A combination therapy of half-dose verteporfin photodynamic therapy and intravitreal injection of ranibizumab for chronic central serous chorioretinopathy
Aim: To study the combination treatment consisting of half-dose verteporfin photodynamic therapy (PDT) and an intravitreal injection of ranibizumab as a potential treatment for patients with chronic central serous chorioretinopathy (CSC). Materials and methods: Six eyes of 6 patients were studied with fundus examination, fluorescein angiography, and optical coherence tomography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. Half-dose verteporfin PDT was applied to areas of choroidal hyperpermeability and, the following day, 0.5 mg/0.05 mL ranibizumab was injected intravitreally. The patients were observed to determine the anatomic and functional outcomes. Results: The combination therapy consisting of half-dose verteporfin PDT and intravitreal injection of ranibizumab was associated with complete resolution of the exudative macular detachments in all of the patients. Vision improved in the 6 eyes and remained unchanged during the follow-up examinations, for at least more than 6 months. At 4 weeks after treatment, the best corrected visual acuity had improved to 20/20 in 5 of the cases. None of the patients had any treatment-related side effects. Conclusion: The combination therapy consisting of half-dose verteporfin PDT and intravitreal injection of ranibizumab seems to result in the resolution of exudative detachments in patients with chronic CSC. This treatment caused a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and the number of patients in this study were limited, the encouraging results and lack of complications suggest the value of further study.
A combination therapy of half-dose verteporfin photodynamic therapy and intravitreal injection of ranibizumab for chronic central serous chorioretinopathy
Aim: To study the combination treatment consisting of half-dose verteporfin photodynamic therapy (PDT) and an intravitreal injection of ranibizumab as a potential treatment for patients with chronic central serous chorioretinopathy (CSC). Materials and methods: Six eyes of 6 patients were studied with fundus examination, fluorescein angiography, and optical coherence tomography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. Half-dose verteporfin PDT was applied to areas of choroidal hyperpermeability and, the following day, 0.5 mg/0.05 mL ranibizumab was injected intravitreally. The patients were observed to determine the anatomic and functional outcomes. Results: The combination therapy consisting of half-dose verteporfin PDT and intravitreal injection of ranibizumab was associated with complete resolution of the exudative macular detachments in all of the patients. Vision improved in the 6 eyes and remained unchanged during the follow-up examinations, for at least more than 6 months. At 4 weeks after treatment, the best corrected visual acuity had improved to 20/20 in 5 of the cases. None of the patients had any treatment-related side effects. Conclusion: The combination therapy consisting of half-dose verteporfin PDT and intravitreal injection of ranibizumab seems to result in the resolution of exudative detachments in patients with chronic CSC. This treatment caused a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and the number of patients in this study were limited, the encouraging results and lack of complications suggest the value of further study.
___
- 1. Spaide RF. Central serous chorioretinopathy. In: Holz FG, Spaide RF, editors. Medical retina. Berlin: Springer-Verlag; 2005. p.77.
- 2. Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol 1967; 63: 1-139.
- 3. Spaide RF. Central serous chorioretinopathy and other causes of serous detachment of the retina. In: Spaide RF, editor. Diseases of the retina and vitreous. Philadelphia (PA): WB Saunders; 1999. p.251.
- 4. Battaglia Parodi M, Da Pozzo S, Ravalico G. Photodynamic therapy in chronic central serous chorioretinopathy. Retina 2003; 23: 235-7.
- 5. Canakis C, Livir-Rallatos C, Panayiotis Z, Livir-Rallatos G, Persidis E, Conway MD et al. Ocular photodynamic therapy for serous macular detachment in the diff use retinal pigment epitheliopathy variant of idiopathic central serous chorioretinopathy. Am J Ophthalmol 2003; 136: 750-2.
- 6. Cardillo Piccolino F, Eandi CM, Ventre L, Rigault de la Longrais RC, Grignolo FM. Photodynamic therapy for chronic central serous chorioretinopathy. Retina 2003; 23: 752-63.
- 7. Yannuzzi LA, Slakter JS, Gross NE, Spaide RF, Costa DL, Huang SJ et al. Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina 2003; 23: 288-98.
- 8. Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, Chan CK. Choroidal vascular remodelling in central serous chorioretinopathy aft er indocyanine green guided photodynamic therapy with verteporfi n: a novel treatment at the primary disease level. Br J Ophthalmol 2003; 87: 1453-8.
- 9. Taban M, Boyer DS, Th omas EL. Chronic central serous chorioretinopathy: photodynamic therapy. Am J Ophthalmol 2004; 137: 1073-80.
