title: Low-fluence photodynamic therapy versus ranibizumab for chronic central serous chorioretinopathy: one-year results of a randomized trial.
abstract: OBJECTIVE
  To compare the efficacy and safety between low-fluence photodynamic therapy (PDT) and the intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC).
  
  
  METHODS
  Prospective, randomized, single-center, parallel-arm, controlled trial.
  
  
  METHODS
  Thirty-four eyes of 32 patients with chronic CSC with >6 months' duration of symptoms or recurrent CSC were randomly placed into the low-fluence PDT group (n = 18) or the ranibizumab group (n = 16).
  
  
  METHODS
  The patients underwent a single session of low-fluence PDT or 3 consecutive monthly injections of ranibizumab. Rescue treatment was available from month 3 if the subretinal fluid (SRF) persisted or recurred after primary treatment; low-fluence PDT was given to the ranibizumab group and intravitreal ranibizumab to the low-fluence PDT group.
  
  
  METHODS
  The primary outcome was the proportion of eyes with complete resolution of SRF without rescue treatment. Secondary outcomes included the mean changes in logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA), central retinal thickness (CRT), and angiographic findings from baseline to 12 months.
  
  
  RESULTS
  At month 12, 16 eyes (88.9%) of the low-fluence PDT group maintained complete resolution of SRF without rescue treatment versus 2 eyes (12.5%) in the ranibizumab group (P <0.001). Two eyes (11.1%) in the low-fluence PDT group and 11 eyes (68.8%) in the ranibizumab group met the criteria for rescue treatment (P = 0.001). In the low-fluence PDT group, the mean decrease in CRT from baseline was significantly greater than that in the ranibizumab group until month 6 (P <0.05), but the differences became insignificant thereafter. The improvement in BCVA from baseline was superior in the low-fluence PDT group to that in the ranibizumab group, but the differences were not statistically significant except at month 3 (P = 0.025). On indocyanine green angiography, a significantly greater proportion of the low-fluence PDT group (16 eyes; 88.9%) showed a marked reduction in choroidal hyperpermeability after primary treatment than that of the ranibizumab group (0 eyes; P <0.001). No serious adverse events related to the drugs or procedures were observed.
  
  
  CONCLUSIONS
  This study represents the overall superiority of low-fluence PDT compared with intravitreal ranibizumab in the treatment of chronic CSC.
authors.affiliation: Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea.
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. Electronic address: hjw68@snu.ac.kr.
authors.forename: Jangwon
authors.initials: J
authors.lastname: Heo
authors.affiliation: Seoul Plus Eye Clinic, Seoul, Korea.
authors.forename: Cinoo
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University, Boramae Medical Center, Seoul Metropolitan Government, Seoul, Korea.
authors.forename: Tae Wan
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Shin
authors.affiliation: Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Joo Yong
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Sungkyunkwan University College of Medicine, Kangbuk Samsung Hospital, Seoul, Korea.
authors.forename: Su Jeong
authors.initials: SJ
authors.lastname: Song
authors.affiliation: Department of Ophthalmology, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Tae Kwann
authors.initials: TK
authors.lastname: Park
authors.affiliation: Department of Ophthalmology, Kyunghee University College of Medicine, Seoul, Korea.
authors.forename: Sang Woong
authors.initials: SW
authors.lastname: Moon
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hum
authors.initials: H
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002908:Chronic Disease; D004396:Coloring Agents; D004311:Double-Blind Method; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D058449:Intravitreal Injections; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D011446:Prospective Studies; D000069579:Ranibizumab; D012160:Retina / Q000473:pathology; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004396:Coloring Agents; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D007208:Indocyanine Green; D000069579:Ranibizumab