title: Intravitreal anti-vascular endothelial growth factor combined with half-fluence photodynamic therapy for choroidal neovascularization in chronic central serous chorioretinopathy.
abstract: PurposeTo evaluate the results of indocyanine green angiography (ICGA)-guided verteporfin photodynamic therapy (PDT) with half-fluence rate combined with intravitreal application of anti-VEGF in treating choroidal neovascularization (CNV) in chronic central serous chorioretinopathy (CSCR).Patients and methodsIn this retrospective cohort study 17 consecutive patients with secondary CNV due to chronic CSCR had their diagnosis verified with fluorescein angiography (FA) and ICGA at baseline. All eyes received either intravitreal ranibizumab (IVR) or bevacizumab (IVB). On the consecutive day following the initial IVR/IVB treatment, ICGA-guided verteporfin (6 mg/m(2)) PDT with half-fluence rate (25 J/cm(2)) was performed on every patient. IVR or IVB was rescheduled on a pro re nata regimen. Main outcome measures were changes in visual acuity (VA) according to the ETDRS letter score and changes in the central foveal thickness (CFT).ResultsBest-corrected VA at baseline was 65.6 letters (±6.7; n=17) according to the ETDRS letter score. At 12 months, mean ETDRS letter score improved to 71.2 letters (P=0.34). CFT was 309 μm and decreased to 216 μm at month 12 control (P=0.0004). Nine eyes (52.9%) received additional treatment with IVR/IVB due to recurrence of subretinal fluid, with an overall mean number of IVR/IVB treatment of 1.8±3.6 per patient with no systemic side effects during 12 months' follow-up.ConclusionsIVR or IVB combined with ICGA-guided half-fluence PDT with verteporfin is effective in treating CNV in chronic CSCR, with choroidal hyperpermeability in ICGA, resulting in stable vision and significant reduction of CFT.
authors.affiliation: Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.|Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Smretschnig
authors.affiliation: Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.|Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Hagen
authors.affiliation: Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.|Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Glittenberg
authors.affiliation: Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Ristl
authors.affiliation: Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.|Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.
authors.forename: I
authors.initials: I
authors.lastname: Krebs
authors.affiliation: Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.|Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.|Retina Center Vienna, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Binder
authors.affiliation: Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.|Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.|Retina Center Vienna, Vienna, Austria.|Department of Ophthalmology, Medical University of Graz, Graz, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Ansari-Shahrezaei
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D056833:Central Serous Chorioretinopathy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D002908:Chronic Disease; D004396:Coloring Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D000077362:Verteporfin
chemical_list: D020533:Angiogenesis Inhibitors; D004396:Coloring Agents; D017319:Photosensitizing Agents; D011166:Porphyrins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; D007208:Indocyanine Green