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

PURPOSE: 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. DESIGN: Prospective, randomized, single-center pilot study. METHODS: 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. RESULTS: At 3 months, the mean excess foveal thickness was reduced from 74.1 +/- 56.0 mu m to -35.4 +/- 44.5 pm in the low-fluence PDT group (P = .017) and from 26.3 +/- 50.6 mu m to -23.1 +/- 56.5 mu m 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. CONCLUSIONS: In terms of anatomic outcomes, the effect of ranibizumab injections was not promising compared with that of low-fluence PDT. (Am J Ophthalmol 2011;152:784-792. (C) 2011 by Elsevier Inc. All rights reserved.)