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BMC Ophthalmology

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Changes in macular sensitivity after half-dose photodynamic therapy for chronic central serous chorioretinopathy

  • Alp Atik1, 2,
  • Yijun Hu3,
  • Honghua Yu4,
  • Chun Yang5,
  • Bin Cai1,
  • Yijing Tao1,
  • Dongli Li1,
  • Yan Chen1,
  • Li Lu1,
  • Guodong Li6 and
  • Ling Yuan1Email author
BMC OphthalmologyBMC series – open, inclusive and trusted201717:140

https://doi.org/10.1186/s12886-017-0535-y

Received: 4 September 2016

Accepted: 31 July 2017

Published: 10 August 2017

Abstract

Background

To evaluate the macular sensitivity changes after half-dose photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSCR).

Methods

Eighteen patients (26 eyes) with chronic CSCR were recruited in the same hospital between April 2011 and December 2012. All patients were treated with one session of half-dose PDT after complete ophthalmic examination. Macular sensitivity examination was performed at baseline and 1, 3 and 6 months post-treatment. Mean sensitivity (MS) of the central 10 degrees (10°) and 4 degrees (4°), mean deviation (MD) and pattern standard deviation (PSD) on automated static perimetry (Humphrey Field Analyzer II-750) were used for analysis.

Results

There was significant improvement of the 10°MS from baseline (29.76 ± 1.51 dB) to 1 month (31.74 ± 1.56 dB), 3 months (31.51 ± 1.38 dB) and 6 months (31.19 ± 1.61 dB) after treatment (P < 0.001). The 4°MS was also significantly improved with half-dose PDT from baseline (28.96 ± 1.78 dB) to 1 month (32.41 ± 1.66 dB), 3 months (32.46 ± 1.50 dB) and 6 months (31.90 ± 1.84 dB) post-treatment (P < 0.001). MD was improved from baseline (−3.39 ± 0.89 dB) to 1 month (−1.96 ± 0.29 dB), 3 months (−1.94 ± 0.29 dB) and 6 months (−2.45 ± 0.13) post-treatment (P = 0.004). PSD also improved from 1.97 ± 0.24 dB at baseline to 1.47 ± 0.27 dB, 1.34 ± 0.24 dB, and 1.53 ± 0.24 dB (P = 0.001) at 1, 3 and 6 months after treatment, respectively.

Conclusion

Macular sensitivity in CSCR can be improved by half-dose PDT, along with improvement of visual acuity and retinal thickness. The treatment outcome at 1 month may be a predictor of the final treatment response.

Keywords

Central serous chorioretinopathy (CSCR)Photodynamic therapy (PDT)Visual fieldMacular sensitivityAutomated static perimetry

Background

Central serous chorioretinopathy (CSCR) is characterized by serous retinal detachment and sometimes retinal pigment epithelial (RPE) detachment, most often confined to the macula and associated with leakage of fluid through the RPE into the subretinal space [1]. CSCR can occur in acute or chronic forms, with 3 months as the most widelyused differentiating parameter [1]. The acute form often presents with a moderate reduction in best-corrected visual acuity (BCVA) and generally resolves spontaneously with minimal sequelae. However, recurrence is quite common, occurring in 30–50% of patients within 1 year [2]. In contrast, chronic CSCR can result in widespread retinal damage, with photoreceptor death, chronic neurosensory retinal detachment, RPE atrophy, choroidal neovascularization (CNV) and permanent loss of vision [35].

Indications for treatment of CSCR include persistent or chronic CSCR, recurrence in eyes with visual deficits from CSCR, visual deficits in the other eye from CSCR, presence of chronic changes and occupational reasons. Photodynamic therapy (PDT) with verteporfinhas been widely used for the treatment of CSCR with promising results [611]. PDT has an occlusive effect on CNV and also causes choroidal hypoperfusion [12]. It is also purported to decrease choroidal hyperpermeability and tighten the blood retinal barrier at the RPE, countering subretinal fluid accumulation [13, 14]. However, these effects can also cause complications such as RPE atrophy, juxtafoveal CNV and transient reduction in macular function [1519]. Thus, ‘safety-enhanced’ (half-dose verteporfin) PDT is now more commonly used in the treatment of CSCR [6, 7, 20, 10].

