Half-fluence Photodynamic Therapy for Central Serous Chorioretinopathy in a Patient Receiving Corticosteroids for Behçet's Uveitis

Abstract

Corticosteroid-induced central serous chorioretinopathy (CSCR) has been reported to develop in many intraocular inflammatory diseases and usually resolves spontaneously after discontinuation of corticosteroids. Patients without any improvement may require alternative therapies. In this case report, we present the case of a 35-year-old man with Behçet's disease who had complaints of decreased vision due to CSCR in his left eye while using systemic corticosteroids along with cyclosporine and azathioprine. Half-fluence photodynamic therapy (PDT) was performed because the CSCR did not regress despite discontinuation of systemic corticosteroids. After treatment, his visual acuity increased with complete resolution of the subfoveal fluid. Half-fluence PDT seems to be an effective and safe treatment for patients who develop acute CSCR while under systemic or local corticosteroid therapy for intraocular inflammatory diseases such as Behçet's uveitis and do not improve despite steroid discontinuation.

Keywords: Behçet’s disease; central serous chorioretinopathy; photodynamic therapy; steroid; uveitis.

Figure 1

Multimodal imaging of the patient at presentation. Widefield fundus photography was unremarkable in the right eye (RE) (A) and retina pigment epithelium changes and peripheral vascular sheathing were observed in the left eye (LE) (B). Fundus autofluorescence showed normal autofluorescence in the RE (C) and speckled hyperautofluorescence in the macula extending inferiorly in the LE (D). There was no pathology in OCT of the RE (E) but serous macular detachment was present in the LE (F) OCT: Optical coherence tomography

Figure 2

Fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed at presentation. FA of the left eye (LE) revealed optic nerve head hyperfluorescence, perivascular leakage, and multifocal leakage points which enlarged in the late phase (A). ICGA revealed bilateral dilated choroidal vessels in the early phase (B, C). Late-phase FA revealed bilateral optic nerve hyperfluorescence (D, F) and diffuse perivascular leakage in the LE (F). Late-phase ICGA was normal in the right eye (E) but a focal hyperpermeability area was observed in the macula of the LE (G)

Figure 3

There was no macular neovascularization in optical coherence tomography angiography of the left eye

Figure 4

Enhanced depth imaging optical coherence tomography (EDI-OCT) images demonstrated serous macular detachment, minimal double-layer sign on the nasal edge of the detachment, and thickened choroid at presentation (A), slightly regressed subfoveal fluid 3 months after corticosteroid cessation (B), and completely resolved subfoveal fluid and thinned choroid 1 month after photodynamic therapy (C)