Longitudinal multimodal functional macular analysis after half-dose photodynamic therapy for central serous chorioretinopathy

BackgroundHalf-dose photodynamic therapy (HD-PDT) has been widely used for central serous chorioretinopathy (CSC) with good anatomical results. However, long-term functional outcomes after this treatment remain uncertain. This study aimed a longitudinal multimodal macular assessment, correlating functional and anatomical outcomes.MethodsThis is a retrospective study performed in a tertiary referral center including 111 eyes from 95 CSC patients. Data on best corrected visual acuity (BCVA), central macular thickness (CMT), central retinal sensitivity (CRS) using microperimetry (MP) and multifocal electroretinography (mfERG) at baseline and 3, 6, 12, 18, 24, 36, 48 and 60 months after treatment were registered. A correlation analysis was performed.ResultsMean follow-up was 34.5 ± 26.3 months. A significant improvement in BCVA and CMT was registered in all the visits. CRS significantly improved until 24 months (p < 0.001 at 12 months, p < 0.05 at 24 months), worsening afterwards. The mfERG amplitude of N1 and P1 waves significantly improved in the first 12 months, aggravating afterwards. The implicit time improved until 24 months, deteriorating after 48 months. This long-term decline was also described in some inactive untreated fellow eyesConclusionsA multimodal longitudinal analysis of CSC patients after HD-PDT shows that, after the first 12 to 24 months, the significant sustained improvement in BCVA and CMT is not paired by a sustained improvement in macular sensitivity or electrical response. This long-term functional deterioration might result from the disease itself and not directly from the treatment .     

Comparison of half-dose versus half-fluence versus standard photodynamic therapy in chronic central serous chorioretinopathy

PurposeTo compare the efficacy and safety of half-dose vs. half-fluence vs. standard photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC).MethodsThis retrospective study included 64 eyes of 61 patients with cCSC who were treated with half-dose PDT (verteporfin 3 mg/m2 and light energy 50 J/cm2), half-fluence PDT (verteporfin 6 mg/m2 and light energy 25 J/cm2) or standard PDT (verteporfin 6 mg/m2 and light energy 50 J/cm2). The complete resorption of subretinal fluid (SRF) and changes of best corrected visual acuity (BCVA) and central retinal thickness (CRT) over the follow-up period were also assessed.ResultsFifteen eyes (65.2 %) in the half-dose PDT group, 12 eyes (80 %) in the half-fluence PDT group, and 20 eyes (76.9 %) in the standard PDT group showed complete resolution of SRF. There were no statistically significant differences in the mean BCVA improvement, CRT and SRF height reduction, number of PDT sessions, complete success, and recurrence rates between groups (p > 0.05). None of the eyes with intact EZ showed failure. There were positive correlations between higher mean CRT values of the last visit, 1st, 3rd, 6th months and failure. None of the treated eyes (0%) developed any systemic or local adverse events.ConclusionHalf-dose, half-fluence or standard PDTs are all effective and safe treatment choices in cCSC with similar BCVA improvements and CRT reductions. The higher mean CRT values of the follow-up period were correlated with failure, and in eyes with intact EZ showed no failure.     

Factors for recurrence in acute central serous chorioretinopathy patients underwent one-third dose verteporfin photodynamic therapy

PurposeTo investigate the factors for recurrence in acute central serous chorioretinopathy (aCSC) for patients who underwent one-third dose verteporfin photodynamic therapy (PDT).Materials and methodsA retrospective study was performed in aCSC patients treated with one-third dose PDT and followed up for 36 months. Demographic information and clinical features were compared. A logistic regression model was used to evaluate the associated factor of aCSC recurrence.ResultsThere were 162 patients with aCSC included in current study. 36-month after one-third dose PDT, good recovery was identified in 131 patients (80.86%), whereas 31 cases (19.14%) developed recurrence. Significant between-group differences were observed in baseline age, the right, left and both eyes, best-corrected visual acuity (BCVA), presenting with pigment epithelium detachment (PED), retinal pigment epithelium (RPE) damage and subfoveal choroidal thickness (SCT) level (P = 0.005, P < 0.001, P < 0.001, P < 0.001, P = 0.006, and P < 0.001, respectively). The recurrence of aCSC was associated with presenting with PED (odds ratio = 1.78; 95% CI, 1.45–1.98; P < 0.001), RPE damage (OR = 1.13; 95%CI: 1.08–1.23; P < 0.001), baseline BCVA (OR = 0.96; 95%CI: 0.95 - 0.99; P = 0.001), and SCT level (OR = 1.18; 95%CI: 1.02–1.20; P < 0.001).ConclusionIn acute CSC after treatment of one-third dose PDT, recurrence is associated with RPE damage, baseline BCVA and SCT level. Our findings will assist clinicians to evaluate aCSC in clinical practice and provide insights into the prevention of recurrence.     