Macular sensitivity is usually reduced in CSCR [21, 22], especially in the chronic form [21]. Studies have shown that half-dose PDT can improve macular sensitivity along with improvement of BCVA [2326]. Most of these studies used microperimetry to assess macular sensitivity [2426]. However, microperimetry is not usually available in many hospitals. In contrast, automated static perimetry (ASP) is more commonly used in many settings. Studies have shown that the results of ASP is significantly correlated with those of microperimetry [27, 28]. Hence it seems reasonable to assess macular sensitivity using ASP when microperimetry is not available. In the present study, we used ASP to evaluate macular sensitivity in patients with chronic CSCR after half-dose verteporfin PDT treatment.

Methods

Study participants

Eighteen patients (26 eyes) with chronic CSCR were recruited in the same hospital between April 2011 and December 2012. All study subjects were male. Informed consent was obtained from each patient. This prospective study was in agreement with the Declaration of Helsinki and approved by the Institutional Review Board of the First Affiliated Hospital of Kunming Medical University.

Inclusion criteria included: 1. BCVA 20/200 or better, 2. visual symptoms associated with CSCR (such as decrease vision, central scotoma) lasting for more than 3 months, 3. presence of subretinal fluid involving the fovea on optical coherence tomography (OCT), 4. active characteristic angiographic leakage (a focal leakage point in the early phase with pooling of fluorescein in the later phases) on fluorescein angiography (FA), 5. presence of choroidal hyperpermeability on indocyanine green angiography (ICGA) [11].

Exclusion criteria were acute CSCR with disease duration less than 3 months, previous PDT or focal laser photocoagulation for CSCR, evidence of other macular diseases (such as age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, retinal vein occlusion), corneal opacity, glaucoma or ocular hypertension, refractive error greater than ±6.00 diopters and a history of ocular surgery, intraocular inflammation, ocular trauma and optic neuropathy.

All patients underwent a complete ophthalmic examination, including BCVA with decimal charts, slit-lamp examination and indirect ophthalmoscopy. Macular sensitivity examination was performed with the Humphrey Field Analyzer II-750 (Carl Zeiss Meditec, Dublin, CA, USA) using SITA-FAS strategy of the 10–2 program at baseline and at each follow-up (1, 3 and 6 months) after treatment. The stimulus size was Goldmann III and the background luminance was 31.5ASB. Visual fields with fixation loss <15%, false positive <20%, false negative <20% were considered as reliable. Mean sensitivity (MS) of the central 10 degrees (10°) and 4 degrees (4°), mean deviation (MD) and pattern standard deviation (PSD) were used for analysis. The MD and PSD were automatically calculated by the Humphrey Field Analyzer II-750. The 10°MS was calculated as the mean of the 68 point sensitivity within the central 10° area and the 4°MS was calculated as the mean of the 16 point sensitivity within the central 4° area.

Central foveal thickness (CFT) was measured at baseline and at each post-treatment follow-up with OCT (STRATUS OCT 3000, Carl Zeiss Meditec, Dublin, CA). FA and ICGA (Heidelberg Retina Angiograph II, Heidelberg Engineering, Heidelberg, Germany) were also performed simultaneously at baseline and at 6 months follow-up.

Patients were treated with one session of half-dose verteporfin PDT after confirmation of diagnosis. Verteporfin was administered intravenously at a dose of 3 mg/m2 body surface area within 8 min, followed by PDT at 10 min from the commencement of infusion to cover the area of leakage on FFA and choroidal hyperpermeability on ICGA using the following parameters: wavelength 689 nm, light intensity 600 mW/cm2, duration 83 s, dose 50 J/cm2.

Statistical analysis

The main outcome measures BCVA, CFT, 10°MS, 4°MS, MD and PSD were assessed by normality test. The main outcome measures between baseline and different post-treatment follow-ups were compared with one-way ANOVA. Two-tailed Student’s t-test was used for the comparison of two time-points. Pearson linear correlation was used to assess the correlation between any two of the main outcome measures. P < 0.05 was considered statistically significant.

