Photodynamic therapy in combination with intravitreal ziv-aflibercept and aflibercept injection in patients with chronic or repeatedly recurrent acute central serous chorioretinopathy: a single-center retrospective study

Figures & data

Table 1 Baseline characteristics

Baseline characteristics						ETDRS BCVA		OCT measurements, sSRF/mSRF (μm)
Patient ID	Gender	Age (years)	Eye	Risk factors	Duration of CSC before ZivA-PDT	Baseline	At 6 months	Baseline	At 6 months
1	M	58	OD	CS	>4 years	40	40	193/262	0/0
2	F	52	OD	HT	9 months	75	85	144/149	0/48
3	M	42	OD	S	9 months	80	85	344/366	0/5
4	M	42	OS		1 year*	85	MD	37/107	MD
5	M	68	OD	CS, HT	4 months	60	80	311/327	0/0
6	M	53	OD	HT	8 months	75	MD	234/324	MD
7	M	40	OD	S	1.5 years	70	35	115/233	84/144
8	M	69	OD		6 years	55	70	282/282	112/112
9	M	46	OS	CS, HT	5.5 years	85	85	200/200	0/68
10	M	53	OS	CS	1.5 years	65	85	162/212	0/178
11	M	47	OD		6 months	75	MD	301/301	MD
12	F	67	OD	CS	>3 years	5	MD	184/185	MD
13	M	48	OS		>4.5 years	65	70	199/231	231/240
14	M	51	OD		3.5 years	70	70	316/322	106/107
15	M	64	OS	HT	>4 years	75	75	251/252	177/177
16	M	46	OS	HT	1.5 years	65	75	75/79	14/14
17	M	40	OS		>2.5 years	85	85	100/100	0/117
18	F	61	OD		>1 years	80	75	250/250	30/39
Mean/summary	15 M/3 F	52.6	11 OD/7 OS	6× HT/5× CS 2× S	>28.5 months	67.2	75.0	205/232	54/78
±SD		9.8			>20.0 months	18.8	15.4	86/81	74/72

Note:

* Bilateral CSC, diagnosis for 1 year, but symptoms of the treated eye for just 1 month.

Abbreviations: BCVA, best corrected visual acuity; CS, corticosteroids; CSC, central serous chorioretinopathy; ETDRS, Early Treatment Diabetic Retinopathy Study; F, female; HT, hypertension; M, male; MD, missing data; mSRF, maximum subretinal fluid; OCT, optical coherence tomography; OD, right eye; OS, left eye; PDT, photodynamic therapy; S, stress; SD, standard deviation; sSRF, subfoveal subretinal fluid; ZivA, ziv-aflibercept and aflibercept.

Table 2 Treatment

Patient ID	Treatment before ZivA-PDT	Treatment during 1st month after ZivA-PDT	Treatment till 3rd month after ZivA-PDT	Treatment till 6th month after ZivA-PDT
1	Acetazolamide, nepafenac	Eplerenone	Eplerenone	Eplerenone, 1× zivafl, 1× HD-PDT
2	Horse chestnut dry extract, acetazolamide, nepafenac, eplerenone	1× zivafl	1× zivafl	1× FD-PDT
3	Acetazolamide, eplerenone	Melatonin	Spironolactone, 1× zivafl, FD-PDT
4
5	Eplerenone
6
7	Acetazolamide, nepafenac, melatonin			1× zivafl
8	Eplerenone		1× zivafl	1× FD-PDT, 2× zivafl
9	Eplerenone
10	Acetazolamide, nepafenac, eplerenone	Eplerenone	1× zivafl	2× zivafl, 1× HD-PDT
11	Nepafenac, eplerenone		1× zivafl	Rifampicin 1× zivafl, 1× HD-PDT
12	3× bevacizumab
13	Acetazolamide, eplerenone, 2× zivafl, 1× HD-PDT		1× afl	Eplerenone 1× afl
14	Acetazolamide, nepafenac, eplerenone 2× HD-PDT			1× zivafl
15	Acetazolamide, 1× HD-PDT
16	Acetazolamide, 2× zivafl
17	Eplerenone, 1× HD-PDT			1× zivafl
18	Acetazolamide, eplerenone, nepafenac, 2× zivafl		Spironolactone 1× zivafl	1× FD-PDT
Summary	15× medication	3× medication	3× medication	3× medication
	9× intravitreal injection	1× injection	7× injection	9× injection
	5× HD-PDT		1× FD-PDT	3× HD-PDT, 3× FD-PDT

