Effectiveness of Reduced-fluence Photodynamic Therapy for Chronic Central Serous Chorioretinopathy: A Propensity Score Analysis

• Published in: Ophthalmology science (Online) Vol. 2; no. 2; p. 100152
• Main Authors: Aisu, Nao, Miyake, Masahiro, Hosoda, Yoshikatsu, Mori, Yuki, Takahashi, Ayako, Muraoka, Yuki, Ueda-Arakawa, Naoko, Miyata, Manabu, Oishi, Akio, Tamura, Hiroshi, Ooto, Sotaro, Yamashiro, Kenji, Tsujikawa, Akitaka
• Format: Journal Article
• Language: English
• Published: Netherlands 01.06.2022
• Subjects: Reduced-fluence photodynamic therapy; VA, visual acuity; SRD, serous retinal detachment; FA/ICGA, fluorescein angiography/indocyanine green angiography; CSC, central serous chorioretinopathy; RPE, retinal pigment epithelium; hd-/hf-PDT, half-dose/half-fluence photodynamic therapy; AMD, age-related macular degeneration; IPTW, inverse probability of treatment weighting; cCSC, chronic central serous chorioretinopathy; Serous retinal detachment; logMAR, logarithm of the minimum angle of resolution; Propensity score; rf-PDT, reduced-fluence photodynamic therapy; Central serous chorioretinopathy; BCVA, best-corrected visual acuity; MNV, macular neovascularization; PS, propensity score; PDT, photodynamic therapy; RCT, randomized clinical trial
• ISSN: 2666-9145; 2666-9145
• DOI: 10.1016/j.xops.2022.100152

To investigate the 2-year effectiveness of reduced-fluence photodynamic therapy (rf-PDT) for chronic central serous chorioretinopathy (cCSC). Retrospective cohort study. A total of 223 consecutive patients with newly diagnosed cCSC with active serous retinal detachment (SRD) were included from May 2007 to June 2017 and followed up for at least 2 years. Patients who underwent ocular treatment other than cataract surgery before the beginning of recruitment and those who had macular neovascularization at baseline were excluded. All patients underwent a comprehensive ophthalmic evaluation, including measurements of best-corrected visual acuity (BCVA), slit-lamp examination, dilated fundus examination, color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and spectral-domain OCT. An inverse probability of treatment weighting (IPTW) methodology was applied to balance 18 baseline characteristics between patients who received rf-PDT (rf-PDT group) and those who did not receive treatment (controls). Inverse probability of treatment weighting survival analysis and regression were performed. The proportion of patients whose BCVA at 24 months was the same or improved compared with the baseline visual acuity (VA) (VA maintenance rate). A total of 155 eyes (rf-PDT group: 74; controls: 81) were analyzed. The patients' backgrounds were well balanced after IPTW with standardized differences of < 0.10. An IPTW regression analysis revealed that the VA maintenance rate was significantly higher in the rf-PDT group than in the controls (93.6% vs. 70.9%,  0.001, 12 months; 85.7% vs. 69.8%, 0.019, 24 months). The rf-PDT group tended to show better VA improvement, but was not statistically significant (-0.06 vs. -0.008, 0.07, 12 months; -0.06 vs. -0.03,  0.32, 24 months). An IPTW Cox regression showed a significantly higher rate of complete SRD remission in the rf-PDT group (hazard ratio, 5.05; 95% confidence interval, 3.24-7.89; 0.001). The study suggests the beneficial effect of rf-PDT for cCSC for both VA maintenance and higher proportion of complete SRD remission in the clinical setting.