Efficacy of subthreshold navigated laser photocoagulation and micropulse laser for chronic central serous chorioretinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To comparatively analyze the efficacy of subthreshold laser photocoagulation with the NAVILAS® Laser system and subthreshold micropulse laser for patients with chronic central serous chorioretinopathy(cCSC).METHODS: A retrospective clinical study. A total of 36 patients(40 eyes)with cCSC were recruited from January 2020 to January 2021 diagnosed at the Affiliated Eye Hospital of Nanjing Medical University. There were 19 patients(23 eyes)treated with subthreshold navigated laser photocoagulation(the Navilas group), and 17 patients(17 eyes)treated with subthreshold micropulse laser(SML)(the SML group). There was no significant difference in baseline data between the two groups(P>0.05). The best corrected visual acuity(BCVA, LogMAR), central macular thickness(CMT), subretinal fluid(SRF)height, vessel densities of the superficial capillary plexus(SCP), the deep capillary plexus(DCP)and area of the foveal avascular zone(FAZ)were collected at 2wk, 1, 3 and 6mo before and after treatment.RESULTS: The BCVA of the two groups were significantly higher than that before treatment at 3 and 6mo after surgery(P<0.05),which was significantly reduced at 2wk after treatment in the Navilas group and was reduced at 1mo after treatment in the SML group(P<0.05). In both groups, there was significant decrease compared with that before treatment at 3 and 6mo after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05). The difference in SRF absorption between the two groups was statistically significant(P<0.05), and the complete absorption rate of SRF in the Navilas group was higher than that in the SML group. SCP, DCP, the area of the FAZ were not significantly different from each time ofbaseline in the two groups(P >0.05).CONCLUSION: Subthreshold laser photocoagulation with the NAVILAS® Laser system can rapidly improve the retinal morphology and shorten the course of cCSC to improve the recovery of visual function with its rapid effect, high cost-effectiveness, non-invasiveness and high repeatability, which can be a new clinical method for patients with cCSC.

Study on influence factors of intravitreal Ranibizumab in chronic central serous chorioretinopathy combined with CNV / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of intravitreal anti-vascular endothelial growth factor(VEGF)injection treatment in chronic central serous chorioretinopathy(CCSC)combined with choroidal neovascularization(CNV)using multimodal imaging, to explore and evaluate the influence factors.<p>METHODS: In this retrospective study, 30 patients(30 eyes)were diagnosed as CCSC combined with CNV. Comprehensive ophthalmologic examinations were performed, including best corrected visual acuity(BCVA), enhanced-depth imaging(EDI)spectral domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), Indocyanine green angiography(ICGA), and optical coherence tomography angiography(OCTA). Patients were treated with intravitreal ranibizumab(IVR)parallel 1+PRN schem for subretinal fluid(SRF)secondary to CCSC combined with CNV. All the patients were followed up at 1wk, 1mo after treatment and 3mo after consecutive treatment. The BCVA, central macular thickness(CMT), subfoveal choroid thickness(SFCT)and CNV flow area were compared.<p>RESULTS: All the patients were observed at baseline, 1wk, 1mo after treatment and 3mo after consecutive treatment. The difference at various time points of CMT(μm)were statistically significant(<i>F</i>=62.06, <i>P</i><0.01). CMT after treatment at each time point was compared with baseline, the difference among each time points was statistically significant(<i>t</i>=3.08, 6.57, 4.90; <i>P</i>=0.01, 0.02, <0.01). In which 46.7% of patients, SRF can be completely absorbed(14/30). The difference at various time points of BCVA(LogMAR)were statistically significant(<i>F</i>=87.21, <i>P</i><0.01). BCVA after treatment at each time point was compared with baseline, the difference between each group was statistically significant(<i>t</i>=6.52, 4.71, 6.01; <i>P</i>=0.03, <0.01, <0.01). The difference at various time points of SFCT(μm)were statistically significant(<i>F=</i>57.98, <i>P</i><0.01). SFCT after treatment at each time point was compared with baseline, the difference among each time points was statistically significant(<i>t</i>=5.11, 9.03, 4.2; <i>P</i>=0.03, <0.01, <0.01). The difference at various time points of CNV area(mm²)were statistically significant(<i>F</i>=70.78, <i>P</i><0.01). CNV area at 1wk and 1mo after treatment was compared with baseline, the difference was no statistically significant(<i>t</i>=7.01, 6.54; <i>P</i>=0.07, 0.05). CNV area at 3mo after the last treatment was compared with baseline, the difference was statistically significant(<i>t</i>=4.51, <i>P</i>=0.02). The change of CMT was positively correlated with the baseline CMT, BCVA and CNV area(<i>r</i>=0.43, 0.41, 0.41; <i>P=</i>0.02, 0.03, 0.03). The change of BCVA was positively correlated with the baseline BCVA and CMT(<i>r</i>=0.89, 0.43; <i>P</i><0.01, 0.02). <p>CONCLUSION: CCSC combined with CNV show different sensitivity to anti-VEGF therapy, the SRF can be completely absorbed after treatment in parts of patients. CNV may not be the only predictive factor leading to the SRF. The baseline BCVA, CMT and CNV area may be the factors that influence the final therapeutic effect of the intravitreal anti-VEGF injection therapy.