Results

Basic characteristics

Twenty-six eyes of 18 patients with CSCR were included in the study. The mean age of the patients was 43.2 years (range: 32–48 years). All patients were male. Eight patients had CSCR in both eyes and 10 patients had CSCR in one eye. Most of the patients had relatively well preserved RPE.

BCVA

There was significant improvement in BCVA from baseline (0.44 ± 0.22) to 1 month (0.69 ± 0.19), 3 months (0.73 ± 0.18) and 6 months (0.70 ± 0.18) post-treatment (ANOVA F = 11.535,P < 0.001). All the post-treatment time-points were significantly different to baseline (all P < 0.001). There was no significant difference in BCVA between any of the post-treatment time-points (P > 0.05) (Tables 1 and 2).
Table 1

Main outcome measures at baseline and different follow-ups (mean ± SD)

Variable

baseline

1 month

3 months

6 months

F

p

BCVA

0.44 ± 0.22

0.69 ± 0.19

0.73 ± 0.18

0.70 ± 0.18

11.535

<0.001

CFT

404.84 ± 28.34

261.38 ± 26.69

227.38 ± 25.57

233.53 ± 23.69

27.227

<0.001

MD

−3.39 ± 0.89

−1.96 ± 0.29

−1.94 ± 0.29

−2.45 ± 0.13

4.744

0.004

10°MS

29.76 ± 1.51

31.74 ± 1.56

31.51 ± 1.38

31.19 ± 1.61

7.108

<0.001

4°MS

28.96 ± 1.78

32.41 ± 1.66

32.46 ± 1.50

31.90 ± 1.84

17.830

<0.001

PSD

1.97 ± 0.24

1.47 ± 0.27

1.34 ± 0.24

1.53 ± 0.24

6.329

0.001

Table 2

p value of comparison of main outcome measures

Variable

baseline vs 1 month

baseline vs 3 months

baseline vs 6 months

1 month vs 3 months

1 month vs 6 months

3 months vs 6 months

BCVA

<0.001

<0.001

<0.001

0.483

0.888

0.574

CFT

<0.001

<0.001

<0.001

0.136

0.221

0.786

MD

0.002

0.001

0.036

0.957

0.270

0.248

10°MS

<0.001

<0.001

0.003

0.629

0.244

0.494

4°MS

<0.001

<0.001

<0.001

0.918

0.372

0.319

PSD

0.003

<0.001

<0.001

0.434

0.520

0.890

CFT

Subretinal fluid resolved completely by 1 month in 23 eyes (88.5%) and by 3 months in 2 eyes. Only one eye had unresolved subretinal fluid at 6 months. CFT was significantly reduced from baseline (404.84 ± 28.34um) to 1 month (261.38 ± 26.69um), 3 months (227.38 ± 25.57um) and 6 months (233.53 ± 23.69um) post-treatment (F = 27.227, P < 0.001). Mean CFT from all the post-treatment time-points was significantly lower than that at baseline (all P < 0.001). Although there was a further decrease in the mean CFT from 1 month to 3 and 6 months post-treatment, the difference between the time-points was not significant (all P > 0.05) (Tables 1 and 2).

FFA and ICGA

All of the eyes had leakage within the foveal avascular zone (FAZ) on FFA. FFA showed that leakage stopped in 24 eyes (92.3%) at 6 months after half-dose PDT. There was reduced leakage in 1 eye (3.84%) and no change in 1 eye (3.84%). No patient developed complications such as RPE atrophy and secondary choroidal ischemia as seen on ICGA after treatment.

Macular sensitivity

There was significant improvement in the 10°MS from baseline (29.76 ± 1.51 dB) to 1 month (31.74 ± 1.56 dB), 3 months (31.51 ± 1.38 dB) and 6 months (31.19 ± 1.61 dB) after treatment (F = 7.108, P < 0.001). All three time-points were significantly different to baseline (P < 0.001, <0.001, =0.003 at 1, 3 and 6 months respectively). There was no significant difference between any two post-treatment time-points (all P > 0.05) (Tables 1 and 2).

