Short-term effects of photodynamic therapy on segmentation of retinal layers in central serous chorioretinopathy

Agharokh, Shahram; Akhlaghi, Mohammad-Reza; Kianersi, Farzan; Jahanbani-Ardakani, Hamidreza; Abtahi, Seyed-Hossein

Short-term effects of photodynamic therapy on segmentation of retinal layers in central serous chorioretinopathy

Document Type : Original Article

Authors

¹ Isfahan Eye Research Center, Feiz Hospital; Department of Ophthalmology, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Ophthalmology, School of Medicine; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

³ Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: The present study aims to evaluate the effect of photodynamic therapy (PDT) on the thickness of segmentation layers of the retina in cases with central serous chorioretinopathy (CSCR). Materials and Methods: This was a prospective, observational study on cases with CSCR who were candidates for PDT therapy. All patients had undergone at least 1 month of conservative management without satisfactory resolution. PDT was carried out according to the safe half-dose therapy scheme. Spectral-domain optical coherence tomography was employed to evaluate the changes in morphology and segmentation of retinal layers. Patients were followed up for 3 months. Results: Twenty-seven cases (18 males and 9 females) were included. Age of the patients varied from 39 to 59 years (mean: 46.61 ± 12.48 years). Cases were followed for 92.17 ± 3.28 days. Sixteen cases had functional and anatomical improvement by the treatment. Changes in overall retinal (377.39 ± 61.36 to 323.61 ± 71.36; P = 0.004) and all outer retinal segmentation layers including outer plexiform layer (34.93 ± 10.07 to 29.25 ± 6.12; P = 0.008), outer nuclear layer (63.52 ± 30.44 to 46.44 ± 20.62; P = 0.017), and retinal pigment epithelium (40.66 ± 37.73 to 23.78 ± 29.33; P = 0.016) were statistically significant. On the contrary, inner retinal segmentation layers, especially retinal ganglion cell (RGC) layer (38.29 ± 16.63 to 37.26 ± 16.18; P = 0.387), remained statistically unchanged. Conclusion: We postulate that PDT alleviates outer retinal edema where fluid accumulation occurs mostly, whereas it does not alter inner retinal and especially RGC layer. These findings may indicate that short-term atrophy of the inner retina did not occur following PDT and may point toward safety of this method for cases with CSCR.

Keywords

References

1.	Ozmert E, Demirel S, Yanik O, Batioglu F. Low-fluence photodynamic therapy versus subthreshold micropulse yellow wavelength laser in the treatment of chronic central serous chorioretinopathy. J Ophthalmol 2016;2016:3513794.
2.	Piccolino FC, de la Longrais RR, Ravera G, Eandi CM, Ventre L, Abdollahi A, et al. The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol 2005;139:87-99.
3.	Wang MS, Sander B, Larsen M. Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol 2002;133:787-93.
4.	Levy J, Marcus M, Belfair N, Klemperer I, Lifshitz T. Central serous chorioretinopathy in patients receiving systemic corticosteroid therapy. Can J Ophthalmol 2005;40:217-21.
5.	Pikkel J, Beiran I, Ophir A, Miller B. Acetazolamide for central serous retinopathy. Ophthalmology 2002;109:1723-5.
6.	Burumcek E, Mudun A, Karacorlu S, Arslan MO. Laser photocoagulation for persistent central serous retinopathy: Results of long-term follow-up. Ophthalmology 1997;104:616-22.
7.	Bae SH, Heo JW, Kim C, Kim TW, Lee JY, Song SJ, et al. A randomized pilot study of low-fluence photodynamic therapy versus intravitreal ranibizumab for chronic central serous chorioretinopathy. Am J Ophthalmol 2011;152:784-92.e2.
8.	Ozmert E, Batioglu F. Fundus autofluorescence before and after photodynamic therapy for chronic central serous chorioretinopathy. Ophthalmologica 2009;223:263-8.
9.	Ma J, Meng N, Xu X, Zhou F, Qu Y. System review and meta-analysis on photodynamic therapy in central serous chorioretinopathy. Acta Ophthalmol 2014;92:e594-601.
10.	Lim JW, Ryu SJ, Shin MC. The effect of intravitreal bevacizumab in patients with acute central serous chorioretinopathy. Korean J Ophthalmol 2010;24:155-8.
11.	Alkin Z, Perente I, Ozkaya A, Alp D, Agca A, Aygit ED, et al. Comparison of efficacy between low-fluence and half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy. Clin Ophthalmol 2014;8:685-90.
12.	Silva RM, Ruiz-Moreno JM, Gomez-Ulla F, Montero JA, Gregorio T, Cachulo ML, et al. Photodynamic therapy for chronic central serous chorioretinopathy: A 4-year follow-up study. Retina 2013;33:309-15.
13.	Colucciello M. Choroidal neovascularization complicating photodynamic therapy for central serous retinopathy. Retina 2006;26:239-42.
14.	Peyman GA, Kazi AA, Unal M, Khoobehi B, Yoneya S, Mori K, et al. Problems with and pitfalls of photodynamic therapy. Ophthalmology 2000;107:29-35.
15.	Reinke MH, Canakis C, Husain D, Michaud N, Flotte TJ, Gragoudas ES, et al. Verteporfin photodynamic therapy retreatment of normal retina and choroid in the cynomolgus monkey. Ophthalmology 1999;106:1915-23.
16.	Schlotzer-Schrehardt U, Viestenz A, Naumann GO, Laqua H, Michels S, Schmidt-Erfurth U. Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes. Graefes Arch Clin Exp Ophthalmol 2002;240:748-57.
17.	Arnold JJ, Blinder KJ, Bressler NM, Bressler SB, Burdan A, Haynes L, et al. Acute severe visual acuity decrease after photodynamic therapy with verteporfin: Case reports from randomized clinical trials-TAP and VIP report no. 3. Am J Ophthalmol 2004;137:683-96.
18.	Duncan JL, Paskowitz DM, Nune GC, Yasumura D, Yang H, Matthes MT, et al. Retinal damage caused by photodynamic therapy can be reduced using BDNF. Adv Exp Med Biol 2006;572:297-302.
19.	Matušková V, Vysloužilová D, Uher M. Half-fluence photodynamic therapy for chronic central serous chorioretinopathy: Predisposing factors for visual acuity outcomes. Semin Ophthalmol 2018;33:690-9.
20.	Fujita K, Shinoda K, Imamura Y, Matsumoto CS, Mizutani Y, Mizota A, et al. Correlation of integrity of cone outer segment tips line with retinal sensitivity after half-dose photodynamic therapy for chronic central serous chorioretinopathy. Am J Ophthalmol 2012;154:579-85.

Advanced Biomedical Research