- 10. Ober MD, Yannuzzi LA, Do DV, Spaide RF, Bressler NM, Jampol LM et al. Photodynamic therapy for focal retinal pigment epithelial leaks secondary to central serous chorioretinopathy. Ophthalmology 2005; 112: 2088-94.
- 11. Schlotzer-Schrehardt U, Viestenz A, Naumann GO, Laqua H, Michels S, Schmidt-Erfurth U. Dose-related structural eff ects of photodynamic therapy on choroidal and retinal structures of human eyes. Graefes Arch Clin Exp Ophthalmol 2002; 240: 748-57.
- 12. Schmidt-Erfurth U, Laqua H, Schlotzer-Schrehard U, Viestenz A, Naumann GO. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol 2002; 120: 835-44.
- 13. Colucciello M. Choroidal neovascularization complicating photodynamic therapy for central serous retinopathy. Retina 2006; 26: 239-42.
- 14. Lai TY, Chan WM, Li H, Lai RY, Liu DT, Lam DS. Safety enhanced photodynamic therapy with half dose verteporfi n for chronic central serous chorioretinopathy: a short term pilot study. Br J Ophthalmol 2006; 90: 869-74.
- 15. Chan WM, Lai TY, Lai RY, Tang EW, Liu DT, Lam DS. Safety enhanced photodynamic therapy for chronic central serous chorioretinopathy: one-year results of a prospective study. Retina 2008; 28: 85-93.
- 16. Torres-Soriano ME, Garcia-Aguirre G, Kon-Jara V, UstarizGonzales O, Abraham-Marin M, Ober MD et al. A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports). Graefes Arch Clin Exp Ophthalmol 2008; 246: 1235-9.
- 17. Gollnick SO, Evans SS, Baumann H, Owczarczak B, Maier P, Vaughan L et al. Role of cytokines in photodynamic therapyinduced local and systemic infl ammation. Br J Cancer 2003; 88: 1772-9.
- 18. Yannuzzi LA, Shakin JL, Fisher YL, Altomonte MA. Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy. Ophthalmology 1984; 91: 1554-72.
- 19. Jalkh AE, Jabbour N, Avila MP, Trempe CL, Schepens CL. Retinal pigment epithelium decompensation. I. Clinical features and natural course. Ophthalmology 1984; 91: 1544-8.
- 20. Levine R, Brucker AJ, Robinson F. Long-term follow-up of idiopathic central serous chorioretinopathy by fl uorescein angiography. Ophthalmology 1989; 96: 854-9.
- 21. 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.
- 22. Oner A, Karakucuk S, Mirza E, Erkilic K. Electrooculography aft er photodynamic therapy. Doc Ophthalmol 2005; 111: 83-6. 23. Oner A, Karakucuk S, Mirza E, Erkilic K. Th e changes of pattern electroretinography at the early stage of photodynamic therapy. Doc Ophthalmol 2005; 111: 107-12.
- 24. Spilsbury K, Garrett KL, Shen WY, Constable IJ, Rakoczy PE. Overexpression of vascular endothelial growth factor (VEGF) in the retinal pigment epithelium leads to the development of choroidal neovascularization. Am J Pathol 2000; 157: 135-44.
- 25. Schmidt-Erfurth U, Schlotzer-Schrehard U, Cursiefen C, Michels S, Beckendorf A, Naumann GO. Infl uence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF), VEGF receptor 3, and pigment epithelium-derived factor. Invest Ophthalmol Vis Sci 2003; 44: 4473-80.
- 26. Schaal KB, Hoeh AE, Scheuerle A, Schuett F, Dithmar S. Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol 2009; 19: 613-7.
- 27. Seong HK, Bae JH, Kim ES, Han JR, Nam WH, Kim HK. Intravitreal bevacizumab to treat acute central serous chorioretinopathy: short-term eff ect. Ophthalmologica 2009; 223: 343-7.
- 28. Lim SJ, Roh MI, Kwon OW. Intravitreal bevacizumab injection for central serous chorioretinopathy. Retina; 30: 100-6.
- 29. Artunay O, Yuzbasioglu E, Rasier R, Sengul A, Bahcecioglu H. Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study. Curr Eye Res; 35: 91-8.
- 30. Symeonidis C, Kaprinis K, Manthos K, Androudi S, Anastassilakis K, Dimitrakos SA. Central serous chorioretinopathy with subretinal deposition of fi brin-like material and its prompt response to ranibizumab injections. Case Report Ophthalmol; 2: 59-64.