Gawęcki Maciej, Kiciński Krzysztof, Kucharczuk Jan, Gołębiowska-Bogaj Monika, Grzybowski Andrzej
Department of Ophthalmology, Pomeranian Hospitals, 84-200 Wejherowo, Poland.
Dobry Wzrok Ophthalmological Center, 80-392 Gdansk, Poland.
Biomedicines. 2025 Apr 11;13(4):944. doi: 10.3390/biomedicines13040944.
: Photodynamic therapy (PDT) is an established treatment modality in central serous chorioretinopathy (CSCR). The goal of our study was to evaluate the morphological and functional effects of PDT in patients with long-lasting CSCR and determine the related predictive factors for improvement. : This retrospective analysis included consecutive patients with chronic CSCR who consented to PDT. The material comprised 98 eyes of 81 patients (67 males and 14 females) with a disease duration longer than 6 months followed for 6 months post treatment. All patients underwent a basic ophthalmological examination including best corrected visual acuity (BCVA) testing and imaging, spectral-domain optical coherence tomography (SD-OCT), and fluorescein angiography. Patients without macular neovascularization (MNV) were subjected to half-dose PDT (3 mg/m) with standard fluence (50 J/cm), guided by indocyanine green angiography. Cases complicated by MNV were subjected to full-dose PDT. : A morphological response, defined as complete resolution of subretinal fluid, was achieved in 76.29% of cases, and an improvement in BCVA of at least one logMAR line was obtained in 77.53% of cases. The mean BCVA gain was 1.2 logMAR line. All SD-OCT measurements (central retinal thickness, macular volume, mean subfield thickness, subretinal fluid height, and subfoveal choroidal thickness) showed a significant reduction post PDT. A multivariate analysis proved better morphological outcome associations with a younger age and male gender and better visual gains achieved in patients without intraretinal abnormalities. Univariate testing also showed strong relationships between better baseline BCVA and greater functional and morphological improvements, between shorter disease duration and morphological gains, and between the absence of MNV or intraretinal abnormalities and morphological gains. PDT was highly effective in providing a resolution of pigment epithelial detachment ( = 0.0004). The observed effect was significantly dependent upon the lower baseline central retinal thickness ( = 0.0095). Patients with intraretinal abnormalities or MNV showed moderate improvements post PDT. : PDT in long-lasting CSCR cases provides good morphological results but generally minor visual gains. Patients' expectations of significant increases in BCVA after prolonged disease with distinct alterations of the neurosensory retina should be managed.
光动力疗法（PDT）是中心性浆液性脉络膜视网膜病变（CSCR）的一种既定治疗方式。我们研究的目的是评估PDT对长期CSCR患者的形态学和功能影响，并确定改善的相关预测因素。
这项回顾性分析纳入了连续同意接受PDT治疗的慢性CSCR患者。研究材料包括81例患者（67例男性和14例女性）的98只眼睛，病程超过6个月，治疗后随访6个月。所有患者均接受了包括最佳矫正视力（BCVA）测试和成像、光谱域光学相干断层扫描（SD-OCT）以及荧光素血管造影在内的基本眼科检查。无黄斑新生血管（MNV）的患者在吲哚菁绿血管造影引导下接受半剂量PDT（3mg/m），标准能量密度为50J/cm。合并MNV的病例接受全剂量PDT。
76.29%的病例实现了形态学反应，定义为视网膜下液完全消退，77.53%的病例BCVA至少提高了一行logMAR。平均BCVA提高了1.2行logMAR。所有SD-OCT测量（中央视网膜厚度、黄斑体积、平均子区域厚度、视网膜下液高度和黄斑中心凹脉络膜厚度）在PDT后均显著降低。多因素分析表明，年龄较小、男性性别与更好的形态学结果相关，无视网膜内异常的患者视力改善更好。单因素测试还显示，基线BCVA较好与功能和形态学改善更大之间、病程较短与形态学改善之间以及无MNV或视网膜内异常与形态学改善之间存在密切关系。PDT在解决色素上皮脱离方面非常有效（P = 0.0004）。观察到的效果显著取决于较低的基线中央视网膜厚度（P = 0.0095）。有视网膜内异常或MNV的患者在PDT后有中度改善。
长期CSCR病例的PDT可提供良好的形态学结果，但一般视力改善较小。对于病程较长且神经感觉视网膜有明显改变的患者，应管理其对BCVA显著提高的期望。