The 4°MS was also significantly improved with half-dose PDT from baseline (28.96 ± 1.78 dB) to 1 month (32.41 ± 1.66 dB), 3 months (32.46 ± 1.50 dB) and 6 months (31.90 ± 1.84 dB) post-treatment (F = 17.830, P < 0.001). All three time-points (1 month, 3 months and 6 months) were significantly different to baseline (all P < 0.001). Comparison of 4°MS between any two postoperative follow-ups was not significant (all P > 0.05) (Tables 1 and 2). Moreover, the 4°MS was lower at baseline but was more significantly improved after treatment than the 10°MS, suggesting that the foveal function was more compromised by the disease but was more restored after treatment than the entire macula.

The half-dose PDT treatment significantly improved the MD from baseline (−3.39 ± 0.89 dB) to 1 month (−1.96 ± 0.29 dB), 3 months (−1.94 ± 0.29 dB) and 6 months (−2.45 ± 0.13) post-treatment (F = 4.744, P = 0.004). All three time points (1 month, 3 months and 6 months) were significantly improved compared with baseline (P = 0.002, 0.001, 0.036 respectively). There was a decrease in mean MD from 3 months to 6 months post-treatment but this was not significant (P > 0.05) (Tables 1 and 2).

Half-dose PDT also improved the PSD (F = 6.329, P = 0.001). The baseline PSD improved from 1.97 ± 0.24 dB to 1.47 ± 0.27 dB (P = 0.003), 1.34 ± 0.24 dB (P < 0.001), and 1.53 ± 0.24 dB (P < 0.001) at 1, 3 and 6 months after treatment, respectively. Despite a slight rise at 6 months, the difference in the PSD between any two post-treatment follow-ups was not significant (all P > 0.05) (Tables 1 and 2).

Correlation of main outcomes

There was modest negative correlation between CFT and BCVA (r = −0.295, P = 0.002), CFT and 10°MS (r = −0.314, P < 0.001) and CFT and MD (r = −0.198, P = 0.038). This meant that with the resolution of subretinal fluid, the macular functions (BCVA, 10°MS and MD) were also improved.

Discussion

CSCR is generally considered to be a self-limited condition. However, some patients can experience significant visual impairment caused by recurrent attacks of CSCR, persistent chronic neurosensory retinal detachment, or RPE atrophy. Since many CSCR patients are working age, this visual impairment (especially if chronic) may adversely interfere with daily activities and productivity, thus enhancing the requirement for safe, effective treatment.

Our results demonstrate that macular sensitivity as assessed with ASP can be improved after half-dose verteporfin PDT. This is clinically important as visual acuity often does not capture the visual disturbances of CSCR patients. Half-dose PDT resulted in significant improvement in BCVA and macular sensitivity along with resolution of subretinal fluid after treatment. In addition, FFA showed a cessation of leakage in 92.3% of patients at 6 months after treatment. None of the patients in our study experienced visual loss (or other complications) after PDT with half-dose verteporfin. No patient developed complications shown to be associated with full-dose verteporfin PDT, such as secondary CNV, RPE atrophy and secondary choroidal ischemia.

Several studies have evaluated the effects of half-dose PDT on macular sensitivity in patients with chronic CSCR using microperimetry. The results were promising and the macular sensitivity improved in most patients up to 12 months after treatment [2426]. However, microperimetry is not commonly available in many hospitals. On the contrary, ASP is commonly used in general practice. Our results demonstrate that ASP can also be used to assess macular sensitivity in CSCR patients. Springer et al. showed that the results of ASP are comparable with microperimetry in healthy volunteers [27]. Inpatients with macular diseases whose visual acuity is low and fixation is poor, ASP may not perform as well as microperimetry [29]. However, patients with CSCR usually have good visual acuity and fixation even when the disease is chronic [21, 24]. To ensure good central fixation during macular sensitivity examination using ASP, we ruled out patients whose BCVA was worse than 20/200. Our results demonstrating improved macular sensitivity as assessed by ASP were consistent with those of other studies using microperimetry [2426].