Optical coherence tomography angiography versus fluorescein angiography in diagnosing choroidal neovascularization in chronic central serous chorioretinopathy

Purpose: Diagnosis of choroidal neovascular membrane (CNVM) is difficult in chronic central serous chorioretinopathy (CCSC) due to overlapping features of both on conventional dye angiography. Optical coherence tomography angiography (OCTA) allows a quick and noninvasive detection of CNVM in these eyes. We compared the fluorescein angiography (FA) features of CNVM with those of OCTA to assess the role of FA in detecting CNVM in CCSC eyes. Methods: Patients with CCSC undergoing FA, spectral domain (SD)-OCT, and OCTA were identified (March 2015–June 2015). Four retina specialists individually reviewed FA images (without OCTA and SD-OCT) to determine whether CNVM was present. In parallel, two other retina specialists reviewed all images (FA/SD-OCT/OCTA) for CCSC features and confirmed whether CNVM was present using OCTA as the gold standard. The inter- and intraobserver variability was measured by Kappa (k) coefficient. The FA features of CNVM were compared and correlated with those on OCTA. Results: Of 43 eyes (26 patients, mean age 45.6 ± 8.5 years, all males), a definite CNVM (detected by OCTA) was present in nine (20.9%) eyes. FA alone detected CNVM in 13 (30.2%) eyes [sensitivity 44.4% (95% confidence interval (CI): 11.9–76.9), specificity 73.5% (95% CI: 58.7–88.3), positive and negative predictive values 30.8% and 83.3%, respectively, and accuracy 67.44% (95% CI: 53.4–81.4)]. Conclusion: When compared with OCTA, the FA was unable to characterize CNVM in CCSC (with a very low sensitivity and moderate specificity) as none of the specific dye leakage patterns on FA correlated with CNVM seen on OCTA, limiting its usefulness and accuracy in detecting CNVM in these eyes.

Comparison of Focal and Conventional Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).METHODS: This study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.RESULTS: The mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).CONCLUSIONS: Focal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.

Comparison of subthreshold micropulse laser treatment and PDT in patients with chronic central serous chorioretinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the efficacy and safety of 577nm subthreshold micropulse laser(SML)and photodynamic therapy(PDT)in patients with chronic central serous chorioretinopathy(cCSC).<p>METHODS: Thirty patients(30 eyes)with cCSC were treated in our hospital from February 2015 to April 2018. And 15 patients(15 eyes)were treated with SML(577 nm)while the others were treated by PDT. The BCVA and CMT as well as complications were observed at 1, 3, 6mo after treatment.<p>RESULTS: At 1mo after treatment, BCVA was increased to 0.37±0.13 in SML group and 0.20±0.11 in PDT group(<i>t</i>=-3.93, <i>P</i><0.001); CMT was decreased to 382.80±76.54μm in SML group and 247.60±28.46μm in PDT group(<i>t</i>=-6.41, <i>P</i><0.001). Although improvements of BCVA and CMT were both achieved in two groups, improvements in PDT group were better than those in SML group. At 3mo and 6mo after treatment, both BCVA and CMT were no significant difference between the two groups(<i>P</i>>0.05). During the follow-up period, there were no obvious complications or recurrence observed.<p>CONCLUSION: Both SML(577nm)and PDT were effective and safe in the treatment of cCSC, but the theraputic effects of PDT was slightly quicker than SML. Further, with the prolongation of recovery time, the curative effects of these treatments were similar. Additionally, SML(577nm)costs was much cheaper than PDT and had no risk of injury or allergy for patients, and patients with cCSC could also be treated repeatedly using it.

