Fluorescein Versus Indocyanine Green Angiography- Guided Primary Photodynamic Therapy for Treatment of Central Serous Chorioretinopathy: A Systematic Review with Meta-Analysis

Authors

  • André Ferreira Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine of University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal https://orcid.org/0000-0001-8577-5128
  • Beatriz Costa Vieira Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal
  • Rafael José Vieira Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal https://orcid.org/0000-0003-1834-3055
  • Ana Marta Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal; ICBAS – Instituto de Ciência Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal https://orcid.org/0000-0003-3495-4649
  • Ana Carolina Abreu Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal; ICBAS – Instituto de Ciência Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal https://orcid.org/0000-0003-4842-8623
  • Tânia Borges Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal
  • Miguel Lume Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal https://orcid.org/0000-0002-8629-1288
  • Maria João Furtado Department of Ophthalmology, Unidade Local de Saúde de Santo António, Porto, Portugal; ICBAS – Instituto de Ciência Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal https://orcid.org/0000-0003-2319-105X

DOI:

https://doi.org/10.48560/rspo.42414

Keywords:

Angiography, Choroid, Central serous chorioretinopathy, Fluorescein angiography, Indocyanine green angiography, Photodynamic therapy

Abstract

INTRODUCTION: We aimed to systematically review the evidence comparing the use of fluorescein angiography (FA) versus indocyanine green angiography (ICGA) as a guide to primary photodynamic therapy (PDT) for central serous chorioretinopathy (CSC).

METHODS: PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for all relevant studies published from inception to May 26th, 2024. Studies comparing the clinical outcomes of primary PDT guided by FA versus ICGA for eyes with chronic CSC were included. Main outcomes were best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and subretinal fluid (SRF) resolution. A meta-analysis was performed using a random-effects model.

RESULTS: Of 451 abstracts, 3 were found eligible, enrolling 179 eyes of 170 CSC patients treated with PDT, 82 of which were guided by FA and 97 by ICGA. In all studies, BCVA improved and CMT and SCFT reduced with PDT, regardless of the angiography used as reference, when compared with baseline. The meta-analysis revealed no significant difference between FA versus ICGA-guided PDT in BCVA (MD -0.01 [-0.07, 0.05] logMAR, p = 0.71), CMT (MD -5.76 [-43.67, 32.15] μm, p = 0.77) and SFCT (MD 16.00 [-8.81, 40.82] μm, p = 0.21) changes. Complete SRF resolution in the last follow-up visit was noticed in 70% – 100% of patients (83.3% – 100% for FA versus 70.8% – 100% for ICGA).

CONCLUSION: The evidence produced so far suggests that FA and ICGA-guided half-dose PDT are similarly effective and safe in treating chronic CSC.

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References

1. Cheung CMG, Lee WK, Koizumi H, Dansingani K, Lai TYY, Freund KB. Pachychoroid disease. Eye (Lond). 2019;33(1):14-33.

2. Spaide RF, Campeas L, Haas A, Yannuzzi LA, Fisher YL, Guyer DR, et al. Central serous chorioretinopathy in younger and older adults. Ophthalmology. 1996;103(12):2070-9; discussion 9-80.

3. Borooah S, Sim PY, Phatak S, Moraes G, Wu CY, Cheung CMG, et al. Pachychoroid spectrum disease. Acta Ophthalmol. 2021;99(6):e806-e22.

4. Prunte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol. 1996;121(1):26-34.

5. Iida T, Kishi S, Hagimura N, Shimizu K. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy. Retina. 1999;19(6):508-12.

6. Guyer DR, Yannuzzi LA, Slakter JS, Sorenson JA, Ho A, Orlock D. Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol. 1994;112(8):1057-62.

7. Gupta A, Tripathy K. Central Serous Chorioretinopathy. StatPearls [Internet]. 2024. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32644399.

8. Siaudvytyte L, Diliene V, Miniauskiene G, Balciuniene VJ. Photodynamic therapy and central serous chorioretinopathy. Med Hypothesis Discov Innov Ophthalmol. 2012;1(4):67-71.

9. Isola V, Pece A, Parodi MB. Choroidal ischemia after photodynamic therapy with verteporfin for choroidal neovascularization. Am J Ophthalmol. 2006;142(4):680-3.

10. 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):1547-55.

11. van Rijssen TJ, van Dijk EHC, Tsonaka R, Feenstra HMA, Dijkman G, Peters PJH, et al. Half-Dose Photodynamic Therapy Versus Eplerenone in Chronic Central Serous Chorioretinopathy (SPECTRA): A Randomized Controlled Trial. Am J Ophthalmol. 2022;233:101-10.

