Single-session combined photodynamic therapy with verteporfin and intravitreal anti-vascular endothelial growth factor therapy for chronic central serous chorioretinopathy: a pilot study at 12-month follow-up

Background To report the anatomic and functional outcomes of a single-session combined photodynamic therapy with verteporfin (PDT) and intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) in patients with chronic central serous chorioretinopathy (CCSCR). Methods Retrospective interventional comparative case series of eyes with symptomatic CCSCR (duration .4 months) and macular neurosensory retinal detachment (MNSRD). The study group, eight eyes (six patients), received a single session of combined full-fluence PDT and IVT anti-VEGF [bevacizumab (2.5 mg), four eyes; pegaptanib sodium [0.3 mg], four eyes). A matched control group, ten eyes (seven patients), treated with full-fluence PDT alone, was included. All patients had 12 months of follow-up. Results The mean CCSCR duration was 12.5}14.2 months (range: 4.47 months) in the study group. In the control group, the mean CCSCR duration was 15.3}7.5 months (range: 4.24 months). In the study group, the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 0.6 (20/80) to 0.2 (20/ 30) (P=0.011). Central macular thickness (CMT) measured by optical coherence tomography (OCT) decreased from 288.4 ƒÊ (range: 165.375 ƒÊ) at baseline to a CMTof 163.1 ƒÊ (range: 120.200 ƒÊ) (P=0.005) at 12 months. In the control group, the mean logMAR BCVA improved from 0.7 (20/ 100) to 0.6 (20/80) (P=0.43). CMT decreased from 332.9 ƒÊ (range: 171.495 ƒÊ) at baseline to a CMT of 213.1 ƒÊ (range: 133.307 ƒÊ) (P=0.002) at 12 months. At 12 months, MNSRD resolved completely in eight eyes (100%) and in seven eyes (70%), in the study group and the control group respectively. In the control group, four eyes (40%) required more than one PDT session (mean: 2.6 sessions; range: 2.4) due to persistent MNSRD. Retinal pigment epithelium (RPE) atrophy changes but no leakage were seen by fluorescein angiography in all eight eyes (100%) in the study group, and in three out of ten eyes (30%) in the control group. No systemic adverse events were observed. Conclusions Combined PDT and IVT anti-VEGF therapy seems to aid in the resolution of MNSRD in patients with CCSCR. Combination therapy was associated with a rapid reduction in MNSRD and improvement in BCVA with no recurrences at 12 months. However, combination therapy with full-fluence PDT has the potential to accelerate RPE atrophy, and this needs further study.