OFTATALKS ONE (Part I) - Clinical cases on CSC - Prof. Massimo Nicolò

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This document appears to be a presentation on clinical cases involving central serous chorioretinopathy (CSC). It describes 5 cases where patients presented with CSC and were treated with either focal laser photocoagulation, half-dose photodynamic therapy (PDT), or a combination. For each case, it provides details on the patient's symptoms, visual acuity measurements, imaging findings, type of treatment administered, and outcomes over time ranging from 1 month to 8 years post-treatment. The presentation concludes with sections on breakthroughs in CSC pathogenesis and research evaluating the safety and efficacy of half-dose PDT for treating both acute and chronic CSC.

Health & Medicine

Clinica Oculistica - Di.N.O.G.M.I.
Università di Genova
Direttore: Professor Carlo E. Traverso
IRCCS Policlinico San Martino
Clinica Oculistica - Di.N.O.G.M.I.
Università di Genova
Direttore: Professor Carlo E. Traverso
IRCCS Policlinico San Martino
Clinica Oculistica - Di.N.O.G.M.I.
Università di Genova
Direttore: Professor Carlo E. Traverso
IRCCS Policlinico San Martino
Massimo Nicolò
From the Retina Medical Center
Clinica Oculistica, Di.N.O.G.Mi. – Università di Genova - Ospedale Policlinico San Martino IRCCS
Direttore: Prof. C.E. Traverso
Clinical Cases on Central Serous Chorioretinopathy – PART I

Central Serous Chorioretinopathy
Increased fluid under the neuroepitethelium - Acute CSC
First episode, no history of steroids, no RPE decompensation
Sep. 15th 2018
Jan. 21th 2019
Case 1
VA 20/25

Mar. 1st 2019
Complete resolution of subretinal fluid
Case 1 Central Serous Chorioretinopathy
VA 20/20

Central Serous Chorioretinopathy
Jan. 27th 2020
Complete resolution of subretinal fluid
Case 1
Complete resolution of subretinal fluid
VA 20/20

Central Serous Chorioretinopathy
• Male
• Ankylosing Spondylitis
• steroid treatment
• Visus 8/10
17 Sep. 2013
ICGFA
FA
Case 2

Central Serous Chorioretinopathy
• Male
• Ankylosing Spondylitis
• steroid treatment
• Visus 8/10
17 Sep. 2013
Focal Light Laser Photocoagulation
ICGFA
FA
Case 2

Central Serous Chorioretinopathy
1 month - Visus 9/10
2 months – Visus 10/10
4 years– Visus 10/10
Case 2

Central Serous Chorioretinopathy
04 Oct.
2017
Recurrence 5 years later.
Performed second FC laser
Case 2

Central Serous Chorioretinopathy
04 Dec. 2017
06 Nov. 2018
Case 2

July 3rd 2009
Case 3 Central Serous Chorioretinopathy

FC laser
July 3rd 2009
Case 3 Central Serous Chorioretinopathy

1 month after FC laserJuly 27th 2009
Case 3 Central Serous Chorioretinopathy

2 months after FC laser
Sep. 14th 2009
Case 3 Central Serous Chorioretinopathy

Sep 30th 2009
Case 3
Recurrence 3 months after FC laser
Central Serous Chorioretinopathy

Sep 30th 2009
Case 3
Recurrence 3 months after FC laser
ICG
Central Serous Chorioretinopathy

ICG-GUIDED PDT in CSC TREATMENT
ICG-guided PDT on areas of choroidal
vascular hyperpermeability at or close to
RPE decompensation
TREATMENT

Central Serous Chorioretinopathy
Breakthrough in the Pathogenesis of CSC

0
10
20
30
40
PDT and CSC
333 paper in 16 years - Mean: 20
38 nel 2015
Year 2003-2019
Photodynamic Therapy with Verteporfin
Retina – June 2003
Retina – December 2003
BJO – March 2003
19 nel 2019

Cardillo Piccolino F. et al. Retina 2003;23:752–63.
Yannuzzi LA et al. Retina 2003;23:288–98.
Chan WM. Br J Ophthalmol 2003;87:1453–8.
Adverse avents:
•RPE atrophy
•CNV
•VA decrease
Clinical and electrophisiological studies showed a transitory
decrease in macular function after PDT
Standard PDT and CSC

Minimizing side effects of verteporfin
halving the dose
Modified PDT dosage and CSC
3 mg/m
2
- 50 J/cm
2
- 600 mW/cm
2
- 83 sec.

