Abstract
Purpose
To compare the efficacy of brolucizumab, half-dose PDT, and aflibercept in treating chronic central serous chorioretinopathy (CSC).
Methods
A retrospective cohort study with chronic CSC patients who underwent intravitreal injection of one shot of brolucizumab or aflibercept in the first 3 months, followed by pro re nata regimens or a single session of half-dose PDT, was retrospectively reviewed. The primary outcome measure was the proportion of eyes that achieved complete absorption of retinal fluid without requiring any rescue treatment. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and central choroidal thickness (CCT).
Results
A total of 54 consecutive patients were included in this study with 18 patients in each group. At months 1 and 2, the brolucizumab group exhibited the highest rate of complete retinal fluid resolution (61% and 77%), followed by the half-dose PDT group (56% and 72%), and lowest in the aflibercept group (28% and 33%), with statistically significant differences noted at month 2 (P = 0.012). The brolucizumab group also demonstrated the most significant reduction in CCT at months 1 and 2 among the three groups (P = 0.007 and 0.001). Recurrence of retinal fluid in the brolucizumab groups was predominantly observed at month 3. Conversely, the half-dose PDT group exhibited the most favorable anatomical results starting from month 3. Notably, mild vitritis was observed in one case from the brolucizumab group.
Conclusions
Single injection of brolucizumab demonstrates trends of faster regression of persistent residual retinal fluid, greater CCT and CRT decline, and matched BCVA compared to half-dose PDT in the short term.
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References
van Rijssen TJ, van Dijk EHC, Yzer S et al (2019) Central serous chorioretinopathy: towards an evidence-based treatment guideline. Prog Retin Eye Res 73:100770. https://doi.org/10.1016/j.preteyeres.2019.07.003
Gass JD (1967) Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol 63(Suppl):1–139
Marmor MF (1988) New hypotheses on the pathogenesis and treatment of serous retinal detachment. Graefes Arch Clin Exp Ophthalmol 1226:548–552. https://doi.org/10.1007/BF02169203
Cheung CMG, Lee WK, Koizumi H, Dansingani K, Lai TYY, Freund KB (2019) Pachychoroid disease. Eye (Lond) 33:14–33. https://doi.org/10.1038/s41433-018-0158-4
Daruich A, Matet A, Marchionno L, De Azevedo JD, Ambresin A, Mantel I, Behar-Cohen F (2017) Acute central serous chorioretinopathy: factors influencing episode duration. Retina 37:1905–1915. https://doi.org/10.1097/IAE.0000000000001443
Chen SN, Hwang JF, Tseng LF, Lin CJ (2008) Subthreshold diode micropulse photocoagulation for the treatment of chronic central serous chorioretinopathy with juxtafoveal leakage. Ophthalmology 115:2229–2234. https://doi.org/10.1016/j.ophtha.2008.08.026
You EL, Hébert M, Jin TS, Bourgault S, Caissie M, Tourville É, Chen J, Ordóñez-Mena J, Dirani A (2023) Comparing interventions for chronic central serous chorioretinopathy: a network meta-analysis. Surv Ophthalmol 68:601–614. https://doi.org/10.1016/j.survophthal.2023.03.001
van Dijk EHC, Feenstra HMA, Bjerager J, Grauslund J, Boon CJF, Subhi Y (2023) Comparative efficacy of treatments for chronic central serous chorioretinopathy: a systematic review with network meta-analyses. Acta Ophthalmol 101:140–159. https://doi.org/10.1111/aos.15263
Tseng CC, Chen SN (2015) Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy. Br J Ophthalmol 99:1070–1077. https://doi.org/10.1136/bjophthalmol-2014-305353
Lai FH, Ng DS, Bakthavatsalam M, Chan VC, Young AL, Luk FO, Tsang CW, Brelén ME (2016) A multicenter study on the long-term outcomes of half-dose photodynamic therapy in chronic central serous chorioretinopathy. Am J Ophthalmol 170:91–99. https://doi.org/10.1016/j.ajo.2016.07.026
Artunay O, Yuzbasioglu E, Rasier R, Sengul A, Bahcecioglu H (2010) Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study. Curr Eye Res 35:91–98. https://doi.org/10.3109/02713680903428306
Semeraro F, Romano MR, Danzi P, Morescalchi F, Costagliola C (2012) Intravitreal bevacizumab versus low-fluence photodynamic therapy for treatment of chronic central serous chorioretinopathy. Jpn J Ophthalmol 56:608–612. https://doi.org/10.1007/s10384-012-0162-3
