A Randomized Pilot Study of Low-Fluence Photodynamic Therapy Versus Intravitreal Ranibizumab for Chronic Central Serous Chorioretinopathy

Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
American Journal of Ophthalmology (Impact Factor: 3.87). 07/2011; 152(5):784-92.e2. DOI: 10.1016/j.ajo.2011.04.008
Source: PubMed


To report 6-month outcomes of a prospective, randomized study comparing the efficacy and safety between low-fluence photodynamic therapy (PDT) and intravitreal injections of ranibizumab in the treatment of chronic central serous chorioretinopathy.
Prospective, randomized, single-center pilot study.
Sixteen eyes with chronic central serous chorioretinopathy were randomized to receive either low-fluence PDT or intravitreal injections of ranibizumab: 8 eyes in the low-fluence PDT group and 8 in the ranibizumab group. Rescue treatment was considered if subretinal fluid was sustained after completion of primary treatment: low-fluence PDT for the ranibizumab group and ranibizumab injection for the low-fluence PDT group. Main outcome measures were excess foveal thickness, resolution of subretinal fluid, choroidal perfusion on indocyanine green angiography, and best-corrected visual acuity.
At 3 months, the mean excess foveal thickness was reduced from 74.1 ± 56.0 μm to -35.4 ± 44.5 μm in the low-fluence PDT group (P = .017) and from 26.3 ± 50.6 μm to -23.1 ± 56.5 μm in the ranibizumab group (P = .058). After a single session of PDT, 6 eyes (75%) in the low-fluence PDT group achieved complete resolution of subretinal fluid and reduction of choroidal hyperpermeability, whereas 2 (25%) eyes in the ranibizumab group achieved this after consecutive ranibizumab injections. Four eyes (50%) in the ranibizumab group underwent additional low-fluence PDT and accomplished complete resolution. At 3 months, significant improvement of best-corrected visual acuity was not demonstrated in the low-fluence PDT group (P = .075), whereas it was observed in the ranibizumab group (P = .012). However, the tendency toward improvement of best-corrected visual acuity was not maintained.
In terms of anatomic outcomes, the effect of ranibizumab injections was not promising compared with that of low-fluence PDT.

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    • "Several small trials have yielded suggestive results, although their effectiveness has not been confirmed. Bae et al. showed in a small randomized trials that half-fluence PDT may be superior to anti-VEGF agent as a treatment for CSC [29]. Anti-VEGF agents are highly effective in reducing subretinal fluid, reducing extravasation from retinal vessels, and neovascularization, but they may not be sufficient to reduce the hyperpermeability of the choroid in eyes with CSC and PCV. "
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