Microperimetric evaluation of chronic central serous chorioretinopathy after half-dose photodynamic therapy

Abstract

Background: The purpose of this study was to determine baseline clinical factors to correlate the outcome of half-dose verteporfin photodynamic therapy (PDT) in eyes with chronic central serous chorioretinopathy (CSC).

Methods: In this prospective, non-comparative, interventional case series, 14 eyes of 14 patients with chronic CSC who received half-dose verteporfin PDT were examined. The best-corrected visual acuity (BCVA), macular sensitivity in the central 4, 8, and 12 degrees, and fixation stability were evaluated at baseline and at months 1, 3, 6, and 12 after half-dose verteporfin PDT. Macular sensitivity and fixation stability were determined by MP-1 microperimetry.

Results: Mean retinal sensitivity in the central 4 and 8 degrees was significantly better at 1, 3, 6, and 12 months after half-dose verteporfin PDT than at baseline. BCVA was significantly better after half-dose verteporfin PDT but only after 3 months. Fixation was relatively unstable in three eyes at baseline, but became stable at 12 months. BCVA at 12 months was significantly correlated with pre-PDT fixation stability (r = 0.7120, P = 0.0038).

Conclusion: Half-dose verteporfin PDT results in a significant increase in mean central retinal sensitivity for at least 12 months. Our findings indicate that microperimetry is a useful method for evaluating the functional benefits of half-dose verteporfin PDT in eyes with chronic CSC.

Keywords: chronic central serous chorioretinopathy; fixation point; microperimetry; photodynamic therapy; retinal sensitivity.

Figure 1

Representative cases with similar pretreatment findings but with different outcomes after half-dose verteporfin PDT. Notes: The left column shows the fundus photographs (top), fluorescence angiographic images at a late phase (middle), and indocyanine green angiographic images at a late phase (bottom) for each case. The middle column shows a horizontally scanned optical coherence tomographic image (top), macular retinal sensitivity (middle), and fixation stability (bottom) at baseline for each case. The right column shows horizontally scanned optical coherence tomographic image (top), macular retinal sensitivity (middle), and fixation stability (bottom) 12 months after half-dose verteporfin PDT for each case. Fundus photography, fluorescein angiography, indocyanine green angiography, and optical coherence tomographic findings, and macular sensitivity, but not fixation stability, at baseline are similar in the two cases. The visual acuity at baseline was 0.5 in each case. The spot size for PDT was 4300 μm for case 9 and 3100 μm for case 11. Twelve months after half-dose verteporfin PDT, the optical coherence tomographic findings and macular sensitivity was different although fixation stability became similar in both cases. Visual acuity was 0.9 in case 9 and 0.4 in case 11. Abbreviation: PDT, photodynamic therapy.

Figure 2

Mean best-corrected visual acuity in logarithm of the minimum angle of resolution units before and after half-dose verteporfin PDT in patients with chronic central serous chorioretinopathy. Notes: The best-corrected visual acuity is significantly better at 3 months than at baseline. *P < 0.0125; Bars are the standard deviations. Abbreviation: M, months; PDT, photodynamic therapy.

Figure 3

Mean retinal sensitivity in the central retinal areas of 4, 8, and 12 degrees before and after half-dose verteporfin PDT in patients with central serous chorioretinopathy. Notes: There is significant improvement in sensitivity compared with baseline after 1 month. *P < 0.0125 in comparison of mean retinal sensitivity from central 4 and 8 degrees at 1 month after treatment. **P < 0.0125 in comparison of mean retinal sensitivity from central 4, 8, and 12 degrees at 3, 6, and 12 months. Bars show standard errors of the means. Abbreviation: M, months; PDT, photodynamic therapy.