Khanani AM, Brown DM, Jaffe GJ, Wykoff CC, Adiguzel E, Wong R, Meng X, Heier JS, Investigators MERLIN (2022) MERLIN: phase 3a, multicenter, randomized, double-masked trial of brolucizumab in participants with neovascular age-related macular degeneration and persistent retinal fluid. Ophthalmology 129:974–985. https://doi.org/10.1016/j.ophtha.2022.04.028
Mukai R, Matsumoto H, Nagai K, Akiyama H (2022) Comparison of the regressive effects of aflibercept and brolucizumab on pigment epithelial detachment. BMC Ophthalmol 22:387. https://doi.org/10.1186/s12886-022-02617-2
Dugel PU, Singh RP, Koh A, Ogura Y, Weissgerber G, Gedif K, Jaffe GJ, Tadayoni R, Schmidt-Erfurth U, Holz FG (2021) HAWK and HARRIER: ninety-six-week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology 128:89–99. https://doi.org/10.1016/j.ophtha.2020.06.028
Brown DM, Emanuelli A, Bandello F et al (2022) KESTREL and KITE: 52-week results from two phase III pivotal trials of brolucizumab for diabetic macular edema. Am J Ophthalmol 238:157–172. https://doi.org/10.1016/j.ajo.2022.01.004
Dugel PU, Jaffe GJ, Sallstig P, Warburton J, Weichselberger A, Wieland M, Singerman L (2017) Brolucizumab versus aflibercept in participants with neovascular age-related macular degeneration: a randomized trial. Ophthalmology 124:1296–1304. https://doi.org/10.1016/j.ophtha.2017.03.057
Liegl RG, Karcher H, Chetty-Mhlanga S, Igwe F, Freitas R (2023) The treatment patterns with brolucizumab in Germany (REALIZE) study: a retrospective cohort study based on longitudinal prescription data. Ophthalmol Ther 12:195–208. https://doi.org/10.1007/s40123-022-00596-7
Torres-Soriano ME, García-Aguirre G, Kon-Jara V, Ustariz-Gonzáles O, Abraham-Marín M, Ober MD, Quiroz-Mercado H (2008) A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports). Graefes Arch Clin Exp Ophthalmol 246:1235–1239. https://doi.org/10.1007/s00417-008-0856-x
Lim JW, Kim MU, Shin MC (2010) Aqueous humor and plasma levels of vascular endothelial growth factor and interleukin-8 in patients with central serous chorioretinopathy. Retina 30:1465–1471. https://doi.org/10.1097/IAE.0b013e3181d8e7fe
Pitcher JD 3rd, Witkin AJ, DeCroos FC, Ho AC (2015) A prospective pilot study of intravitreal aflibercept for the treatment of chronic central serous chorioretinopathy: the CONTAIN study. Br J Ophthalmol 99:848–852. https://doi.org/10.1136/bjophthalmol-2014-306018
Fukuda Y, Sakurada Y, Matsubara M, Hasebe Y, Sugiyama A, Kikushima W, Kashiwagi K (2021) Comparison of outcomes between 3 monthly brolucizumab and aflibercept injections for polypoidal choroidal vasculopathy. Biomedicines 9:1164. https://doi.org/10.3390/biomedicines9091164
Kitajima Y, Maruyama-Inoue M, Ikeda S, Ito A, Inoue T, Yanagi Y, Kadonosono K (2022) Short-term outcomes of switching to brolucizumab in Japanese patients with neovascular age-related macular degeneration. Jpn J Ophthalmol 66:511–517. https://doi.org/10.1007/s10384-022-00940-1
van Dijk EHC, Fauser S, Breukink MB et al (2018) Half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial. Ophthalmology 125:1547–1555. https://doi.org/10.1016/j.ophtha.2018.04.021
Ratanasukon M, Thongthong K, Bhurayanontachai P, Jirarattanasopa P (2013) Photoreceptor disruption in central serous chorioretinopathy treated by half-dose photodynamic therapy. Clin Ophthalmol 7:87–92. https://doi.org/10.2147/OPTH.S39584
Bae SH, Heo JW, Kim C, Kim TW, Lee JY, Song SJ, Park TK, Moon SW, Chung H (2011) A randomized pilot study of low-fluence photodynamic therapy versus intravitreal ranibizumab for chronic central serous chorioretinopathy. Am J Ophthalmol 152:784–92.e2. https://doi.org/10.1016/j.ajo.2011.04.008
Sirks MJ, van Dijk EHC, Rosenberg N et al (2022) Clinical impact of the worldwide shortage of verteporfin (Visudyne®) on ophthalmic care. Acta Ophthalmol 100:e1522–e1532. https://doi.org/10.1111/aos.15148
Karakus SH, Basarir B, Pinarci EY, Kirandi EU, Demirok A (2013) Long-term results of half-dose photodynamic therapy for chronic central serous chorioretinopathy with contrast sensitivity changes. Eye (Lond) 27:612–620. https://doi.org/10.1038/eye.2013.24
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the China Medical University Hospital Research Ethics Committee (CMUH111-REC1-192) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Huang, YT., Tien, PT., Chen, PY. et al. Comparative efficacy of brolucizumab, half-dose photodynamic therapy, and aflibercept in managing chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-024-06373-5
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DOI: https://doi.org/10.1007/s00417-024-06373-5