Note: Blank spaces in the table indicate either no treatment before ZivA-PDT or data not available.

Abbreviations: afl, aflibercept; FD, full-dose; HD, half-dose; PDT, photodynamic therapy; ZivA, ziv-aflibercept and aflibercept; zivafl, ziv-aflibercept.

Table 3 ETDRS

BCVA (by ETDRS)	Median ETDRS	Interquartile range	Significance
Before treatment	72.50	65.00, 78.75
1 month after PDT	75.00	67.50, 83.50
3 months after PDT	72.50	65.00, 85.00
6 months after PDT	75.00	70.00, 85.00	0.065#

Notes: p-value, comparison with before treatment.

# Continuity for the distribution of the paired differences was not given, and therefore a sign test was performed.

Abbreviations: BCVA, best corrected visual acuity; ETDRS, Early Treatment Diabetic Retinopathy Study; PDT, photodynamic therapy.

Figure 1 ETDRS BCVA.

Notes: Boxplots show median, first and third quartile, upper/lower whisker extends from the hinge to the largest/smallest value no further than 1.5×IQR from the hinge. Dots indicate individual values.
Abbreviations: BCVA, best corrected visual acuity; ETDRS, Early Treatment Diabetic Retinopathy Study; IQR, interquartile range; PDT, photodynamic therapy; ZivA, ziv-aflibercept and aflibercept.

Table 4 sSRF

	Mean sSRF (μm)	SD	Significance
sSRF before treatment	205.19	88.45
sSRF after injection, before PDT	161.56	94.77	0.002#
sSRF 1 month after PDT	90.53	88.24	<0.001
sSRF 3 months after PDT	134.97	104.55	0.008
sSRF 6 months after PDT	53.79	76.50	<0.001

Notes: p-value, comparison with before treatment.

# Paired differences were not normally distributed, and therefore an exact Wilcoxon signed-rank test was performed.

Abbreviations: PDT, photodynamic therapy; SD, standard deviation; sSRF, subfoveal subretinal fluid.

Figure 2 Subfoveal SRF.

Notes: Boxplots show median, first and third quartile, upper/lower whisker extends from the hinge to the largest/smallest value no further than 1.5×IQR from the hinge. Dots indicate individual values.
Abbreviations: IQR, interquartile range; PDT, photodynamic therapy; SRF, subretinal fluid; ZivA, ziv-aflibercept and aflibercept.

Table 5 mSRF

	Mean mSRF (μm)	SD	Significance
mSRF before treatment	232.17	83.77
mSRF after injection, before PDT	179.39	84.34	<0.001#
mSRF 1 month after PDT	106.80	90.80	<0.001
mSRF 3 months after PDT	143.06	97.97	0.002
mSRF 6 months after PDT	77.54	74.21	<0.001

Notes: p-value, comparison with before treatment.

# Paired differences were not normally distributed, and therefore an exact Wilcoxon signed-rank test was performed.

Abbreviations: mSRF, maximum subretinal fluid; PDT, photodynamic therapy; SD, standard deviation.

Figure 3 Maximum SRF.

Notes: Boxplots show median, first and third quartile, upper/lower whisker extends from the hinge to the largest/smallest value no further than 1.5×IQR from the hinge. Dots indicate individual values.
Abbreviations: IQR, interquartile range; PDT, photodynamic therapy; SRF, subretinal fluid; ZivA, ziv-aflibercept and aflibercept.