”Double-layer sign” on spectral domain optical coherence tomography in pachychoroid spectrum disease

Purpose: The “double-layer sign (DLS)” describes the shallow and irregular elevation of the retinal pigment epithelium from the underlying intact Bruch's membrane visualized on the spectral domain optical coherence tomography. In this study, we evaluated the frequency, characteristics of the space within the double layer and other features in the pachychoroid spectrum to aid the clinical diagnosis of these variants. Methods: This retrospective study evaluated the features of the DLS on multimodal imaging in consecutive patients with a clinical diagnosis of one of the four variants of pachychoroid: pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PCN), chronic central serous chorioretinopathy (CCSCR), and polypoidal choroidal vasculopathy (PCV). The features of the DLS were graded by two masked graders. Results: Overall, 102 eyes of 79 consecutive patients with pachychoroid spectrum were identified for grading. Sixteen eyes with PPE did not show any evidence of DLS. The DLS was identified in 15/16 (93.75%) eyes with PCN, 11/35 (31.43%) with CCSCR, and 32/35 (91.43%) with PCV (P < 0.001). The space within the DLS showed moderate hyperreflectivity in all eyes with PCV and PCN, while the space in the DLS in CCSCR showed uniform hyporeflectivity in 10/11 (%) eyes. Conclusion: The DLS sign was most frequent in polypoidal vasculopathy and PCN. A hyporeflective gap within the DLS favored the diagnosis of CCSCR.

Subthreshold micropulse yellow laser (577 nm) for chronic central serous chorioretinopathy with foveal leakage / 眼科新进展

Objective To assess the safety and efficacy of subthreshold micropulse yellow laser (577 nm) in the treatment of chronic central serous chorioretinopathy with foveal leakage.Methods This was a prospective study of 12 patients (12 eyes) with chronic central serous chorioretinopathy (CSC).All patients had been treated using multiple spots of subthreshold micropulse yellow laser at 577 nm with a duty cycle of 5％ over areas of focal and diffuse leakage.And lweeks,1 months,3 months,and 6 months after treatment,the best corrected visual acuity (BCVA),central macular thickness (CMT) and reduction in subretinal fluid (SRF) were recorded.Results The mean BCVA measured at 6 months after laser treatment was 0.19 ±0.11,which was in comparison to 0.27 ± 0.08 before laser treatment,and the difference was statistically significant (P =0.016).The mean CMT was significantly reduced from (432.42 ±134.17) μm before laser treatment to (248.75 ±36.06) μm after 6 months (P =0.002).The mean SRF height was significantly decreased from (213.58 ± 132.60) μm at baseline to (17.25 ±21.90) μm (P =0.002).At the last follow-up,the SRF had disappeared completely in 6 out of 12 eyes,but there were still 6 eyes suffering from SRF.There was no evidence of retinal or choroidal damage during 6-month follow up.Conclusion Subthreshold micropulse yellow laser (577 nm) is an effective treatment option for chronic CSC with foveal leakage.

Half-dose verteporfin and half-fluence photodynamic therapy for chronic central serous chorioretinopathy / 眼科新进展

