Department of Ophthalmology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2021 Apr;259(4):905-910. doi: 10.1007/s00417-020-04959-3. Epub 2020 Oct 29.
To evaluate the clinical outcomes after half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSC) patients with pre-existent fovea-involving atrophy.
In this retrospective study, cCSC patients who had a window defect of the retinal pigment epithelium (RPE) on fluorescein angiography (FA), compatible with RPE atrophy, prior to half-dose PDT were included.
Thirty-four cCSC eyes with typical findings of cCSC on multimodal imaging, and fovea-involving RPE atrophy on FA, were included. At the first visit after PDT (at a median of 1.8 months after half-dose PDT), 20 eyes (59%) had a complete resolution of SRF (p < 0.001), while this was the case in 19 eyes (56%) at final visit (median of 11.3 months after half-dose PDT; p < 0.001). The mean BCVA in Early Treatment of Diabetic Retinopathy Study letters was 71. 2 ± 15.9 at last visit before PDT, which increased to 74.1 ± 14.1 at first visit after PDT (p = 0.093, compared with baseline), and changed to 73.0 ± 19.1 at final visit (p = 0.392, compared with baseline). Both at first visit after PDT and at final visit, a significant decrease in subfoveal choroidal thickness was observed (p = 0.032 and p = 0.004, respectively).
Half-dose PDT in cCSC patients with pre-existing fovea-involving atrophy may lead to anatomical changes, but not to functional improvements. Ideally, cCSC should be treated with half-dose PDT before the occurrence of such atrophy.
评估伴有预先存在的累及黄斑的脉络膜视网膜色素上皮萎缩的慢性中心性浆液性脉络膜视网膜病变（cCSC）患者接受半剂量光动力疗法（PDT）后的临床疗效。
在这项回顾性研究中，纳入了在荧光素血管造影（FA）上具有窗样缺损的表现（提示 RPE 萎缩）的 cCSC 患者，这些患者之前接受过半剂量 PDT 治疗。
34 只 cCSC 眼在多模态成像上具有典型的 cCSC 表现，FA 上存在累及黄斑的 RPE 萎缩。在 PDT 后首次就诊（接受半剂量 PDT 后 1.8 个月的中位数时间）时，20 只眼（59%）的 SRF 完全消退（p<0.001），而在最终就诊时（接受半剂量 PDT 后 11.3 个月的中位数时间）19 只眼（56%）达到了完全消退（p<0.001）。在 PDT 前的最后一次就诊时，最佳矫正视力（BCVA）的平均 ETDRS 字母数为 71.2±15.9，在 PDT 后首次就诊时增加到 74.1±14.1（p=0.093，与基线相比），在最终就诊时改变为 73.0±19.1（p=0.392，与基线相比）。在 PDT 后首次就诊和最终就诊时，均观察到了脉络膜厚度的显著减少（p=0.032 和 p=0.004）。
对于伴有预先存在的累及黄斑的脉络膜视网膜色素上皮萎缩的 cCSC 患者，接受半剂量 PDT 治疗可能会导致解剖结构的改变，但不会导致功能的改善。理想情况下，应在发生这种萎缩之前，用半剂量 PDT 治疗 cCSC。