中心性浆液性脉络膜视网膜病变两例

例1，男性，31岁，歼击机飞行员，总飞行时间1320h。1995年5月向航医主诉右眼视物模糊伴眼前团块状阴影(9点位置)1周。专科检查：右眼视力0．8，眼底黄斑部水肿，少量渗出，中心凹反光消失。诊断：中心性浆液性脉络膜视网膜病变。给予能量合剂、激素、高压氧治疗，视力有所好转。送上级医疗进一步检查治疗，眼底无明显变化。眼底荧光血管造影示：右黄斑区透见荧光。     

Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning

PurposeTo assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL).MethodsRetrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n = 100); Group 2, partial SRF resorption (n = 66); and Group 3, absence of any SRF resorption (n = 50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1 vs. 2 and 3 together; 3rd compares groups 2 vs. 3.ResultsThe mean age was 55.6 ± 10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529 ± 0.035. In the second model, the mean accuracy was higher (0.670 ± 0.046). In the third approach, the algorithm showed a precision of 0.74 ± 0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69 ± 0.15 in group 3 (absence of SRF resolution).ConclusionDespite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.     

中心性浆液性脉络膜视网膜病变的电生理功能检查和医学鉴定

目的 探索视觉电生理学检查技术在中心性浆液性脉络膜视网膜病变医学鉴定的作用。方法 采用图形视觉诱发电位（PVEP）、视网膜电图（ERG）和多焦点视网膜电图（mERG)检查技术对临床诊断为中心性浆液性脉络膜视网膜病变的16例病例（包括飞行员和飞行学员各1例）进行功能评定，并与荧光血管造影和常规的眼科检查方法比较。结果 荧光造影证实11例（13眼）为急性中心性浆液性视网膜脉络膜病变，其PVEP的P100波幅值降低，峰时值均无明显改变；传统ERG 5种反应没有明显改变。mERG波幅值明显降低，降低区域与荧光血管所显示的病变范围相对应。没有荧光渗漏，只表现为色素脱失和色素紊乱的陈旧性黄斑病变者mERG仍可以表现为异常。结论 mERG能够对视网膜黄斑区病变进行客观反映，视觉电生理检查技术在航空临床医学鉴定中具有重要价值。     

Anatomical and functional impact of verteporfin shortage in patients with chronic central serous chorioretinopathy

BackgroundTo describe the functional and anatomical impact that the worldwide shortage of verteporfin has had on patients diagnosed with chronic central serous chorioretinopathy (cCSCR) whose treatment with photodynamic therapy (PDT) had to be delayed.MethodsProspective observational study. Patients were divided into two groups based on the time interval since PDT had been indicated: groups 1 and 2, with waiting times of less and more than 9 months respectively. Best corrected visual acuity (BCVA), the maximum height of the subretinal fluid (MSRF) and subfoveal choroidal thickness (SFCT) at the baseline visit and the last visit were compared.Results49 eyes of 48 patients with cCSCR were included. The mean waiting time for PDT was 9.0 ±3.8 months. The mean BCVA was 69.0 ±17.1 letters and 68.9 ±16.4 letters for the baseline and last visit respectively, showing no difference (p= 0.958). Although there was no difference in the mean global BCVA, 15 eyes (30.5%) showed a deterioration of ≥5 letters, including 7 eyes (14%) with a decrease of ≥10 letters. Mean MSRF height was 151.4 ±97.2 μm and 98.2 ±83.1 μm for the baseline and last visit respectively (p= 0.005), persisting in 74.5% of the eyes.ConclusionNo significant impact was observed in the BCVA in cCSCR due to the shortage of verteporfin. However, one-third of patients had BCVA loss. There was a significant spontaneous decrease in MSRF, but it persisted in the majority of the patients, still susceptible to PDT.     

Efficacy of subthreshold micropulse laser for chronic central serous chorioretinopathy: A meta-analysis

