Severe choroidal ischemia following photodynamic therapy for pigment epithelial detachment and chronic central serous chorioretinopathy

Abstract

Background: Photodynamic therapy (PDT) has proven beneficial in the treatment of central serous chorioretinopathy (CSC).

Cases: Two patients with serous pigment epithelial detachments (PEDs) and one patient with chronic CSC developed an abrupt visual loss caused by severe choroidal ischemia following PDT. Serous PEDs in the two patients were regarded as a latent variant of CSC. PDT was performed in accordance with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy guidelines.

Observations: Although following PDT, PEDs and serous sensory retinal detachments resolved in all patients, the laser-treated areas of the patients revealed severe choroidal ischemia and their visual acuity decreased. Only in case 1 did visual acuity recover to the pretreatment level 2 months after treatment. In case 2, visual acuity was still reduced 7 months after treatment. In case 3, secondary choroidal neovascularization developed in the treatment area 1 month after treatment.

Conclusions: In the CSC variant associated with PED only or in chronic CSC, PDT performed by the standard procedure can increase the risk of severe choroidal ischemia. Further studies are needed to find safe and optimal PDT parameters.