[Long-term outcome after photodynamic therapy of persistent central serous chorioretinopathy].

Abstract

Background and objective: Persistent central serous chorioretinopathy (CSC) is a complex macular disease that if left untreated can lead to deterioration of visual acuity and impairment of the quality of life. A treatment of choice is photodynamic therapy (PDT), which in studies has been shown to achieve stable functional and morphological results with a short follow-up period. As there are only few studies on the long-term evolution after PDT, this study aims to evaluate the long-term functional and morphological outcomes after PDT.

Material and methods: In this multicenter retrospective cohort analysis, patients with persistent CSC treated with PDT during 2004-2020 were analyzed over a follow-up period of at least 4 years after PDT. In addition to the clinical examination, the results of multimodal imaging techniques such as optical coherence tomography (OCT), OCT angiography, fundus autofluorescence and fluorescein angiography were analyzed.

Results: A total of 33 eyes of 31 patients were analyzed over a mean follow-up period of 7.3 ± 3.6 years (4-19 years) after PDT. During the observation period a stable mean visual acuity of 0.41 ± 0.29 logMAR before PDT and 0.39 ± 0.38 logMAR at the last follow-up was observed. The subfoveal subretinal fluid (SRF) decreased significantly from a mean of 153 ± 90 µm (median 137 µm) before PDT to 24 ± 61 µm (median 0 µm) at the last follow-up. Of the 33 eyes 23 showed no evidence of SRF at the last OCT examination. Five eyes developed new choroidal neovascularization during the course of the study, which was treated with intravitreal injections. In a total of nine eyes newly occurring atrophy of the retinal pigment epithelium was detected at the last follow-up.

Conclusion: In the present study a predominantly stable functional and improved anatomical outcome after PDT was observed over a long observation period of more than 7 years. Further prospective long-term studies with a high level of evidence are required for a better assessment of the safety and functionality of PDT.