PurposeTo evaluate the efficacy of subthreshold micropulse laser (SML) treatment for chronic central serous chorioretinopathy (CSC).MethodsPubMed, Cochrane Library, and Embase were comprehensively searched for studies published up to April 19, 2021. Randomized controlled trials (RCTs), retrospective and prospective cohort studies that compared SML with any other intervention for chronic CSC were selected. The primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT). Meta-analysis was performed using Review Manager 5.3. Random-effect model was used for pooled analysis.ResultsEleven studies including 834 eyes were included, with 428 eyes undergoing SML treatment and 406 eyes receiving other interventions. Pooled results showed no significant differences between SML and control with respect to BCVA, CMT, or complete resolution of subretinal fluid, while SML treatment was inferior to control in terms of subfoveal choroidal thickness (SFCT) reduction [weighted mean difference (WMD)=44.75, 95% Cl, 14.31–75.20, P<0.05, I²=72%]. However, SML was not superior to photodynamic therapy with respect to SFCT (WMD=61.29, 95% Cl, 29.50–93.08, P<0.05, I²=56%), retinal sensitivity (WMD=-1.85, 95% Cl, -3.05–-0.65, P<0.01, I²=0) or NEI-VFQ25 score (WMD=-2.44, 95% Cl, -4.72–-0.16, P<0.05, I²=0). No serious side effects of SML treatment were observed.ConclusionAvailable evidence suggests that the clinical efficacy of SML therapy is similar to other treatment modalities for chronic CSC. However, because of the lack of serious side effects, SML may be the most promising alternative therapy for chronic CSC. The study protocol was registered on PROSPERO (CRD42021 258837).     

Topographical changes and bactericidal efficacy of antimicrobial photodynamic therapy on titanium implant surface

BackgroundreExtensive rsearch has been done on various disinfection modalities used to achieve an aseptic implant surface. However, the bacterial efficacy and the topographical alterations resulting from the use of these techniques have never been compared.ObjectiveThis study aimed to evaluate and compare the disinfection efficacy and surface changes on a bacteria contaminated titanium block following application of various disinfectants.MethodUltrasonically cleaned titanium blocks were contaminated with Porphyromonas gingivalis and Tannerella forsythia. The infected titanium implants were randomly divided into four experimental groups and decontaminated using antimicrobial photodynamic therapy (aPDT), laser therapy, chlorhexidine and hydrogen peroxide. Bacterial viability and surface changes following decontamination were analyzed.ResultBacterial viability decreased in all the groups, with aPDT having the highest reduction. Surface roughness remained unchanged whereas the contact angle lessened in the aPDT group. Conclusion: aPDT could possibly be a suitable alternative to other disinfection regimen to treat periimplantitis.     

Changes of microstructure of central serous chorioretinopathy on OCT and its relationship with prognosis

PurposeTo quantitatively evaluate the relationship between retinal microstructure and prognosis in patients with central serous chorioretinopathy(CSC) using optical coherence tomography(OCT).MethodsThree hundred and ninty-eight affected eyes of patients with central serous chorioretinopathy were included in this retrospective study. The OCT images of all patients were analyzed in baseline, and logistic regression analysis were performed with 11 independent variables, and subretinal fluid absorption in 3 months after therapy as dependent variable. The correlation between shortage of ellipsoid baseline and height of foveal subretinal fluid, width of foveal subretinal fluid were analyzed respectively. The difference of duration and baseline logMAR visual acuity in eyes with and without double layer sign or subretinal hyper-reflective materials were analyzed respectively. The difference of therapeutic outcome among different therapeutic methods was also analyzed in eyes with double-layer sign and subretinal hyper-reflective materials respectively.ResultsIn the regression analysis with subretinal fluid absorption in 3 months after therapy as dependent variable, disintegrity of ellipsoid zone was statistically significant(P<0.0001,B=1.288). There is no correlation between disintegrity of the ellipsoid zone and the width or height of subretinal fluid. The duration of disease in eyes with double layer sign or subretinal hyper-reflective materials was longer than those without these features(P<0.001, P<0.0001). In the eyes with the double-layer sign or subretinal hyper-reflective material, the difference of logMAR visual acuity 3 months after treatment between 2 therapeutic methods was not statistically significant.ConclusionsUsing optical coherence tomography to evaluate microstructure changes in eyes with central serous chorioretinopathy quantitatively, we found that subretinal fluid was easier to absorb completely in eyes with less disintegrity of ellipsoid zone. Double layer sign and subretinal hyper-reflective materials are more common in eyes with longer duration of disease.     

Therapeutic efficacy of adjunctive photodynamic therapy in the treatment of denture stomatitis

