First Author: E.Pedanova RUSSIA
Co Author(s): A. Doga P. Volodin O. Klepinina
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The frequency of choroidal neovascular membrane (CNV) type 1 detection in central serous chorioretinopathy (CSR) reaches 25% of cases, which is associated with an increased level of diagnostic equipment. Photodynamic therapy (PDT) with Verteporfin is widely used for the treatment of chronic CSR. To the moment, there is no data on efficacy of PDT with chlorine photosensitizers in neovascular CSR treatment. The processes occurring directly in pathological vessels after PDT are not sufficiently studied. The purpose is to assess the short-term changes in the chorioretinal complex in patients with type 1 CNV in chronic CSR after PDT with chlorine e6.
The academic Fyodorov Eye Microsurgery Complex of the Ministry of Health of Russia
Nine patients (9 eyes) with a chronic CSR and type 1 CNV, confirmed by indocyanine-green angiography (ICGA) and optical coherence tomography-angiography (OCT-A) were observed in this study. Among them 5 were men and 4 women, the mean age was 48.4 ± 8.5 years. Ophthalmological examination included OCT with EDI module, autofluorescence, angiography with fluorescein (FAG) and ICGA(«Spectralis Multicolour», Heidelberg Engineering Inc., Germany), OCT-A (RTVue xR Avanti, Optovue, USA), measurement of the best corrected visual acuity (BCVA) and microperimetry (MAIA, centreview, Italy). Patients were examined at the baseline, 3- and 6-month follow-up visits. All patients underwent PDT with a standard dose (6 mg/m2) of Photolon photosensitizer (trisodium salt of chlorin e6) with standard-fluence (50 J/cm2) over 83 seconds from a 662 nm laser. Statistical data processing was not performed because of the small number of subjects.
Assessment of treatment results at one month showed marked anatomical improvement in complete resorption of the subretinal fluid from the initial neuroepithelium detachment of 250 ± 80 μm height. BCVA increased from 0.56 ± 0.12 to 0.68 ± 0.15 and central sensitivity (CS) increased from 22.3 ± 13 to 25.5 ± 8.6 dB. Three months after PDT no marked changes were observed. Seven of 9 patients showed no neurosensory detachment, BCVA and CS were 0.69 ± 0.15 and 25.3 ± 8.8 dB, respectively. However, in 2 cases, a negative dynamic was observed as a recurrence of neurosensory detachment with a height of 320 ± 50 μm, a decrease both in the BCVA by 0.15 and CS by 8 dB. At all follow up periods the 'double layer' sign on OCT and the preservation of the neovascular network on OCT-A were detected in all examined eyes.
PDT with chlorin e6 photosensitizer (“Photon”) showed efficacy in reducing exudation and functional impairment in the short-term postoperative period. By the three months of follow up, there was a slight decrease in the therapeutic effect, which can be explained by the preservation of the network of neovascular vessels as seen on OCT-A.