We feel that the improvements in MS, MD and PSD seen in our study are both statistically and clinically significant. In a previous study Squirrell et al. has demonstrate that a change of >1.5 dB in MS detected by microperimetry can be regarded as a significant change in visual function in wet AMD patients [30]. The mean change of 10°MS in our study was 1.98 dB at 1 month, 1.75 dB at 3 months and 1.43 dB at 6 months. The mean change of 4°MS in our study was 3.45 dB at 1 month, 3.5 dB at 3 months and 2.94 dB at 6 months. Most of the MS changes in our study were more than 1.5 dB. In a study by Frennesson et al. the mean improvement of MD in wet AMD patients successfully treated with ranibizumab was at least 27% from the baseline MD [31]. In our study, the mean improvement of MD from baseline was 42.2% at 1 month, 42.8% at 3 months and 27.7% at 6 months. All of the improvement was more than 27%. Moreover, a less extent of change in MS and MD would be expected in CSCR patients. This is because patients with better central vision usually have smaller variation in MS and MD [32] and CSCR patients usually have better central vision than wet AMD patients.

In our study, BCVA was significantly improved at 1 month after treatment and remained stable at 3 months and 6 months. Consistently, 10°MS and 4°MS were also improved in the same manner, suggesting that macular function as well as foveal function improved after treatment. This is because in a majority of CSCR cases the subretinal fluid is not limited to the subfoveal area, usually extending to the juxtafoveal region and in some cases even beyond, to involve the whole macula. In chronic CSCR the photoreceptors at the areas of subretinal fluid may undergo dysfunction and degeneration and causes visual disturbance. Some photoreceptors may partially regain function with resolution of the subretinal fluid, which is reflected by the increase in 10°MS and 4°MS. However, our results indicate that macular function is not fully restored after treatment, with MD at post-treatment follow-ups higher than baseline, but still lower than normal subjects. An interesting finding of our study is that the foveal function recovery seem to be more significant than the entire macula. This is consistent with some previous studies. Sekine et al. have shown a lower MS at the fovea compared to that at the outer macular area in CSCR [33]. Ehrlich et al. have also shown that improvement of 6°MS is more profound than 12°MS at 3 months and 6 months after PDT treatment for CSCR [34].

Sanguansaket al. found that macular sensitivity in eyes with resolved CSCR after half-dose PDT was still lower than the normal fellow eyes [23]. The loss and recovery of photoreceptor function seems to be more significant at the fovea, as suggested by the results of our study. Lower BCVA before treatment was associated with higher PSD, indicating that foveal function was more damaged compared to other regions of the macula. Similarly, higher BCVA after treatment was associated with lower PSD, suggesting that recovery of foveal function was more significant than other macular areas. Our findings are consistent with Piccolino et al. who found that photoreceptor damage in CSCR is more profound at the fovea [35].

Interestingly, we showed no significant difference in treatment response with any of the macular sensitivity parameters between 1, 3 and 6 months. Most of the patients who showed improvement in macular sensitivity at 1 month post-treatment did not demonstrate a further response to half-dose PDT at 3 or 6 months. Clinically, this suggests that success of half-dose PDT treatment may be determined early, with the potential to utilize other treatment modalities after assessing response at 1 month.

Our study had several limitations, including small sample size. We did not obtain data on choroidal thickness, as can be done by enhanced depth imaging OCT. It would be interesting to assess whether baseline choroidal thickness is significantly altered by half-dose PDT and whether this correlates with treatment response. We were also only able to report 6 months follow-up results and further research is required to assess patients at 1 year or longer. In addition, although severe damage to the retina or choroid did not occur within the trial period, further follow-up is needed to establish long-term safety. Our results are not generalizable to all CSCR patients given the small and short term nature of this study, but they do indicate that automated static perimetry may play a useful role in evaluating treatment response in this patient population.

Conclusion

In conclusion, macular sensitivity may be improved by half-dose PDT along with improvement of BCVA and CFT in chronic CSCR. The treatment outcome at 1 month may be a predictor of the final treatment response. Our results showing improvement in macular sensitivity in the chronic CSCR patients treated with half-dose PDT provide further evidence supporting the role of half-dose PDT treatment in this patient population.

