Servillo Andrea, Sacconi Riccardo, Zucchiatti Ilaria, Grachova Elena, Querques Lea, Prascina Francesco, Tombolini Beatrice, Dorin Giorgio, Mainster Martin, Bandello Francesco, Querques Giuseppe
Division of Head and Neck, Ophthalmology Unit, University Vita-Salute, IRCSS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
Ophthalmol Ther. 2023 Aug;12(4):2199-2208. doi: 10.1007/s40123-023-00739-4. Epub 2023 Jun 8.
This study aimed to describe the effects of no-dose full-fluence photodynamic therapy without verteporfin (no-dose PDT) and to compare no-dose PDT with half-dose verteporfin full-fluence photodynamic therapy (HDFF PDT) for managing chronic central serous chorioretinopathy (cCSC).
This retrospective study evaluated 11 patients with chronic recurrent CSC treated with no-dose PDT between January 2019 and March 2022. Most of these patients were also treated with HDFF PDT a minimum of 3 months before and were considered as the control group. We described the changes of best corrected visual acuity (BCVA), maximum subretinal fluid (mSRF), foveal subretinal fluid (fSRF), and choroidal thickness (CT) 8 ± 2 weeks after no-dose PDT, and we compared BVCA, mSRF, fSRF, and CT of no-dose PDT with those of the of same patients previously treated with HDFF PDT.
Fifteen eyes of 11 patients (10 male, mean age 54 ± 12 years) received no-dose PDT; among these, 10 eyes of 8 patients (7 male, mean age 53 ± 12 years) also received HDFF PDT. Three eyes showed complete resolution of fSRF after no-dose PDT. No significant differences were disclosed between treatment with and without verteporfin comparing BCVA, mSRF, fSRF, and CT at baseline and 8 ± 2 weeks from the treatment (p > 0.05 in all analyses).
BVCA and CT significantly improved after no-dose PDT. Short-term functional and anatomical treatment outcomes for cCSC were similar for HDFF PDT and no-dose PDT. We hypothesize that the potential benefits of no-dose PDT may arise from thermal elevation that triggers and enhances photochemical activities by endogenous fluorophores, activating a biochemical cascade response that rescues/replaces sick, dysfunctional retinal pigment epithelial (RPE) cells. Results of this study suggest the potential value of a prospective clinical trial to evaluate no-dose PDT for managing cCSC, especially when verteporfin is contraindicated or unavailable.
本研究旨在描述无剂量全通量光动力疗法（无剂量光动力疗法）在不使用维替泊芬情况下的效果，并比较无剂量光动力疗法与半剂量维替泊芬全通量光动力疗法（HDFF光动力疗法）治疗慢性中心性浆液性脉络膜视网膜病变（cCSC）的疗效。
本回顾性研究评估了2019年1月至2022年3月期间接受无剂量光动力疗法治疗的11例慢性复发性CSC患者。这些患者中的大多数在至少3个月前也接受了HDFF光动力疗法治疗，并被视为对照组。我们描述了无剂量光动力疗法后8±2周时最佳矫正视力（BCVA）、最大视网膜下液（mSRF）、黄斑区视网膜下液（fSRF）和脉络膜厚度（CT）的变化，并将无剂量光动力疗法组的BCVA、mSRF、fSRF和CT与这些患者先前接受HDFF光动力疗法治疗后的情况进行了比较。
11例患者（10例男性，平均年龄54±12岁）的15只眼接受了无剂量光动力疗法；其中，8例患者（7例男性，平均年龄53±12岁）的10只眼也接受了HDFF光动力疗法。3只眼在无剂量光动力疗法后fSRF完全消退。在基线时以及治疗后8±2周时，比较有无维替泊芬治疗的BCVA、mSRF\、fSRF和CT，未发现显著差异（所有分析中p>0.05）。
无剂量光动力疗法后BCVA和CT显著改善。HDFF光动力疗法和无剂量光动力疗法治疗cCSC的短期功能和解剖学治疗结果相似。我们推测，无剂量光动力疗法的潜在益处可能源于温度升高，这种升高触发并增强了内源性荧光团的光化学活性，并激活了生化级联反应，从而挽救/替代患病的、功能失调的视网膜色素上皮（RPE）细胞。本研究结果提示，开展一项前瞻性临床试验以评估无剂量光动力疗法治疗cCSC的潜在价值，特别是在维替泊芬禁忌或无法获得时。
