Evaluation of choriocapillaris perfusion changes in chronic central serous chorioretinopathy following Half-Dose photodynamic therapy

TL;DR

This study shows that half-dose photodynamic therapy improves blood flow and other eye health metrics in patients with chronic central serous chorioretinopathy.

Contribution

The study introduces half-dose PDT as an effective treatment for chronic central serous chorioretinopathy, showing improvements in choriocapillaris perfusion.

Findings

Choriocapillaris flow deficits decreased significantly after 6 months of half-dose PDT.

Best-corrected visual acuity and macular thickness improved significantly following treatment.

Subfoveal choroidal thickness and serous retinal fluid resolved or reduced in most patients.

Abstract

This study aimed to evaluate changes in choriocapillaris (CC) perfusion in patients with chronic central serous chorioretinopathy (cCSC) following treatment with half-dose photodynamic therapy (PDT), using swept-source optical coherence tomography angiography (SS-OCTA).

This pilot study included patients diagnosed with cCSC who underwent half-dose PDT using the Visulas 690s PDT Laser System (Carl Zeiss Meditec, Inc., Jena, Germany; 689-nm wavelength, 50J/cm², 83s). Fovea-centered OCTA scans (6 × 6mm) were obtained using the Zeiss Plex Elite 9000 SS-OCT system. OCTA assessments were conducted at baseline prior to treatment and 6 months post-treatment. The primary outcome was the percentage of choriocapillaris flow deficits (FD%) on OCTA. Secondary outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT).

The study included 23 eyes from 23 patients with cCSC, with a mean age of 46.3 ± 2.1 years, of which 16 out of 23 were men. Significant improvements were observed in all parameters at 6 months. The FD% decreased significantly from 28.9 ± 2.2% at baseline to 26.4 ± 1.9% after 6 months (p = 0.023). BCVA improved from 0.28 ± 0.13 LogMAR to 0.22 ± 0.11 LogMAR (p = 0.025). Both CMT and SFCT showed significant reductions (p < 0.05). After 6-months, SRF was resolved in 21 out of 23 eyes (91.3%) included in the analysis, while the remaining two eyes showed a reduction of SRF.

Half-dose PDT was effective in improving CC perfusion and other morpho-functional parameters in eyes with cCSC. These findings provide valuable insights into the potential mechanisms through which PDT may influence the progression of cCSC.

Figures