two or more lines and 29% gained three or more lines.

Among eyes with baseline visual acuity of 20/100 or worse, 59% gained two or more lines and 48% gained three or more lines.

“One concern about PDT has always been the acute vision loss following PDT treatment,” Singh said. “This occurred rarely, in about 1.5% of the patients who were studied in this group. Further prospective studies really need to be done to determine how this is going to end up being there for our patients.” – by Matt Hasson and Patricia Nale

Disclosure: Singh has financial relationships with Alcon, Genentech, Ophthotech, Regeneron, Shire Pharmaceuticals, ThromboGenics and Valeant.

Perspective

Pravin U. Dugel, MD

We realize now that central serous chorioretinopathy is not always a benign disease as was once thought. Even when it takes a typical course and resolves spontaneously, it can be debilitating. In some cases, chronic central serous chorioretinopathy will cause scarring and permanent vision loss. Unfortunately, this disease usually occurs in younger patients who are in the workforce; therefore, the societal impact is large.
Dr. Singh’s study is impactful for our treatment of these difficult patients with chronic central serous chorioretinopathy. It is important to avoid scarring and loss of photoreceptor cells and return patients back to their functional vision as soon as possible. We have known that PDT will allow for reabsorption of fluid. However, as Dr. Singh mentions, we have been concerned about loss of vision.
It is very encouraging that he has shown in his excellent study that only 1.5% of patients suffer from an acute loss of vision. This is encouraging, although not definitive. We need further confirmation in a larger study, and we also need long-term results. It is important to know whether in these typically younger patients if long-term vision loss occurs as a result of PDT. Singh’s study is impactful not only in our current clinical practice, but also hopefully it will give rise to a larger long-term study examining the use of PDT in central serous chorioretinopathy.

Pravin U. Dugel, MD

OSN Retina/Vitreous Board Member

Disclosures: Dugel has no relevant financial disclosures.