Photodynamic therapy for steroid-associated central serous chorioretinopathy

To evaluate the short-term efficacy of photodynamic therapy (PDT) for steroid-associated chronic or recurrent central serous chorioretinopathy (CSC).

Interventional case series.

Retrospective review of nine consecutive cases of steroid-associated CSC treated with PDT using half-fluence for fovea involving treatments (n=4) and full-fluence for extrafoveal treatments (n=5). The main outcome measures included anatomical changes measured on optical coherence tomography (OCT) and changes in best-corrected visual acuity (BCVA) after PDT.

All eyes had fovea involving serous retinal detachment on OCT, and six (67%) eyes had a history of three or more recurrences. The mean duration of current episode of CSC prior to PDT was 45 months (range: 3-131 months). The mean follow-up after PDT was 8 months (range: 3-18 months). Serous retinal detachment disappeared in all cases following PDT without any complications. One patient had a recurrence and was re-treated. Compared to the mean BCVA of 20/83 (logMAR 0.62) at baseline, the mean BCVA was 20/40 (logMAR 0.33) at 3 months (p=0.018), and 20/47 (logMAR 0.37) at last follow up (p=0.075). Visual acuity improved by at least two lines in three (33%) eyes.

Despite chronicity and recurrences seen in steroid-associated CSC, serous retinal detachment resolved in all cases, and a modest improvement in visual acuity was observed following PDT, at least for the short term. Given the difficulty of managing these cases, PDT as applied in this study may be an effective treatment.