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Chronic chorioretinopathy centralis serosa (CCS): qualitative analysis of macula recovery upon treatment of combined half-dose photodynamic therapy (PDT) and vascular epithelial growth factor (VEGF) inhibitors

Session Details

Session Title: Quick Fire Free Paper Session 03

Session Date/Time: Sunday 29/09/2013 | 08:30-09:30

Paper Time: 09:50

Venue: Hall C (Level 1)

First Author: H.Kaymak GERMANY

Co Author(s):    D. Breyer   K. Klabe   C. Pohl        

Abstract Details

Purpose:

CCS is rare distributed and occurs mostly to men between the age of 20 to mid-fifty. The causes are still unknown, and successful treatments are rarely reported. Since a serous leakage is observed in all cases, treatment with antiVEGF substances could lead to a decrease. Alternatively, radical oxygen species evolved by excitation of photosensitizers could lead to the destruction of pathogenic proliferated blood vessels. Here we present a combination of both therapies as an option to encounter different levels of origin of foveal detachment during CCS.

Setting:

Private Clinic

Methods:

Seven patients were treated with a combination of PDT with reduced photosensitizer-injection (3 mg/m2) and laser excitement with individual adjusted time and spot size of laser treatment. Laser energy was always used according to recommendation of manufacturer: 50 J / cm2. After a short time period (zero to five days) VEGF inhibitors - either Bevacizumab or Ranibizumab – were injected. Results were analyzed retro- and prospectively with regard to macula morphology via OCT and autofluorescence, visual acuity quantification with ETDRS chart and check for presence and intensity of metamorphopsies by Amsler-Test.

Results:

Upon treatment we observed a rapid fovea recovery: fovea detachment decreased in all cases, longtime observation yielded an average fovea thickness decrease of 70 ± 30%. In parallel the visual acuity showed a remarkable increase: minimal 2 lines in ETDRS chart from 0.6 to 1.0 decimal visus 2 days postoperatively with one patient, maximal from 0.5 to 1.2 decimal visus one year after combined treatment with a different patient. Metamorphopsies decreased at all patients except for one, who exhibited the longest period before the first treatment: 26 months (longtime CCS case). The latter case showed also the lowest visual preoperative visual acuity: 0.05 decimal visus along with a strong metamorphopsy phenotype.

Conclusions:

The longtime CCS case represents the only non-responder to the combined therapy, which point toward a threshold concerning the time between diagnose and treatment. As a consequence of that time period, the untreated CCS might evolve to an irreversible macular damage, which excludes any successful medical treatment. In all other cases the combined therapy showed a rapid restauration of mature foveal environment, which concomitantly went along with a rapid increase in visual outcome. Future studies have to clarify, if radiation dose by laser application can be further reduced, since it remarks a pivotal point between necessary treatment and potential harm due to irreversible photo bleaching.

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