TREATMENT
OF CSC
Review
서울성모병원
R3 김은경/AP.박영훈
Treatment
Photocoagulation
PDT
Lucentis injection
Photocoagulation
1) shorten the course of the disease
2) accelerating the resorption of the fluid
3) has no effect on final visual acuity
4) 3개월간 관찰  macular detachment가 지속되면
> 500µm from the center of the fovea : photocoagulation
< 500µm from the center of the fovea : 6개월간 관찰
5) permanent visual loss from an untreated macular
detachment in the fellow eye
6) recurrent macular detachment who has experienced
permanent visual loss from the initial episode
7) severe forms of CSC(multiple, bullous RD..)
Method
1. FAG within 1 week
2.Argon, Krypton
3. Spot size(200micro meter) > leaking point
4.100~200 mW , 0.2~0.3 sec , > 35 pulses
5. Focus on RPE level
Complication of laser Tx.
1. inadvertent photocoagulation of the fovea
2. secondary CNV
3. enlargement of the area of RPE atrophy
PDT
ICG angiographic-guided photodynamic therapy for chronic CSC
 rationale : reduction of blood flow in hyperpermeable choriocapillaris
Basic of PDT
 A photosensitizer is a chemical compound that can be excited by light of a spe
cific wavelength
 Singlet oxygen is a very aggressive chemical species and will very rapidly react
with any nearby biomolecules.
 Ultimately, these destructive reactions will kill cells through apoptosis or
necrosis.
Various photosensitizers
PDT in chronic CSC
 When it is thought to be wise to avoid photocoagulation
 Juxtafoveal or subfoveal location of RPE lesion
 Lack of a clearly defined leakage hotspot
 Concern about the potential induction of CNV or
suspicion that CNV was already present
PDT in chronic CSC
 might be successful because PDT also affects the
longstanding non-neovascular component of CSC.
 Aid in the resolution of exudative detachment in patients with
chronic CSC.
 PDT treatment is associated with a rapid reduction in subretinal
fluid and improvement in visual acuity.
 Complication of PDT : Secondary RPE changes due to hypoxic
damage caused by choriocapillaris occlusion
 Reduced-dose verteporfin PDT for chronic CSC
Lucentis
 Anti-angiogenic agent : wet type AMD
 The binding of Lucentis to VEGF-A prevents the
interaction of VEGF-A with its receptors (VEGFR1
and VEGFR2) on the surface of endothelial cells
 Reducing endothelial cell proliferation
Vascular leakage
New blood vessel formation
Journals
 Photodynamic Therapy for Chronic Central Serous Chorioret
inopathy.
 Acta Ophthalmol. 2009 Nov 27.
 Photodynamic Therapy in the Treatment of Choroidal Neov
ascularization Complicating Central Serous Chorioretinopat
hy.
 J Chi Med Assoc. 2009;72:501-5.
 Photodynamic Therapy with Verteporfin in Subfoveal Choro
idal Neovascularization Secondary to Central Serous Chorio
retinopathy.
 Arch Ophthalmol. 2004;122:37-41
Journals
 Treatment of Choroidal Neovascularization in Central
Serous Chorioretinopathy by Photodynamic Therapy
with Verteporfin.
 Am J Ophthalmol. 2003;136:836-845.
 Photodynamic Therapy for acute Central Serous Chori
oretinopathy.
 Retina. 29:1155-1161, 2009
Journals
 Intravitreal Bevacizumab Injection for Central Serous
Chorioretinopathy.
 Retina. 30:100-106, 2010
 Intravitreal bevacizumab for treatment of chronic central
serous chorioretinopathy.
 Eur J Ophthalmol 2009;19:613-7
 Intravitreal Bevacizumab (Avastin) for Choroidal
Neovascularization Secondary to Central Serous
Chorioretinopathy, Secondary to Punctate Inner
Chorioretinopathy, or of idiopathic Origin.
 Am J Ophthalmol 2007;143:977-983.