Objective To compare the efficacy and safety of half-dose verteporfin and half-fluence photodynamic therapy in chronic central serous chorioretinopathy (CSC).Methods The medical records of 42 patients (42 eyes) with chronic CSC were retrospectively reviewed.According to the difference of drug dose and laser parameters in the course of PDT,the patients were divided into two groups:half-dose group and half-fluence group.Half-dose group:22 patients (22 eyes) received half-dose verteporfin(3 mg· m-2)and standard PDT(83 s,50 J · cm-2).Half-fluence group:20 patients (20 eyes) received full-dose verteporfin (6 mg · m-2) and half-fluence PDT (42 s,25 J · cm-2).Patients were followed up at 1 month,3 months,6 months after PDT.The outcome measures was the proportion of eyes with complete resolution of subretinal fluid(SRF),the changes in best corrected visual acuity (BCVA) and central retinal thickness(CMT).Results At 6 months after PDT,22 eyes(100％) that received half-dose PDT showed complete resolution of SRF,19 eyes(95％)that received half-fulence PDT showed complete resolution of SRF.There was no statistical difference between two groups (P ＞ 0.05).At 6 months after PDT,the mean BCVA improved 7.2 letters in half-dose group and 6.7 letters in half-fluence group.There was no statistical difference compared with the improvement of BCVA between two groups(P ＞ 0.05).In half-dose group,mean baseline central retinal thickness was (351 ± 90) μm,which was decreased to (178 ±55) μm after 6 months,respectively (P ＜ 0.05).In half-fluence group,mean baseline central retinal thickness was (322 ± 96) μm,which was decreased to (181 ± 47) μm after 6 months,respectively (P ＜ 0.05).None of the patients developed retinal pigment epithelium atrophy and CNV.Conclusion Half-dose verteporfm PDT and half-fluence PDT are effective and safe in the treatment of chronic CSC.

Observation on the efficacy of Conbercept for chronic central serous chorioretinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the efficacy of intravitreal conbercept injection for chronic central serous chorioretinopathy (CSC).METHODS: Nine eyes of 9 patients diagnosed as chronic CSC between October 2015 to May 2016 were treated with an intravitreal injection of conbercept (0.5mg/0.05mL) (six patients were given the same does of intravitreal injection again at 1mo after the first injection).Follow-up observation was at 1, 2, and 6mo after injection.Observed indicators included best-corrected visual acuity (BCVA), intraocular pressure, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), choroidal indocyanine green angiography (ICGA), macular fovea thickness (CMT), subfoveal choroidal thickness (SFCT).RESULTS:Seven of the 9 patients responded significantly to the drug, while 2 patients had no response.The CMT was 373.12±72.43μm at baseline, which decreased significantly to 332.05±67.13μm, 282.24±62.30μm and 225.56±71.08μm at 1, 2 and 6mo after the intravitreal injection.The mean thickness of SFCT was 422.11±64.82μm before treatment.The choroidal thickness of non-responsive patients before treatment was below average, respectively 353μm and 365μm.The SFCT of 1, 2, and 6mo after treatment was 391.45±75.24μm, 365.53±63.07μm, 355.40±66.65μm.Before treatment and 1mo after, there was no significant difference (P=0.074), but there was statistically significant (P0.05).CONCLUSION: Intravitreal conbercept injection in chronic CSC may have some effect in accelerating subertinal fluid resolution and decreasing the CMT.The SFCT within 6mo after treatment was significantly lower than pretreatment.The SFCT may be an indicator of whether patients respond.

Outer Retinal Layers Alterations in Chronic Central Serous Chorioretinopathy: Spectral Domain-OCT and Fundus Autofluorescence Findings

PURPOSE: To document alteration of the outer retinal layers and fundus autofluorescence (FAF) change in eyes with chronic central serous chorioretinopathy (CSCR). METHODS: Seventeen eyes of fifteen patients diagnosed with chronic CSCR from January 2014 to March 2015 with at least 6 months of follow-up and no history of surgery were enrolled in this study. Morphologic alterations in the retinal pigment epithelium (RPE), the photoreceptor inner segment/outer segment (IS/OS) junction layer, and the outer retina were evaluated by Spectral domain optical coherence tomography (SD-OCT). The FAF images were obtained via Heidelberg Retina Angiogram using a view mode of 30° and were described using distribution patterns of retinal autofluorescence compared to background autofluorescence. After tomographic alignment of the FAF intensities with the OCT findings, we analyzed and assessed the alteration of the outer retinal layers and the characteristics of retinal autofluorescence. RESULTS: RPE detachment lesions in SD-OCT showed little or no change in autofluorescence pattern. Five of seven eyes with RPE humps in SD-OCT showed hyper-fluorescence in FAF. All of the eyes with defects or changes of the reflective line representing the IS/OS junction in SD-OCT correlated with hyper-fluorescence in FAF. Seven of nine eyes with persistent subretinal detachment (SRD) showed specific ring-shaped hyper-fluorescence in FAF matching up with the border of the SRD, and five eyes with photoreceptor OS elongation within SRD showed a granular type of hyper-fluorescence within the ring-shaped hyper-fluorescence in FAF. CONCLUSIONS: In chronic CSCR, we found that RPE humps, the lesion IS/OS junction defect, the border of SRD, photoreceptor OS elongation in SD-OCT correlate with hyper-fluorescence lesions in FAF. The areas of the autofluorescence changes in the FAF images are associated with the extent of change in the RPE and outer retina.