12. Liu HY, Yang CH, Yang CM, Ho TC, Lin CP, Hsieh YT. Half-dose Versus Half-time Photodynamic Therapy for Central Serous Chorioretinopathy. Am J Ophthalmol. 2016;167:57-64.

13. Ladas ID, Andreanos KD, Ladas DS, Moschos MM, Rotsos T, Kotsolis AI. Three-Year Results of Fluorescein Angiography-Guided Standard Photodynamic Therapy with Multiple Spots for Central Serous Chorioretinopathy. Ophthalmol Retina. 2018;2(7):703-11.

14. Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Kabadayi K. Comparison of half-dose versus half-fluence versus standard photodynamic therapy in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther. 2021;33:102081.

15. Hayashida M, Miki A, Honda S, Nakamura M. Comparison between the outcomes of fluorescein angiography-guided and indocyanine green angiography-guided half-time photodynamic therapy for central serous chorioretinopathy. Photodiagnosis Photodyn Ther. 2020;31:101955.

16. Ebrahimiadib N, Mirzaei A, Esfandiarifard S, Tuli S, Najibzadeh E, Imani Fooladi M, et al. Comparison of the fluorescein angiography-guided and indocyanine green angiography-guided photodynamic therapy in the treatment of non-resolving central serous chorioretinopathy. Sci Rep. 2023;13(1):1682.

17. Moodi F, Naseripour M, Zand A, Mirshahi R, Moodi V, Amirpooya Alemzadeh S, et al. Fluorescein versus Indocyanine Green Angiography Guided Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy. J Ophthalmic Vis Res. 2024;19(1):12-7.

18. Koytak A, Bayraktar H, Ozdemir H. Fluorescein angiography as a primary guide for reduced-fluence photodynamic therapy for the treatment of chronic central serous chorioretinopathy. Int Ophthalmol. 2020;40(7):1807-13.

19. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006-12.

20. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.

21. Higgins J, Li T, Deeks JJ (editors). Chapter 6: Choosing effect measures and computing estimates of effect. 2023. In: Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. (editors), Cochrane Handbook for Systematic Reviews of Interventions version 64 (updated August 2023). Cochrane, 2023. Available from: www.training.cochrane.org/handbook.

22. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58.

23. Deeks JJ, Higgins JP, Altman DG, Group CSM. Analysing data and undertaking meta‐analyses. Cochrane handbook for systematic reviews of interventions. 2019:241-84.

24. Sterne JA, Egger M, Moher D. Addressing reporting biases. Cochrane handbook for systematic reviews of interventions: Cochrane book series. 2008:297-333.

25. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

26. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Research Synthesis Methods. 2020;n/a(n/a).

27. Kianersi F, Masjedi M, Razmjoo H, Ghanbari H, Fazel F, Dehghani A, et al. Comparison of Indocyanine Green Angiography and Fluorescein Angiography for Imaging of Central Serous Chorioretinopathy Patients as Candidates for Photodynamic Therapy. J Fr Ophtalmol. 2022;45(3):338-43.

28. Chen SN, Hwang JF, Tseng LF, Lin CJ. Subthreshold diode micropulse photocoagulation for the treatment of chronic central serous chorioretinopathy with juxtafoveal leakage. Ophthalmology. 2008;115(12):2229-34.

29. Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology. 2008;115(10):1756-65.

30. Tsai MJ, Hsieh YT. Half-time photodynamic therapy for central serous chorioretinopathy. Optom Vis Sci. 2014;91(9):1140-5.

31. Chan WM, Lam DS, Lai TY, Tam BS, Liu DT, Chan CK. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003;87(12):1453-8.

32. Matsumoto H, Hoshino J, Nakamura K, Kishi S, Akiyama H. Attenuation of irradiated choroid and its regional vortex veins in central serous chorioretinopathy after photodynamic therapy. Sci Rep. 2023;13(1):19903.

33. Nishigori N, Muraoka Y, Ishikura M, Kogo T, Ueda-Arakawa N, Miyata M, et al. Extensive reduction in choroidal thickness after photodynamic therapy in eyes with central serous chorioretinopathy. Sci Rep. 2023;13(1):10890.

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Published

2026-03-19

How to Cite

Ferreira, A., Costa Vieira, B., Vieira, R. J., Marta, A., Abreu, A. C., Borges, T., … Furtado, M. J. (2026). Fluorescein Versus Indocyanine Green Angiography- Guided Primary Photodynamic Therapy for Treatment of Central Serous Chorioretinopathy: A Systematic Review with Meta-Analysis. Revista Sociedade Portuguesa De Oftalmologia, 50(2), 158–167. https://doi.org/10.48560/rspo.42414

Issue

Vol. 50 No. 2 (2026)

Section

Review Article

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