Efficacy of reduced-fluence photodynamic therapy for serous retinal pigment epithelial detachment with choroidal hyperpermeability
The patient was a 38-year-old woman. She had been attending hospital for 15 months, with principal complaints of reduced visual acuity and distorted vision in the right eye. On initial examination, log of the minimum angle of resolution (log-MAR) best-corrected visual acuity (BCVA) of the right eye was 0.1. The images of FA, ICGA, and OCT are described in . No serous retinal detachment was evident on OCT images, which showed PED of half the disc diameter in the subfovea, including the fovea, and continuity of the inner and outer segments (IS/OS) line was unclear. FA showed hyperfluorescence in the early phase of contrast enhancement in the same location as the PED, and ICGA revealed hyperfluorescence in the mid-phase and late-phase of contrast enhancement in the same location as the PED, as well as hyperpermeability of the choroidal vessels in the surrounding area, resulting in a diagnosis of ISPED. In ICGA, no polypoidal lesion or branching vascular network, which is diagnostically seen in polypoidal choroidal vasculopathy, were observed. Because the PED had not improved, RFPDT (spot size: 5,400 μm) was performed 16 months after onset. The PED was seen to have completely disappeared 1 month after RFPDT. Continuity of the IS/OS line was restored on the OCT images, and logMAR BCVA improved to −0.1 with symptomatic improvement of the distorted vision. Visual acuity was maintained at 12 months posttreatment, with no recurrence of PED. No adverse events were seen in this case during follow-up after RFPDT.