Photodynamic Therapy and Focal Laser Photocoagulation in Chronic Central Serous Chorioretinopathy

PURPOSE: The aim of this study was to compare the treatment efficacy of photodynamic therapy (PDT) and focal laser photocoagulation in chronic central serous chorio retinopathy (CSC). METHODS: A retrospective study in a clinical practice setting including 40 eyes of 40 patients with chronic CSC which were treated with PDT or focal laser photocoagulation were recruited in this study from March 2011 to December 2013. Mean change in best corrected visual acuity (BCVA), presence or absence of resolution of subretinal fluid (SRF) and pigment epithelial detachment (PED), recurrence rate, and complications were analyzed. RESULTS: PDT was performed in 23 eyes of 23 patients and focal laser photocoagulation was performed in 17 eyes of 17 patients, and all patients were followed up for more than six months. Location of leakage point and appearance of leakage showed no statistically significant difference between the two groups. Both groups showed significant improvement in BCVA at one month and six months after the treatment; however, there was no statistically significant difference in BCVA improvement between the two groups. In both groups, SRF and PED were partially or completely resolved. Resolution of SRF was better in the PDT group at one month after the treatment; however, no statistically significant difference in the resolution period was observed between the two groups. None of the patients experienced adverse events in the PDT group, but one patient developed choroidal neovascularization after treatment in the focal laser photocoagulation group. Two patients showed recurrence in the PDT group and needed retreatment. CONCLUSIONS: Both treatments are beneficial in patients with chronic CSC. Focal laser photocoagulation can be a good treatment option in terms of cost-effectiveness and convenience.

Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy

PURPOSE: To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). METHODS: Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumab for chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessful at 3 months. A commercially available image analysis program (Adobe(R) Photoshop(R) CS6 [Adobe Systems, Inc., San Jose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energy PDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatment images after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability. RESULTS: The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 +/- 8.74) than in the ranibizumab group (6.78 +/- 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolution of subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energy PDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5 eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showing poor response (10.31 +/- 4.00 vs. 2.74 +/- 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significant difference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124). CONCLUSIONS: Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC, greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may be attributed to greater influence on choroidal hyperpermeability.

Outer Retinal Tubulation in Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate outer retinal tubulation (ORT) found in chronic central serous chorioretinopathy (CSC) using color fundus photography and spectral domain optical coherence tomography (SD-OCT). METHODS: ORT identified in patients with chronic CSC was examined using color fundus photography, fundus autofluorescence image, fluorescein angiography, indocyanin green angiography, and SD-OCT. The images were analyzed for morphological features, location, and size of ORT in the retinal layers. RESULTS: ORT was detected in 3 of 342 (0.88%) chronic CSC patients. Color fundus photography revealed circular or ovoid shape with hollow lumen and deep yellowish border mainly appearing at the affected retinal pigment epithelium layer in the macular area. SD-OCT B-scan revealed hyperreflective material observed inside the hyporeflective internal space with hyperreflective border. ORT had circular or ovoid shape on the SD-OCT C-scan. ORT was primarily located on the outer nuclear layer in the retina, emanating to the inner nuclear layer and was not greater than 170 x 170 microm in size when measured with SD-OCT B-scan image. CONCLUSIONS: ORT was identified in patients with chronic CSC which was observed using color fundus photography and circular or ovoid structure was observed using a SD-OCT C-scan.