6 mg/m
2
- 25J/cm
2
– 300 mW/cm
2
– 83 sec.
Minimizing side effects of verteporfin
halving the fluence
Modified PDT dosage and CSC

• PDT a mezza dose è superiore al laser micropulsato
nell’indurre il riassorbimento del fluido
• PDT a mezza dose è sicura
2018

Oct. 1st 2009 half-dose PDT on choroidal hyperpermeability areas
Sep 30th 2009
Case 3
Recurrence 3 months after FC laser
Central Serous Chorioretinopathy

2 months after half-dose PDTNov. 30th 2009
Case 3 Central Serous Chorioretinopathy

8 years after half-dose PDT
Mar. 6th 2018
Case 3 Central Serous Chorioretinopathy

Nov. 3th 2009
Case 4 Central Serous Chorioretinopathy

PDT
a dosaggio dimezzato
nella CSC cronica
Nov. 3th 2009
Case 4 Central Serous Chorioretinopathy

Half-Dose PDT performed
on Nov. 12th 2009
Nov. 3th 2009
Case 4 Central Serous Chorioretinopathy

1 month post half-dose PDT
Dec. 15th 2009
Case 4 Central Serous Chorioretinopathy

Oct. 11th 2016
Case 4 Central Serous Chorioretinopathy
7 years post half-dose PDT

1 month post Half dose PDT in chronic CSCCase 5

3 months post Half dose PDT in chronic CSCCase 5

24 months post Half dose PDT in chronic CSCCase 5

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OFTATALKS ONE (Part I) - Clinical cases on CSC - Prof. Massimo Nicolò

1. Clinica Oculistica - Di.N.O.G.M.I. Università di Genova Direttore: Professor Carlo E. Traverso IRCCS Policlinico San Martino Clinica Oculistica - Di.N.O.G.M.I. Università di Genova Direttore: Professor Carlo E. Traverso IRCCS Policlinico San Martino Clinica Oculistica - Di.N.O.G.M.I. Università di Genova Direttore: Professor Carlo E. Traverso IRCCS Policlinico San Martino Massimo Nicolò From the Retina Medical Center Clinica Oculistica, Di.N.O.G.Mi. – Università di Genova - Ospedale Policlinico San Martino IRCCS Direttore: Prof. C.E. Traverso Clinical Cases on Central Serous Chorioretinopathy – PART I

2. Central Serous Chorioretinopathy Increased fluid under the neuroepitethelium - Acute CSC First episode, no history of steroids, no RPE decompensation Sep. 15th 2018 Jan. 21th 2019 Case 1 VA 20/25

3. Central Serous Chorioretinopathy Increased fluid under the neuroepitethelium - Acute CSC First episode, no history of steroids, no RPE decompensation Sep. 15th 2018 Small RPD detach. Jan. 21th 2019 Case 1 VA 20/25

4. Central Serous Chorioretinopathy Increased fluid under the neuroepitethelium - Acute CSC First episode, no history of steroids, no RPE decompensation Jan. 21th 2019 Small RPD detach. Case 1 VA 20/25

5. Central Serous Chorioretinopathy Increased fluid under the neuroepitethelium - Acute CSC First episode, no history of steroids, no RPE decompensation Jan. 21th 2019 Small RPD detach. Jan. 23rd 2019 Focal laser (577 nm) Case 1 VA 20/25

6. Mar. 1st 2019 Complete resolution of subretinal fluid Case 1 Central Serous Chorioretinopathy VA 20/20

7. Central Serous Chorioretinopathy Jan. 27th 2020 Complete resolution of subretinal fluid Case 1 Complete resolution of subretinal fluid VA 20/20

8. Central Serous Chorioretinopathy • Male • Ankylosing Spondylitis • steroid treatment • Visus 8/10 17 Sep. 2013 ICGFA FA Case 2

