Clinical spectrum of severe chronic central serous chorioretinopathy and outcome of photodynamic therapy

Danial Mohabati; Elon Hc van Dijk; Thomas J van Rijssen; Eiko K de Jong; Myrte B Breukink; Jose P Martinez-Ciriano; Greet Dijkman; Carel B Hoyng; Sascha Fauser; Suzanne Yzer; Camiel Jf Boon

doi:10.2147/OPTH.S174573

Clinical spectrum of severe chronic central serous chorioretinopathy and outcome of photodynamic therapy

Clin Ophthalmol. 2018 Oct 24:12:2167-2176. doi: 10.2147/OPTH.S174573. eCollection 2018.

Authors

Affiliations

¹ Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands, [email protected].
² Department of Ophthalmology, Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands.
³ Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ Department of Ophthalmology, The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
⁵ Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
⁶ Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands, [email protected].

Abstract

Purpose: To describe a spectrum of severe chronic central serous chorioretinopathy (cCSC) cases and their response to photodynamic therapy (PDT).

Patients and methods: A total of 66 patients (81 eyes) with active severe cCSC were studied, and their response to PDT was compared with a control group consisting of 35 active cCSCs (37 eyes) that did not display characteristics of severity. Best-corrected visual acuity (BCVA) and complete resolution of subretinal fluid (SRF) were considered as main outcome measures.

Results: In severe cCSC cases, we found cumulative areas of diffuse atrophic retinal pigment epithelium alterations in 48 eyes (59%), multiple "hot spots" of leakage in 36 eyes (44%), posterior cystoid retinal degeneration in 25 eyes (31%), and 13 eyes (16%) had a diffuse leakage on fluorescein angiography. After PDT treatment, BCVA increased in both groups, from 66 to 72 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters in the case group (P<0.001), and from 78 to 82 ETDRS letters in the control group (P<0.001). SRF had resolved completely in 87% of severe cCSC cases and 95% of controls at final follow-up visit.

Conclusion: A spectrum of severe cCSC exists, and PDT seems to be an effective treatment in both severe cCSC and nonsevere cCSC in terms of resolution of SRF. Final BCVA shows a significant improvement in both groups after PDT treatment.

Keywords: chronic central serous chorioretinopathy; photodynamic therapy; posterior cystoid retinal degeneration; severe phenotype; therapeutic outcome.