Correlation Between Optical Coherence Tomography and Visual-Acuity in Chronic Central Serous Chorioretinopathy Treated with Half Dose Photodynamic Therapy

PURPOSE: To evaluate the results of half-dose photodynamic therapy (PDT) and determine the correlation between morphological changes measured by spectral-domain optical coherence tomography (SD-OCT) and visual acuity in patients with chronic central serous chorioretinopathy (CSC). METHODS: Twenty-five eyes of 25 patients with chronic CSC who had received half-dose verteporfin PDT were enrolled in the present study. The best-corrected visual acuity (BCVA), outer nuclear layer (ONL) thickness, and the integrity of the photoreceptor inner and outer segment junction (IS/OS) using SD-OCT were evaluated at baseline and at 3 and 6 months after treatment. RESULTS: The neurosensory retinal detachment disappeared in all eyes 6 months after treatment. The BCVA improved significantly from 0.50 +/- 0.32 to 0.31 +/- 0.29 log MAR at 6 months (p < 0.001). The average ONL thickness at the central fovea was 88.76 +/- 19.95 microm at 6 months and the ONL thickness was well correlated with the BCVA (gamma = -0.64; p = 0.001). There was no significant correlation between the status of IS/OS and the BCVA. CONCLUSIONS: Half-dose PDT is effective in treating chronic CSC resulting in visual improvement and complete resolution of neurosensory retinal detachment. The ONL thickness which was positively correlated with the BCVA could be an indicator for visual prognosis of chronic CSC.

Clinical Characteristics of Polypoidal Choroidal Vasculopathy Associated with Chronic Central Serous Chorioretionopathy

PURPOSE: To investigate the clinical characteristics of polypoidal choroidal vasculopathy (PCV) associated with chronic central serous chorioretinopathy (CSC). METHODS: We retrospectively reviewed the medical records of 246 PCV patients (283 eyes) between July 2004 and August 2009 and investigated the clinical characteristics of the PCV patients who had specific fundus findings of chronic CSC. RESULTS: Among PCV patients, 13 eyes (4.6%) of 13 PCV patients (5.3%) had fundus findings of chronic CSC. All of the PCV lesions had a solitary polyp located outside the atrophic retina, predominantly in the macular area (84.6%), most showed an exudative pattern (69.2%) and there were a few that showed a hemorrhagic pattern (30.8%). All of the lesions were smaller than 1 disc diameter. Most of the PCV lesions (76.9%) were cured with less than two treatments in a short period of 6.4 +/- 1.9 months; however, visual acuity deteriorated (61.5%) or was not changed (30.8%) in most of the cases. CONCLUSIONS: The PCV associated with chronic CSC had several clinical features such as a small exudative retinal lesion with a solitary polyp and frequent involvement of the macular area. Even though there was poor visual outcome due to the atrophic change, all of the PCV lesions were easily resolved in a short period with a simple treatment course and no recurrence.

Photodynamic Therapy for Chronic Central Serous Chorioretinopathy According to Degree of Choroidal Hyperfluorescence

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) depending on the degree of hyperfluorescence based on indocyanine green angiography (ICGA) for treating chronic central serous chorioretinopathy (CSC). METHODS: Twenty-three eyes of 23 patients with chronic CSC were recruited for the present study. The minimum follow-up period was six months. The total energy of PDT was reduced to 25 J/cm2 for 83 seconds. The baseline middle-phase ICGA findings were classified as intense or low hyperfluorescence depending on the degree of hyperpermeability from choriocapillaris. The change in mean best-corrected visual acuity, the resolution of subretinal fluid, recurrence rate, and complication were analyzed in relation to each ICGA finding at baseline. RESULTS: The baseline ICGA findings showed intense hyperfluorescence in 11 eyes (47.8%) and low hyperfluorescence in 12 eyes (52.2%). The subretinal fluid resolved completely one month after a single application of low-fluence PDT in both groups. The subretinal fluid recurred in one of 12 eyes (8.3%) with low hyperfluorescence and in no eyes (0%) with intense hyperfluorescence. There was no statistically significant difference in the rate of recurrence between the two groups. CONCLUSIONS: Low-fluence PDT appears to be an effective and safe treatment option for long-standing chronic CSC regardless of the degree of hyperfluorescence based on the ICGA.

