RCOphth Annual Congress 2026

Real-World Outcomes of Half-Dose Photodynamic Therapy for Central Serous Chorioretinopathy: A 7-Year Audit from a UK Tertiary Eye Unit

Muhammad Azzam1, Ahmad Samir Alfaar1, Nicholas Beare1,2, Michael Briggs1, Savita Madhusudhan1,2

1St Paul’s Eye Unit, Royal Liverpool University Hospital, United Kingdom

2Department of Eye and Vision Sciences, University of Liverpool, United Kingdom

Purpose

Treatment with photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSCR) is effective in approximately 80–85% of eyes¹ and is thought to act by inducing damage through free radical formation, primarily at the level of the choriocapillaris, resulting in choroidal vascular remodelling².

The aim of this audit is to evaluate real-world anatomical and functional outcomes following half-dose verteporfin PDT for CSCR, and to assess service performance in order to identify opportunities for optimising patient care and future PDT service delivery.

Methods

A retrospective single-centre audit was conducted of all patients diagnosed with chronic CSCR and treated with half-dose verteporfin PDT at St Paul’s Eye Unit, Royal Liverpool University Hospital, between 2017–2023. Electronic patient records (mediSIGHT) and multimodal imaging (OCT, FAF, and FFA/ICGA) were reviewed.

The treatment cohort included patients who received at least one PDT session and had a minimum of one documented follow-up visit. Exclusion criteria were PDT for non-CSCR indications (e.g., PCV, nAMD), macular neovascularisation secondary to CSCR at baseline, or absence of post-PDT follow-up.

All PDT treatments were delivered using half-dose verteporfin, with treatment planning guided by FFA and/or ICGA. For each treated eye, best-recorded visual acuity (logMAR), subretinal fluid (SRF) status, and central subfield thickness (CST) on macular OCT were recorded at baseline, first follow-up (4–8 weeks), and 6–12 months post-treatment.

The primary outcome was complete SRF resolution. Secondary outcomes included CST change and visual acuity change. Meaningful CST response was defined as ≥20% or ≥50 µm reduction in CST compared with baseline.

Results

Demographics and baseline characteristics

•A total of 102 eyes from 92 patients were included (75% male; mean age 52.4 years [range 18–96])

•A fifth of patients (21%) received bilateral treatment

•Treatment was repeated in 15% of eyes within the first year

•Based on FA/ICGA findings, CSCR at baseline was classified as unifocal or multifocal (Fig. 1)

Results

Anatomical response

a. SRF Resolution:

•Total SRF resolution occurred in 72% of eyes at the first follow-up visit (Fig. 2a)

•At the 6–12-month follow-up interval, 68% maintained complete SRF resolution, (increasing to 78% when excluding lost-to-follow-up cases) (Fig. 2b)

b. CST Improvement:

•Mean CST decreased from 367.2 µm at baseline to 269.9 µm at first follow-up (–97.3 µm; –26.5%) (Fig. 3)

•A further reduction to 253.7 µm was observed at 6–12 months (–113.5 µm; –30.9% from baseline) (Fig. 3)

•Meaningful CST improvement was seen in 69% of eyes at first follow-up and 73.5% at long-term follow-up

•CST worsening occurred in 17.6% early and ~15% at long-term follow-up

Visual outcomes

•Mean logMAR improved from 0.35 at baseline to 0.27 (+4 ETDRS letters) at first follow-up, and to 0.23 (+6 letters) at 6–12 months

•At first follow-up, 45% of eyes gained ≥5 letters, 27.5% gained ≥10 letters, and 9.8% gained ≥15 letters. Loss of ≥5 letters occurred in 9.8% of eyes (Fig. 4a)

•At 6–12 months, 55.9% of eyes gained ≥5 letters, 38.2% gained ≥10 letters, and 20.6% gained ≥15 letters. Loss of ≥5 letters occurred in only 6.9% of eyes (Fig. 4b)

Discussions

•Early SRF resolution rates exceeded the early anatomical success reported in the PLACE Trial (51.2%)³. Long-term outcomes (68–78%) were closely aligned with the trial’s reported 67.2%.

•Letter gain categories demonstrated progressively improving outcomes.

Conclusions

•

•Half-dose PDT demonstrated robust and durable anatomical and functional benefits in this real-world CSCR cohort. Anatomical success rates were comparable to, or exceeded, those reported in major clinical trials.³ Visual acuity improved steadily over time, with low rates of vision loss or anatomical worsening.

•These findings support half-dose PDT as an effective, durable, and safe treatment for chronic CSCR, and highlight the need for strengthened PDT service capacity, improved follow-up pathways, and structured triage processes to meet future clinical demand.

References

1.Chhablani J, Anantharaman G, Behar-Cohen F, Boon C, Manayath G, Singh R. Management of central serous chorioretinopathy: Expert panel discussion. Indian J Ophthalmol. 2018 Dec;66(12):1700-1703.

2.Schmidt-Erfurth U, Hasan T. Mechanisms of action of photodynamic therapy with verteporfin for the treatment of age-related macular degeneration. Surv Ophthalmol. 2000 Nov-Dec;45(3):195-214. doi: 10.1016/s0039-6257(00)00158-2. PMID: 11094244.

3.van Dijk EHC, Fauser S, Breukink MB, Blanco-Garavito R, Groenewoud JMM, Keunen JEE, et al. Half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial. Ophthalmology. 2018;125(10):1547–1555. doi:10.1016/j.ophtha.2018.04.021.

RCOphth Annual Congress 2026

Real-World Outcomes of Half-Dose Photodynamic Therapy for Central Serous Chorioretinopathy: A 7-Year Audit from a UK Tertiary Eye Unit

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