Focal and diffuse chronic central serous chorioretinopathy treated with half-dose photodynamic therapy or subthreshold micropulse laser.
van Rijssen TJ., van Dijk EHC., Scholz P., Breukink MB., Blanco-Garavito R., Souied EH., Keunen JEE., MacLaren RE., Querques G., Fauser S., Downes SM., Hoyng CB., Boon CJF.
PURPOSE: To compare the outcome between high-density subthreshold micropulse laser (HSML) treatment and half-dose photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSC) patients, subdivided based on either focal or diffuse leakage on fluorescein angiography (FA). Design; Retrospective analysis of multicenter randomized controlled trial data METHODS: Patients were treated with either half-dose PDT or HSML (both ICGA-guided) and categorized in 2 groups, based on focal or diffuse leakage on FA. Clinical outcomes were evaluated at baseline and during follow-up. RESULTS: In the focal leakage group (63 patients), both at first evaluation and final visit, more PDT-treated than HSML-treated patients demonstrated a resolution of subretinal fluid (evaluation visit 1: 57% in the PDT group and 17% in the HSML group, p=0.007; final visit:75% and 38%, p=0.012). In the diffuse leakage group (93 patients), both at first evaluation and final visit, more PDT-treated than HSML-treated patients showed a resolution of subretinal fluid (evaluation visit 1:48% in the PDT group and 16% in the HSML group, p=0.002; final visit:67% and 21%, p=0.002). PDT-treated patients in the focal and diffuse leakage group had a higher retinal sensitivity increase, comparing baseline and final visit (+3.1±3.1dB versus +1.2±4.0dB, p=0.048, and +2.7±3.3dB versus +1.0±3.8dB, p=0.036, respectively). Only in the diffuse leakage group, the increase in ETDRS letters was higher in the PDT-treated group when comparing baseline and first evaluation visit (+4.4±6.1 versus +0.9±10.0, p=0.049). CONCLUSIONS: Half-dose PDT is superior to HSML treatment in cCSC patients, regardless of the presence of focal or diffuse leakage on FA.