Factors Influencing the Visual Acuity of Chronic Central Serous Chorioretinopathy

PURPOSE: To investigate correlated factors on final visual acuity in conjunction with fluorescein angiography (FA) and optical coherence tomography (OCT) findings of chronic central serous chorioretinopathy (CSCR). METHODS: Twenty-four patients (36 eyes) with typical findings of chronic CSCR based on medical records, FA and OCT results were enrolled in this study. We investigated demographic findings, initial and final visual acuity (VA), and some typical findings of FA including the type of leakage pattern, the existence of a gravitational tract and an abnormal hyperfluorescent area centered on the fovea. We also investigated OCT findings to examine serous retinal detachment, outer photoreceptor layer (OPRL) preservation, continuity of the inner segment (IS) and the outer segment (OS) of the photoreceptor layer in case of macular attachment, and other typical findings. The converted logarithm of the minimum angle of resolution VA was used to investigate the statistical correlation with these FA and OCT findings. RESULTS: An abnormal hyperfluorescent area within 1 macular photocoagulation study disc area on FA and cystoid degeneration on OCT were correlated with poor final VA of less than 20 / 40. However, the preserved OPRL and the continuity of IS / OS junction were correlated with a good final VA of 0.5 or more. CONCLUSIONS: These specific findings could be associated with recurrent or persistent subretinal fluid and could be important parameters of decision for treatment.

A Case of Central Serous Chorioretinopathy Associated With Retinal Detachment Improved by Intravitreal Bevacizumab Injection

PURPOSE: To report a case of chronic central serous chorioretinopathy treated with an intravitreal injection of 2.5 mg of bevacizumab. CASE SUMMARY: A 38-year-old male complained of visual disturbance in the right eye. He had a history of central serous chorioretinopathy which improved without treatment. Since the patient did not feel any ocular discomfort, he did not visit our clinic for approximately 11 months. At the time of presentation, fundus examination revealed exudative retinal detachment involving the macular area. Additionally, fluorescein angiography revealed multiple early phase hyperfluorescent lesions. Neurosensory detachment around the macula and increased central macular thickness were also observed using optical coherence tomography. Under the diagnosis of chronic central serous chorioretinoapthy, the patient was treated with 2.5 mg of intravitreal bevacizumab. Visual acuity improved two months after treatment, with improvement in both neurosensory retinal detachment and fluorescein leakage. No changes were observed at the six-month follow-up.

Photodynamic Therapy With Verteporfin using Half Fluence for Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the clinical results of half-fluence photodynamic therapy (PDT) using verteporfin in patients with chronic central serous chorioretinopathy (CSC). METHODS: The author reviewed the charts of 20 patients (22 eyes) who underwent PDT for chronic central serous chorioretinopathy. All 22 eyes were treated using an irradiance of 300 mW over 83 second (25 J/cm2). Postoperative evaluation included improvements in visual acuity, complications, changes in central macular thickness with the optical coherence tomogram (OCT), and recurrence. RESULTS: The best-corrected visual acuity improved significantly from 0.50+/-0.32 to 0.12+/-0.19 logMAR at 3 months (p<0.01), and the mean central macular thickness decreased from 377.7+/-86.3 micrometer to 166.2+/-29.3 micrometer at 3 months (p<0.01). Exudative serous macular detachments were resolved completely in all eyes within 3 months. There was no recurrence after PDT during the follow-up period. CONCLUSIONS: PDT using half fluence appeared to be a beneficial treatment option for patients with chronic CSC. Further studies are needed to verify treatment safety as well as the time and rate of recurrences.

Photodynamic Therapy with Vertepofin for Short Time for Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the clinical results of short duration photodynamic therapy (PDT) using verteporfin in patients with chronic central serous chorioretinopathy (CSC). METHODS: We retrospectively examined 15 eyes after PDT for chronic central serous chorioretinopathy. PDT for 83 seconds was evaluated for 8 eyes, and PDT for 60 seconds was evaluated for 7 eyes. Improvement in vision and changes in central macular thickness were evaluated with an optical coherence tomogram (OCT), and improvement in leaking was evaluated with a fluorescein angiogram (FA). Recurrence was also studied. RESULTS: Visual acuity improved from 0.39 to 0.57 (p=0.04), and the mean central macular thickness decreased from 426.29 micrometer to 184.71 micrometer (p<0.01) in 7 eyes treated with PDT for 60 seconds. There was no significant change in visual acuity between the two groups (p=0.77) or in central macular thickness (p=0.52). Central macular exudation resolved completely in all eyes. After PDT, there was no recurrence during the follow-up period. CONCLUSIONS: Short duration PDT with verteporfin appears to be a beneficial treatment option for patients with chronic CSC.