Hindawi Publishing Corporation
Journal of Ophthalmology
Volume 2012, Article ID 347206, 4 pages
Topographical ChoroidalThickness ChangeFollowing PDT for
WilliamJ.Wirostko,1RickN. Nordgren,1and AdamM. Dubis2
1Department of Ophthalmology, The Eye Institute, Medical College of Wisconsin, 925 North 87th Street, Milwaukee, WI 53226, USA
2Department of Cell Biology Neurobiology and Anatomy, Medical College of Wisconsin, 8700 West Wisconsin Avenue, Milwaukee,
WI 53226, USA
Correspondence should be addressed to William J. Wirostko,email@example.com
Received 11 February 2011; Revised 30 March 2011; Accepted 11 October 2011
Academic Editor: Stefan Mennel
Copyright © 2012 William J. Wirostko et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
Purpose. To describe topographical changes in choroidal thickness as measured by optical coherence tomography following
photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). Methods. Case report. Results. By 1 month following
PDT, mean (SD) choroidal thickness decreased from 562 microns (24) to 424 microns (27) (P < 0.01) at 3mm temporal to fovea,
483 microns (9) to 341 microns (21) (P < 0.01) at 1.5mm temporal to fovea, 576 microns (52) to 370 microns (81) (P < 0.01)
under the fovea, 442 microns (30) to 331 microns (54) (P < 0.04) at 1.5mm nasal to fovea, and 274 microns (39) to 171 microns
(17) (P < 0.01) at 3mm nasal to fovea. The Location of greatest choroidal thickness (648 microns) prior to treatment was at point
of leakage on fluorescein angiogram (FA). This region decreased to 504 microns following treatment. Conclusion. A decrease in
choroidal thickness can be seen followingPDT for CSC as far as 3mm temporal and 3mm nasal to fovea. The Location of greatest
choroidal thickness may be at point of leakage on FA.
Central serous chorioretinopathy (CSC) is characterized by
a neurosensory retinal detachment in the posterior fundus
associated with one or more leaks at the level of the retinal
pigment epithelium (RPE) . Etiology of leakage is unclear
but thought to be related to hyperpermeability of the cho-
roidal vasculature. Although many cases of CSC resolve
spontaneously with improvement of vision, treatment may
be considered for eyes with persistent or progressive vision
loss from serous retinal detachment. Current treatment op-
tions include thermal laser photocoagulation or photody-
namic therapy (PDT) with verteporfin (QLT Ophthalmics,
Inc. Menlo Park, CA, USA) [1, 2].
Optical coherence tomography (OCT) is an imaging
modality capable of depicting the retinochoroidal layers and
the presence of a neurosensory retinal detachment in eyes
with CSC . In a recent OCT study, subfoveal choroidal
thickness was shown to decrease following PDT for CSC .
However, the topographical location and extent of choroidal
thickness changes following PDT for CSC were not de-
ic choroidal changes as measured by raster lines on spectral
domain OCT following PDT for CSC. Findings are also
described in relation to fluorescein angiography (FA) find-
A retrospective case study of a patient receiving PDT with
Visudyne for CSC was performed. Medical records were
reviewed for clinical findings, FA results, OCT findings, and
PDT treatment parameters. Outcome parameters included
visual acuity, clinical findings, and choroidal thickness as
measured by OCT images. Choroidal thickness measure-
ments were obtained by exporting all OCT images into
Image J (http://rsb.info.nih.gov/ij/) where number of pixels
in choroidal layer was counted and converted into microns
using micron/pixel ratio. All measurements were performed
2Journal of Ophthalmology
by one grader (RNN). The authors are not aware of any
automated method to measure topographical choroidal
thickness. Statistical analysis using the Mann-Whitney test
was used to compare choroidal thickness before and after
treatment at 3mm temporal to the fovea, 1.5mm temporal
to the fovea, under the fovea, 1.5mm nasal to the fovea, and
3mm nasal to the fovea. Data set for each of these five loca-
tions was obtained from 5 horizontal raster scans (Figure 3).
A 52-year-old woman presented for decreased vision in her
right eye of 1-month duration. Visual acuity was 20/60 OD
and 20/20 OS. Fundus exam of OD revealed a neurosensory
detachment of the fovea with abnormalities of the retinal
pigment epithelium (RPE) just superonasal to the fovea.
Fluorescein angiography depicted leakage superonasal to the
fovea at the level of the RPE with pooling into the neuro-
sensory space (Figure 1). Spectral domain OCT using Cirrus
HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA, JUSA)
demonstrated a neurosensory detachment of the fovea
(Figure 2). Five 6mm long horizontal raster lines centered
on the fovea and spaced 0.25mm apart were obtained to
topographically map the choroidal thickness. Mean (SD)
choroidal thickness was 562 microns (24) at 3mm temporal
to fovea, 483 microns (9) at 1.5mm temporal to fovea, 576
microns (52) under the fovea, 442 microns (30) at 1.5mm
nasal to fovea, and 274 microns (39) at 3mm nasal to fovea.
Thickest area of choroid (648 microns) was under area of
leakage as seen on FA (Figure 3). Diagnosis of CSC was
established, and treatment with PDT was recommended.