Abbreviations

ASP: 

Automated static perimetry

BCVA: 

Best-corrected visual acuity

CFT: 

Central foveal thickness

CNV: 

Choroidal neovascularization

CSCR: 

Central serous chorioretinopathy

FA: 

Fluorescein angiography

ICGA: 

Indocyanine green angiography

MD: 

Mean deviation

MS: 

Mean sensitivity

OCT: 

Optical coherence tomography

PDT: 

Photodynamic therapy

PSD: 

Pattern standard deviation

RPE: 

retinal pigment epithelial

Declarations

Acknowledgement

None.

Funding

The study was supported by the National Natural Science Foundation of China (81260151), Beijing, China and the Research Foundation of the Department of Science and Technology of Yunnan Province, Yunnan, China (2011FB062 and 2014RA009).

Availability of data and materials

All the data supporting the conclusions of this article is included in the present article. However, most of the patients wish not to share their raw data after thorough consideration.

Authors’ contributions

YH, GL and LY designed the study. CY, BC, YT, DL, YC and LL collected the dada. YH and LY analyzed the data. AA, YH and HY wrote the article. GL and LY made critical revision to the article. AA, YH and HY contributed equally to the research and therefore can be considered as first co-authors. LY andGL (email: daliguodong@sina.com) are to be considered as the corresponding co-authors. All authors read and approved the final manuscript.

Ethics approval and consent to participate

This prospective study was in agreement with the Declaration of Helsinki and approved by the Institutional Review Board of the First Affiliated Hospital of Kunming Medical University. Informed consent was obtained from each patient.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Authors’ Affiliations

(1)
Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University
(2)
Royal Victorian Eye and Ear Hospital
(3)
Shanwei Project Vision Eye Hospital
(4)
Department of Ophthalmology, General Hospital of Guangzhou Military Command of PLA
(5)
Department of Ophthalmology, The People’s Hospital of Gejiu City
(6)
Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University

