Reduced-fluence Photodynamic Therapy for Subfoveal Serous Pigment Epithelial Detachment With Choroidal Vascular Hyperpermeability

PURPOSE: To evaluate the efficacy of reduced-fluence photodynamic therapy (PDT) for treating symptomatic subfoveal serous pigment epithelial detachments (PEDs) with hyperfluorescence on late-phase indocyanine green angiography (ICGA) without choroidal neovascularization (CNV). DESIGN: Retrospective, interventional case series. METHODS: Fifteen eyes of 15 patients (mean age, 55.3 years) with a serous PED were included. Baseline ICGA showed hyperpermeable choroidal vessels but no CNV in any eyes. Reduced-fluence PDT was applied and included treatment of hyperfluorescent areas on late-phase ICGA. We evaluated changes in the PEDs and hyperfluorescence on late-phase ICGA at baseline and 3 months after PDT. We compared the subfoveal choroidal thickness and best-corrected visual acuity (BCVA). RESULTS: The baseline ICGA showed mild to intense hyperfluorescence at the PED with hyperpermeable choroidal vessels. One month after reduced-fluence PDT, the PED resolved in 14 eyes (93%) and decreased in height in 1 eye. The PED flattening continued for more than 3 months. The baseline hyperfluorescence on ICGA decreased at month 3 except for 1 eye. The subfoveal choroidal thickness decreased significantly (P < .0001) from 297 to 238 mu m; the BCVA significantly (P = .019) improved from 0.08 to -0.01 between baseline and month 3. The month-3 BCVA was significantly associated with the baseline BCVA and the duration and size of the PED. No PEDs recurred or complications developed, such as secondary CNV or retinal pigment epithelial tears. CONCLUSION: Serous PEDs accompanying hyperfluorescence on ICGA are considered a variant of central serous chorioretinopathy. Reduced-fluence PDT is beneficial for resolving PEDs. (Am J Ophthalmol 2012; 154:865-871. (C) 2012 by Elsevier Inc. All rights reserved.)