9. Central Serous Chorioretinopathy • Male • Ankylosing Spondylitis • steroid treatment • Visus 8/10 17 Sep. 2013 Focal Light Laser Photocoagulation ICGFA FA Case 2

10. Central Serous Chorioretinopathy 1 month - Visus 9/10 2 months – Visus 10/10 4 years– Visus 10/10 Case 2

11. Central Serous Chorioretinopathy 04 Oct. 2017 Recurrence 5 years later. Performed second FC laser Case 2

12. Central Serous Chorioretinopathy 04 Dec. 2017 06 Nov. 2018 Case 2

13. July 3rd 2009 Case 3 Central Serous Chorioretinopathy

14. July 3rd 2009 Case 3 Central Serous Chorioretinopathy

15. FC laser July 3rd 2009 Case 3 Central Serous Chorioretinopathy

16. 1 month after FC laserJuly 27th 2009 Case 3 Central Serous Chorioretinopathy

17. 2 months after FC laser Sep. 14th 2009 Case 3 Central Serous Chorioretinopathy

18. Sep 30th 2009 Case 3 Recurrence 3 months after FC laser Central Serous Chorioretinopathy

19. Sep 30th 2009 Case 3 Recurrence 3 months after FC laser ICG Central Serous Chorioretinopathy

20. ICG-GUIDED PDT in CSC TREATMENT ICG-guided PDT on areas of choroidal vascular hyperpermeability at or close to RPE decompensation TREATMENT

21. Central Serous Chorioretinopathy Breakthrough in the Pathogenesis of CSC

22. 0 10 20 30 40 PDT and CSC 333 paper in 16 years - Mean: 20 38 nel 2015 Year 2003-2019 Photodynamic Therapy with Verteporfin Retina – June 2003 Retina – December 2003 BJO – March 2003 19 nel 2019

23. Cardillo Piccolino F. et al. Retina 2003;23:752–63. Yannuzzi LA et al. Retina 2003;23:288–98. Chan WM. Br J Ophthalmol 2003;87:1453–8. Adverse avents: •RPE atrophy •CNV •VA decrease Clinical and electrophisiological studies showed a transitory decrease in macular function after PDT Standard PDT and CSC

24. Minimizing side effects of verteporfin halving the dose Modified PDT dosage and CSC 3 mg/m 2 - 50 J/cm 2 - 600 mW/cm 2 - 83 sec.

25. 6 mg/m 2 - 25J/cm 2 – 300 mW/cm 2 – 83 sec. Minimizing side effects of verteporfin halving the fluence Modified PDT dosage and CSC

26.

27. • PDT a mezza dose è superiore al laser micropulsato nell’indurre il riassorbimento del fluido • PDT a mezza dose è sicura 2018

28. Oct. 1st 2009 half-dose PDT on choroidal hyperpermeability areas Sep 30th 2009 Case 3 Recurrence 3 months after FC laser Central Serous Chorioretinopathy

29. 2 months after half-dose PDTNov. 30th 2009 Case 3 Central Serous Chorioretinopathy

30. 8 years after half-dose PDT Mar. 6th 2018 Case 3 Central Serous Chorioretinopathy

31. Nov. 3th 2009 Case 4 Central Serous Chorioretinopathy

32. PDT a dosaggio dimezzato nella CSC cronica Nov. 3th 2009 Case 4 Central Serous Chorioretinopathy

33. Half-Dose PDT performed on Nov. 12th 2009 Nov. 3th 2009 Case 4 Central Serous Chorioretinopathy

34. 1 month post half-dose PDT Dec. 15th 2009 Case 4 Central Serous Chorioretinopathy

35. Oct. 11th 2016 Case 4 Central Serous Chorioretinopathy 7 years post half-dose PDT

36. chronic CSC 14 Apr. 2009 Case 5

37. chronic CSC Case 5

38. 1 month post Half dose PDT in chronic CSCCase 5

39. 3 months post Half dose PDT in chronic CSCCase 5

40. 24 months post Half dose PDT in chronic CSCCase 5

OFTATALKS ONE (Part I) - Clinical cases on CSC - Prof. Massimo Nicolò

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OFTATALKS ONE (Part I) - Clinical cases on CSC - Prof. Massimo Nicolò