References

  1. Nicholson B, Noble J, Forooghian F, Meyerle C. Central serous chorioretinopathy: update on pathophysiology and treatment. Surv Ophthalmol. 2013;58(2):103–26. doi:10.1016/j.survophthal.2012.07.004.View ArticlePubMedPubMed CentralGoogle Scholar
  2. Loo RH, Scott IU, Flynn HW Jr, Gass JD, Murray TG, Lewis ML, Rosenfeld PJ, Smiddy WE. Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina. 2002;22(1):19–24.View ArticlePubMedGoogle Scholar
  3. Baran NV, Gurlu VP, Esgin H. Long-term macular function in eyes with central serous chorioretinopathy. Clin Experiment Ophthalmol. 2005;33(4):369–72. doi:10.1111/j.1442-9071.2005.01027.x.View ArticlePubMedGoogle Scholar
  4. Folk JC, Thompson HS, Han DP, Brown CK. Visual function abnormalities in central serous retinopathy. Arch Ophthalmol. 1984;102(9):1299–302.View ArticlePubMedGoogle Scholar
  5. Maaranen TH, Tuppurainen KT, Mantyjarvi MI. Color vision defects after central serous chorioretinopathy. Retina. 2000;20(6):633–7.View ArticlePubMedGoogle Scholar
  6. Fujita K, Imamura Y, Shinoda K, Matsumoto CS, Mizutani Y, Hashizume K, Mizota A, Yuzawa M. One-year outcomes with half-dose Verteporfin photodynamic therapy for chronic central serous Chorioretinopathy. Ophthalmology. 2014; doi:10.1016/j.ophtha.2014.09.034.
  7. Fujita K, Imamura Y, Shinoda K, Matsumoto CS, Mizutani Y, Mizota A, Yuzawa M. Quantification of metamorphopsia in chronic central serous chorioretinopathy after half-dose verteporfin photodynamic therapy. Retina. 2014;34(5):964–70. doi:10.1097/iae.0000000000000027.View ArticlePubMedGoogle Scholar
  8. Nicolo M, Eandi CM, Alovisi C, Grignolo FM, Traverso CE, Musetti D, Cardillo Piccolino F. Half-fluence versus half-dose photodynamic therapy in chronic central serous chorioretinopathy. Am J Ophthalmol. 2014;157(5):1033–7. doi:10.1016/j.ajo.2014.01.022.View ArticlePubMedGoogle Scholar
  9. Modi RR, Butola S, Behera UC. Half-fluence versus half-dose photodynamic therapy in chronic central serous Chorioretinopathy. Am J Ophthalmol. 2015;159(1):205. doi:10.1016/j.ajo.2014.09.038.View ArticlePubMedGoogle Scholar
  10. Zhao M, Zhang F, Chen Y, Dai H, Qu J, Dong C, Kang X, Liu Y, Yang L, Li Y, Zhou P, Pan C, Zhang L, Liu P, Zhou H, Jiao X, Xiong Y, Tian R, Lu Y, Yu X, Li X. A 50% vs 30% dose of Verteporfin (photodynamic therapy) for acute central serous Chorioretinopathy: one-year results of a randomized clinical trial. JAMA Ophthalmol. 2015; doi:10.1001/jamaophthalmol.2014.5312.
  11. Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology. 2008;115(10):1756–65. doi:10.1016/j.ophtha.2008.04.014.View ArticlePubMedGoogle Scholar
  12. Husain D, Kramer M, Kenny A, Michaud N, Flotte T, Gragoudas E, Miller J. Effects of photodynamic therapy using verteporfin on experimental choroidal neovascularization and normal retina and choroid up to 7 weeks after treatment. Invest Ophthalmol Vis Sci. 1999;40(10):2322–31.PubMedGoogle Scholar
  13. Tarantola RM, Law JC, Recchia FM, Sternberg P Jr, Agarwal A. Photodynamic therapy as treatment of chronic idiopathic central serous chorioretinopathy. Lasers Surg Med. 2008;40(10):671–5. doi:10.1002/lsm.20720.View ArticlePubMedGoogle Scholar
  14. Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment. Eye. 2010;24(12):1743–56. doi:10.1038/eye.2010.130.View ArticlePubMedGoogle Scholar
  15. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials--TAP report. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study Group (1999). Archives of ophthalmology 117 (10):1329–1345.Google Scholar
  16. Cardillo Piccolino F, Eandi CM, Ventre L, Rigault de la Longrais RC, Grignolo FM. Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003;23(6):752–63.View ArticlePubMedGoogle Scholar
  17. Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, Chan CK. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003;87(12):1453–8.View ArticlePubMedPubMed CentralGoogle Scholar
  18. Lai TY, Chan WM, Lam DS. Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy. Am J Ophthalmol. 2004;137(5):826–33. doi:10.1016/j.ajo.2003.11.079.View ArticlePubMedGoogle Scholar
  19. Tzekov R, Lin T, Zhang KM, Jackson B, Oyejide A, Orilla W, Kulkarni AD, Kuppermann BD, Wheeler L, Burke J. Ocular changes after photodynamic therapy. Invest Ophthalmol Vis Sci. 2006;47(1):377–85. doi:10.1167/iovs.05-0838.View ArticlePubMedGoogle Scholar