BackgroundThe present report assessed the efficacy of curcumin-mediated photodynamic therapy (CUR-mediated PDT) as an adjunct to antifungal gel treatment by evaluating the salivary interleukin-6 (IL-6) and matrix metalloproteinases-8 (MMP-8) levels together with Candida species counts in denture stomatitis (DS) patients.MethodsIn total, 50 DS subjects were randomly categorized into 2 groups: Group-1: subjects who received the antifungal gel treatment and Group-2: participants who received CUR-mediated PDT. The Sabourad Dextrose Agar and CHROMAgar were utilized for evaluating Candida species counts, while the Enzyme-Linked Immunosorbent Assay was employed to estimate the salivary levels of IL-6 and MMP-8. All clinical evaluations were performed at the baseline, 1 month, and 2 months.ResultsIn total, group-2 subjects showed a significant decrease in Candida albicans (C. albicans) counts on both follow-ups (i.e., 1-month and 2-month) than group-1 participants. C. krusei count also reduced in group-2 subejcts than group-1 participants at the 2nd follow-up as compared to the baseline, nevertheless, a slight increase in C. krusei count was noticed in group-2 subjects at the 2nd follow-up than the 1st follow-up. The salivary IL-6 and MMP-8 levels in both groups reduced significantly at both follow-ups than the baseline. According to the stepwise logistic regression analysis, no statistically significant correlation was observed between Candida species count and other parameters such as age and gender of the patient, duration of DS, and frequency of treatment(s).ConclusionCUR-mediated PDT is an efficaciousness therapeutic modality for alleviating Candida species counts on the surface of denture and the palatal mucosa, as well as improving the salivary IL-6 and MMP-8 levels in DS patients.     

光动力治疗恶性肿瘤27例临床疗效分析

目的：观察光动力疗法（PDT）治疗恶性肿瘤的临床疗效。方法：分析27例各种恶性肿瘤患者行PDT治疗或PDT结合手术内镜等治疗后的近期疗效。结果：27例恶性肿瘤PDT治疗后随访1～6个月，19例有不同程度改善，有效率为70．4％0；8例无应答，占29．6％；6例死亡，死因与PDT治疗无关。结论：PDT治疗恶性肿瘤有明显疗效，尤其是对晚期恶性肿瘤胸腹水的治疗效果更佳。     

Evaluating the efficacy of photodynamic therapy with indocyanine green in the treatment of keloid

BackgroundThis study aimed to evaluate the efficacy of photodynamic therapy (PDT) with topical indocyanine green (ICG) in the treatment of keloid lesions.MethodsIn this pilot study, fifteen keloids (6 lesions on the sternal area, 3 on the shoulders, 2 on the abdomen, 2 on the legs, and 2 on the forearms) were selected. To enhance drug penetration, pretreatment with CO2 laser was performed. Then Lesions were covered with 0.2% transfersomal ICG gel with 1 mm thickness and occluded with light-proof plastic nylon for 2 h. Afterward, it was wiped off and underwent photodynamic therapy with source LumaCare with 730 nm probe and fluence of 23 J/cm2 every week for 6 sessions. Patients were also assessed 6 and 12 weeks after the treatment for any recurrences. The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the scars.ResultsThe mean POSAS score significantly reduced by 23.69% from 46.86 at baseline to 35.76 at the 6th treatment session (P< 0.001). The mean scores of patient and observer overall opinion significantly decreased by 16.35% (P< 0.001) and 12.31% (P = 0.001) respectively. No side effects were observed during treatment and after 3 months of follow-ups. After discontinuation of therapy, the mean score of POSAS significantly increased by 13.77% to 40.80. (P = 0.001)ConclusionAccording to our study, ICG-PDT is an effective and safe treatment for keloid. However, due to the recurrence following discontinuation of treatment, further studies are needed.     

Effectiveness of antimicrobial photodynamic therapy as an adjunct to open flap debridement in patients with aggressive periodontitis

AimThe aim of the present clinical trial was to evaluate the clinical efficacy of photodynamic therapy (PDT) as an adjunct to open flap debridement (OFD) in the treatment of generalized aggressive periodontitis (GAP).Materials and methodsThe subjects recruited for the study were divided into two groups: ‘control group’ received treatment through OFD, whereas the test participants were treated with OFD and adjunctive PDT. The clinical periodontal parameters were plaque index (PI), full mouth probing depth (FMPD) and full mouth relative attachment loss (FMRA). The microbial levels of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannarella forsythia (Tf) were analyzed. All parameters were assessed at baseline and 3 months.Statistical analysisThe observed values for all the parameters were reported in mean and standard deviation (mean ± SD). In order to analyse the mean values and inter-group comparisons, the Mann-Whitney U test was employed. The p-value was set at <0.05 to establish a significant difference among the reported values.ResultsA statistically significant improvement for BOP was observed in PDT group in comparison to the control group at 3 months only (p < 0.05). A significant reduction in the microbiological levels for Aa, Pg and Tf in both the study groups was observed. However, no significant differences in microbial levels were observed at any time point when the control and test groups were compared to each other.ConclusionPDT in conjuction with OFD plays a significant role in reducing the microbial load and improving the clinical periodontal parameters in patients with GAP. Moreover, it is regarded as a safe treatment regimen as no side effects have been reported regarding its use in GAP.