After discussing the off-label nature of PDT for CSC, patient
chose to proceed with treatment. Photodynamic therapy
with verteporfin using 1.5mm laser spot size, standard
treatment parameters, and 83 seconds of duration was
applied to juxtafoveal area of leakage as guided by FA .
Care was takento avoiddirectly treating the fovea (Figure 1).
At 1 month following treatment, visual acuity improved
to 20/20. Optical coherence tomography demonstrated
resolution ofsubretinal fluid. Mean (SD)posttreatment cho-
roidal thickness measurements were 424 microns (27) at
3mm temporal to fovea, 341 microns (21)at 1.5mm tempo-
ral to fovea, 370 microns (81) under the fovea, 331 microns
(54) at 1.5mm nasal to fovea, and 171 microns (17) at 3mm
nasal to fovea (Figure 3). This reduction was statistically
significant (P < 0.01, P < 0.01, P < 0.01, P < 0.04, P < 0.01)
at each location, respectively, using the Mann-Whitney test
(Figure 4). Point of prior greatest choroidal thickness (648
microns) decreased to 504 microns, but was still the point of
greatest choroidal thickness (Figure 3).
This study describes topographical thickness changes in the
choroidal layer using OCT for an eye with CSC undergoing
PDT with verteporfin. Thickness changes are described with
regard to FA findings and treatment location. The authors
are not aware that this has been previously described. Prior
Figure 1: Fluorescein angiography of right eye demonstrating hy-
perfluorescence and leakageat level of RPE. White circle depicts the
area of fundus treated with PDT (1.5mm laser spot).
Figure 2: OCT image of retina and choroid prior to treatment de-
monstrating neurosensory retinal detachment. Arrowheads mark
outer boundary of choroid used to measure choroidal thickness.
reports on choroidal thickness in CSC have only described
subfoveal thickness findings with no reference to location of
changes of the choroid following PDT for CSC may be
important, both for advancing our understanding of CSC
and also improving our ability to restore vision.
Our findings of decreased choroidal thickness following
PDT concur with prior reports . In 2010, Maruko et al.
found subfoveal choroidal thickness decreased from 389 ±
106 micron at baseline to 330 ± 103 microns at one month
. Our patient’s mean (SD) subfoveal choroidal thickness
decreased from 576 microns (52) to 370 microns (81) (P <
0.01 Mann-Whitney test). Interestingly, our report suggests
that the reduction in choroidal thickness is diffuse and
extends further than just under the fovea as previously
reported. We measured a statistically significant reduction in
3mm nasal of the fovea following a 1.5mm juxtafoveal PDT
laser spot applied to an area of juxtafoveal leakage as seen on
FA (Figure 4). It remains unclear whether a similar diffuse
effect or as significant of an effect would occur if the PDT
Journal of Ophthalmology3
One month after treatment
Figure 3: Fundus photograph of OD demonstrating thickness of choroid in microns at each specific measured point both before and after
laser spot was not applied over the leakage as seen on FA.
Distinguishing these effects may be important for some
cases, especially when FA leakage is subfoveal and the treat-
ing physician wishes to avoid exposing the fovea to PDT
It is interesting to observe that the single thickest mea-
surement of the choroid (648 microns) before treatment was
in the area of leakage as seen on FA. Following treatment,
this single location decreased to 504 microns but was still
the pointof greatest choroidal thickness(Figure 3).Unfortu-
nately, theauthors cannot commenton how abnormal either
of these measurements is since complete normative data on
choroidal thickness correcting for age, race, refractive area,
and fundus location is not available .
Limitations of our study include the single sample size,
the retrospective nature, short duration of follow-up, and
limitedsampling ofchoroid.Additionally,indocyanine green
angiography which can provide information on choroidal
hyperpermeability was not obtained on this patient. Non-
etheless, the authorsfeel publishing this case isvaluablesince
its unique combination of small focal juxtafoveal leakage on
FA and small PDT laser spot allows us to make some inter-
esting observations. Certainly, further studies are needed to
corroborate our findings.
4Journal of Ophthalmology
Retinal eccentricity (mm)
One month after treatment
Choroidal thickness (µm)
3 T1.5 TFovea1.5 N3 N
Figure 4: Chart comparing thickness of choroid at 3mm temporal
Error bars represent onestandard deviation. At all points, there was
a significant reduction in choroidal thickness (the Mann-Whitney
test):∗∗∗P < 0.01,∗∗P < 0.04.
This study documents the topographical changes in the
choroidal layer as measured with OCT in an eye undergoing
treatment with PDT and verteporfin for CSC. A reduction in
choroidal thickness was observed as far away as 3mm tem-
poral and nasal to the area of leakage as seen on FAfollowing
treatment. Point of greatest choroidal thickness before and
after treatment was in the area of leakage on FA.
The authors have no proprietary interest in any aspect of this
The authorswish tothank Joe Carroll, PhD (MedicalCollege
of Wisconsin, Milwaukee, WI, USA) for assistance with ana-
lyzing the OCT images and for his helpful comments on
this manuscript. This paper is supported in part by an unre-
stricted grant from the Research to Prevent Blindness, Inc.,
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