Journal d'ophtalmologie clinique et expérimentale
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Chronicity and Recurrence as Prognostic Factors in Central Serous Chorioretinopathy after Half-Dose Photodynamic Therapy

Susana Penas, Ana F Costa, Joana R Araújo, Pedro Alves Faria, Elisete Brandão, Amandio Rocha-Sousa, Angela Carneiro and Fernando Falcão-Reis

Purpose: To analyze the influence of pre-treatment chronicity signs and post-treatment recurrence events in short and long-term structural and functional outcomes in central serous chorioretinopathy (CSC) patients submitted to half-dose photodynamic therapy (PDT), and to determine the profile of patients that recurred after treatment.
Methods: A retrospective, observational study included treatment-naïve patients with CSC submitted to half-dose PDT. Best corrected visual acuity (BCVA), central macular thickness (CMT) using OCT and retinal sensitivity (RS) assessed by microperimetry were registered. A sub-analysis was performed considering both chronicity signs and recurrence.
Results: Eighty-four eyes of 73 patients were included in this study. The mean follow up was 32.18 ± 23.03 months. A total of 79 eyes (94%) presented a complete resolution of sub-retinal fluid at the 3-months follow-up visit. Chronicity versus no- chronicity signs: 57 eyes (67.9%) had chronicity signs and 22.8% of those had at least one recurrence. Recurrence was significantly higher in the chronicity group (p=0.031). The chronicity group was significantly older (p=0.009) and with lower baseline CMT (p=0.041). A significant long-term improvement in BCVA, CMT and RS was consistently found in both groups (p<0.05), however patients with chronicity signs presented worse visual outcomes (p<0.05). Recurrence versus no-recurrence: 14 eyes (16.7%) had post-treatment relapses, and 92.9% of those had chronicity signs (p=0.031). Recurrent patients presented with lower baseline CMT as well (p=0.017). A significant long-term improvement was observed for all outcomes in non-recurring patients (p<0.05) whereas a significant improvement in BCVA was only found 3 months after treatment in the recurrent group (p=0.009).
Conclusions: Half-dose PDT is an effective and safe treatment for CSC. Nonetheless, patients with pretreatment chronicity signs presented more recurrences and worse functional and morphological outcomes, suggesting they should be treated earlier in order to avoid poorer results. Post-treatment recurrence negatively influenced the outcomes.