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. 2023 Nov;261(11):3149-3158.
doi: 10.1007/s00417-023-06147-5. Epub 2023 Jun 22.

Optical coherence tomography angiography-guided vs indocyanine green angiography-guided half-dose photodynamic therapy for acute central serous chorioretinopathy: 6-month randomized trial results

Siying Li  1 , Linqi Zhang  1 , Jiyang Tang  1 , Zongyi Wang  1 , Jinfeng Qu  2 , Mingwei Zhao  3
Affiliations

Optical coherence tomography angiography-guided vs indocyanine green angiography-guided half-dose photodynamic therapy for acute central serous chorioretinopathy: 6-month randomized trial results

Siying Li et al. Graefes Arch Clin Exp Ophthalmol. 2023 Nov.

Abstract

Purpose: This study aimed to compare the anatomic and functional results of optical coherence tomography angiography (OCTA)-guided half-dose photodynamic therapy (PDT) versus indocyanine green angiography (ICGA)-guided PDT in eyes with acute central serous chorioretinopathy (CSC).

Methods: One hundred and thirty-one eyes of 131 patients with acute central serous chorioretinopathy (CSC) were recruited, and randomly assigned to the OCTA-guided group and ICGA-guided group. The primary outcome measures were the rates of complete subretinal fluid (SRF) resolution at 1 month, 3 months, and 6 months. The secondary outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), choroidal capillary flow deficit density at each scheduled visit, and recurrence rate of SRF at 3 months and 6 months.

Results: There were 110 eyes that finished the follow-up, with 56 eyes in the OCTA-guided group and 54 eyes in the ICGA guided group. OCTA-guided PDT was demonstrated to be noninferior to ICGA-guided PDT for SRF resolution rate at 1 months and 6 months (P = 0.021 and P = 0.037), but not at 3 months for acute CSC (P = 0.247). The average CRT of the ICGA-guided group was significantly lower than that of the OCTA-guided group at 3-month visit (P = 0.046), but no significant difference was found between them at the 1-month and 6-month visits (P = 0.891 and 0.527). There was no significant difference between the two groups for BCVA (P = 0.359, 0.700, and 0.143, respectively) and the deficit area on CC (P = 0.537, 0.744,and 0.604, respectively) at 1, 3, and 6 months.

Conclusion: OCTA may replace ICGA to guide PDT for the treatment of acute CSC and their follow-up.

Keywords: Acute CSC; ICGA-guided; OCTA-guided; PDT.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Binarizing of choriocapillaris flow imaging and measurement of flow deficit density (FDD) by using Image J
Fig. 2
Fig. 2
Flowchart showing the distribution of the study population
Fig. 3
Fig. 3
Non-inferiority test of OCTA-guided PDT to ICGA-guided PDT for complete SRF resolution rate at 1, 3, and 6 months after treatment
Fig. 4
Fig. 4
Images of a 23-year-old man with acute CSC treated with ICGA-guided PDT. The patient companied of blurred vision of the left eye for 1 week. CFP, ICGA, and FFA images, 6 × 6 mm en face OCTA image at the level of the choriocapillaris, B scan of the structural OCT before PDT (A1–E1), 1 month after PDT (A2–E2), 3 months after PDT (A3–E3), and 6 months after PDT (A4–E4). Red circles indicate the PDT spot area. Note the SRF was completely resolved at 1 month after PDT (CSC, central serous chorioretinopathy; OCTA, optical coherence tomography angiography; PDT, photodynamic therapy; CFP, color fundus photograph; ICGA, indocyanine green angiography; FFA, fundus fluorescein angiography; SRF, subretinal fluid)
Fig. 5
Fig. 5
Images of a 42-year-old man with acute CSC treated with OCTA-guided PDT. CFP, ICGA, and FFA images, 6 × 6 mm en face OCTA image at the level of the choriocapillaris, B scan of the structural OCT before PDT (A1–E1), 1 month after PDT (A2–E2), 3 months after PDT (A3–E3), and 6 months after PDT (A4–E4). Red circles indicate the PDT spot area. Note the SRF was partially resolved at 1 and 3 months after PDT and completely resolved with a small serous PED appeared at 6 months after PDT. The leakage on FFA and ICGA partially resolved at 1 and 3 months after PDT. The en face OCTA image at the level of the choriocapillaris hyper-reflective area on OCTA also gradually disappeared during the 6 months of follow-up (CSC, central serous chorioretinopathy; OCTA, optical coherence tomography angiography; PDT, photodynamic therapy; CFP, color fundus photograph; ICGA, indocyanine green angiography; FFA, fundus fluorescein angiography; SRF, subretinal fluid)
Fig. 6
Fig. 6
A Comparison of CRT at each visit between two groups. B Comparison of Log MAR BCVA at each visit between two groups. C Comparison of FDD at CC level on 6 × 6 mm en face OCTA image at each visit between two groups
Fig. 7
Fig. 7
The change in choroicapillaris flow deficit density (FDD) after half dose PDT calculated by using binarized OCTA image at CC level throughout follow-up period
See this image and copyright information in PMC

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