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Volume 4 No. 2, April 2009 |
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Assessment of the Safety-Enhanced Protocol of Photodynamic Therapy (PDT) In the Management of Chronic and Recurrent Cases of Central Serous Chorioretinopathy (CSC) Mamdouh M. Kabeel, Ashraf M. El-Batarny, Mohamed K. Tameesh & Ahmad M. Ghonaim
Ophthalmology Department, Faculty of Medicine, Tanta University,
Egypt
Background/Aim: Central Serous Chorioretinopathy (CSC) is
characterized by the development of serous neurosensory retinal
detachment at the posterior pole. The traditional management option
for CSC whereby observation or thermal laser photocoagulation.
Photodynamic Therapy (PDT) with verteporfin has recently been
performed for the treatment of CSC. However, the application of
conventional PDT in CSC, if not without its complication, like the
development of RPE atrophy, choriocapillaries ischaemia, and
secondary CNV. Patients and Methods: This is to our knowledge, the
1st study that compared the safety enhanced PDT for chronic CSC
cases in relation to a natural history of the same cases. Two groups
were recruited in this study. Group I includes 10 eyes of 10
patients with chronic or recurrent CSC cases more than 6 months
treated with the modified PDT protocol. The other group which is
group II includes 8 eyes of 8 patients with also chronic CSC for
more than 6 months duration followed up for another 6 months without
any interference. The safety enhanced PDT protocol by using half the
normal dose Verteporfin (3mg/m2) infusion of Verteporfin, which was
infused over 8 minutes followed by delivery of laser at 692 nm at 10
minutes a total light energy of 50 joules/cm2 over 83 seconds were
delivered over the area of choroidal hyperperfusion. Results: In
group I, by comparing the pre-treatment BCVA to the final
post-treatment BCVA, there was a significant difference as P<0.001.
. By comparing the pre-treatment to the post treatment CFT there was
statistically significant difference as P<0.001. For this group also
at 6 months post treatment, only 1 case (10%) showed recurrence of
the neurosensory detachment and the other 9 cases (90%) showed
complete resolution of the edema. In group II, by comparing the
pre-operative to the final follow-up BCVA, there was no statistical
significant difference as P=0.004. By comparing the pre-study with
the final CFT at 6 months, there was also no statistical significant
difference as P=0.142. For this group in contrary to group I, only 1
eye (12.5%) showed complete absorption at 6 months follow-up while 2
eyes(25%) showed no improvement and the rest, 5 eyes(62.55%) showed
residual neurosensory detachment with a variable degrees. As regards
the complication following the PDT treatment, we only record one eye
in group I that developed an area of choroidal hypoperfusion
corresponding to the laser treated area 6 months after treatment in
spite of the safety enhanced protocol. The age of the patients and
the duration of the symptoms are of good prognostic index in both
groups. Conclusion: PDT with the safety enhanced protocol for
treatment of cases with chronic CSC is superior to non-treatment
option as regarding the CFT and visual acuity in spite it is not
completely out of complication. The age of the patients and the
duration of the symptoms are of good prognostic index.
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