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Analysis of choriocapillaris perfusion and choroidal layer changes in patients with chronic central serous chorioretinopathy randomised to micropulse laser or photodynamic therapy
  1. Mary Ho1,2,
  2. Frank Hiu Ping Lai3,
  3. Danny Siu Chun Ng1,
  4. Lawrence Pui Leung Iu1,2,
  5. Li Jia Chen1,2,
  6. Andrew Chun Yue Mak1,2,
  7. Yolanda Yip1,
  8. Carol Cheung1,
  9. Alvin Lerrmann Young1,2,
  10. Marten Brelen1,2
  1. 1 Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
  2. 2 Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
  3. 3 Department of Ophthalmology, Caritas Medical Centre, Hong Kong, China
  1. Correspondence to Dr Marten Brelen, Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, Hong Kong; marten.brelen{at}


Purpose The purpose of this study was to investigate the signal changes in choriocapillaris flow deficits and choroidal thickness changes using swept-source optical coherence tomography angiography (OCTA) following different treatments.

Design A double-blind, randomised controlled trial.

Methods Patients with unilateral chronic central serous chorioretinopathy (CSC) were randomised to receive subthreshold micropulse laser therapy (MLT) or half-dose photodynamic therapy (PDT). Choroidal thickness and choriocapillaris flow deficit signals were investigated.

Results Eighteen patients were randomised into the MLT group and 15 patients into the PDT group. Areas with flow deficit signals were identified in all baseline OCTA images of the choriocapillaris, with mean areas of 0.420 and 0.465 mm2 in the MLT and PDT groups, respectively. These flow deficit signal areas were significantly reduced at 6 months (p=0.011) in the MLT group and at 3 months (p=0.008) in the PDT group. Patients from the PDT group were shown to have smaller flow deficit areas than patients from the MLT group at all time points after treatment (p=0.001, analyses of variance). The mean choroidal volume of the fovea showed a significant reduction at 1 month (p=0.003), 3 months (p=0.199) and 6 months (p=0.006) in the PDT group.

Conclusion The flow deficit areas identified in the choriocapillaris layer may suggest possible relative choroidal ischaemia. With measurement of choroidal volume reduction and faster rates of flow deficit area change, PDT has a stronger effect than MLT in promoting choriocapillaris recovery.

  • choroid
  • imaging
  • macula
  • retina

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  • Funding This research was supported by the Health and Medical Research Fund (HMRF) granted by the Hong Kong Government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This was a prospective, randomised controlled trial approved by the Clinical Research Ethics Committees of the New Territories East Cluster. Written informed consent was obtained from all participants. This study adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data summary relevant to the study are included in the article or uploaded as supplementary information. Original data files are available upon reasonable request.

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