  20. Kim KS, Lee WK, Lee SB. Half-dose photodynamic therapy targeting the leakage point on the fluorescein angiography in acute central serous chorioretinopathy: a pilot study. Am J Ophthalmol. 2014;157(2):366–373 e361. doi:10.1016/j.ajo.2013.10.013.View ArticlePubMedGoogle Scholar
  21. Eandi CM, Piccolino FC, Alovisi C, Tridico F, Giacomello D, Grignolo FM. Correlation between fundus autofluorescence and central visual function in chronic central serous chorioretinopathy. Am J Ophthalmol. 2015;159(4):652–8. doi:10.1016/j.ajo.2014.12.023.View ArticlePubMedGoogle Scholar
  22. Ozdemir H, Senturk F, Karacorlu M, Arf Karacorlu S, Uysal O. Macular sensitivity in eyes with central serous chorioretinopathy. Eur J Ophthalmol. 2008;18(5):799–804.PubMedGoogle Scholar
  23. Sanguansak T, Pitujaturont P, Yospaiboon Y, Sinawat S, Ratanapakorn T, Bhoomibunchoo C. Macular sensitivity after half-dose verteporfin photodynamic therapy in central serous chorioretinopathy. Clin Ophthalmol. 2015;9:2257–61. doi:10.2147/opth.s95748.PubMedPubMed CentralGoogle Scholar
  24. Fujita K, Shinoda K, Imamura Y, Matsumoto CS, Mizutani Y, Mizota A, Yuzawa M. Correlation of integrity of cone outer segment tips line with retinal sensitivity after half-dose photodynamic therapy for chronic central serous chorioretinopathy. Am J Ophthalmol. 2012;154(3):579–85. doi:10.1016/j.ajo.2012.03.043.View ArticlePubMedGoogle Scholar
  25. Senturk F, Karacorlu M, Ozdemir H, Karacorlu SA, Uysal O. Microperimetric changes after photodynamic therapy for central serous chorioretinopathy. Am J Ophthalmol. 2011;151(2):303–309 e301. doi:10.1016/j.ajo.2010.08.019.View ArticlePubMedGoogle Scholar
  26. Fujita K, Yuzawa M, Mori R. Retinal sensitivity after photodynamic therapy with half-dose verteporfin for chronic central serous chorioretinopathy: short-term results. Retina. 2011;31(4):772–8. doi:10.1097/IAE.0b013e3181f049d3.View ArticlePubMedGoogle Scholar
  27. Springer C, Bultmann S, Volcker HE, Rohrschneider K. Fundus perimetry with the micro perimeter 1 in normal individuals: comparison with conventional threshold perimetry. Ophthalmology. 2005;112(5):848–54. doi:10.1016/j.ophtha.2004.11.051.View ArticlePubMedGoogle Scholar
  28. Lima VC, Prata TS, De Moraes CG, Kim J, Seiple W, Rosen RB, Liebmann JM, Ritch R. A comparison between microperimetry and standard achromatic perimetry of the central visual field in eyes with glaucomatous paracentral visual-field defects. Br J Ophthalmol. 2010;94(1):64–7. doi:10.1136/bjo.2009.159772.View ArticlePubMedGoogle Scholar
  29. Midena E, Radin PP, Convento E, Cavarzeran F. Macular automatic fundus perimetry threshold versus standard perimetry threshold. Eur J Ophthalmol. 2007;17(1):63–8.PubMedGoogle Scholar
  30. Squirrell DM, Mawer NP, Mody CH, Brand CS. Visual outcome after intravitreal ranibizumab for wet age-related macular degeneration: a comparison between best-corrected visual acuity and microperimetry. Retina. 2010;30(3):436–42. doi:10.1097/IAE.0b013e3181bd2f29.View ArticlePubMedGoogle Scholar
  31. Frennesson C, Nilsson UL, Peebo BB, Nilsson SE. Significant improvements in near vision, reading speed, central visual field and related quality of life after ranibizumab treatment of wet age-related macular degeneration. Acta Ophthalmol. 2010;88(4):420–5. doi:10.1111/j.1755-3768.2009.01576.x.View ArticlePubMedGoogle Scholar
  32. Acton JH, Gibson JM, Cubbidge RP. Quantification of visual field loss in age-related macular degeneration. PLoS One. 2012;7(6):e39944. doi:10.1371/journal.pone.0039944.View ArticlePubMedPubMed CentralGoogle Scholar
  33. Sekine A, Imasawa M, Iijima H. Retinal thickness and perimetric sensitivity in central serous chorioretinopathy. Jpn J Ophthalmol. 2010;54(6):578–83. doi:10.1007/s10384-010-0869-y.View ArticlePubMedGoogle Scholar
  34. Ehrlich R, Mawer NP, Mody CH, Brand CS, Squirrell D. Visual function following photodynamic therapy for central serous chorioretinopathy: a comparison of automated macular microperimetry versus best-corrected visual acuity. Clin Exp Rheumatol. 2012;40(1):e32–9. doi:10.1111/j.1442-9071.2011.02654.x.Google Scholar
  35. Piccolino FC, de la Longrais RR, Ravera G, Eandi CM, Ventre L, Abdollahi A, Manea M. The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol. 2005;139(1):87–99. doi:10.1016/j.ajo.2004.08.037.View ArticlePubMedGoogle Scholar

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