Retinopathia centralis serosa (RCS) is an acquired retinal disease, in which fluid leaks from the choroid under the retina for unexplained reasons. This leads to swelling of the center of the retina.
Typical symptoms of retinopathia centralis serosa, include image distortion in the form of wave vision (metamorphopsia), a loss in the central visual field (scotoma), farsightedness, and color vision deficits.
In most cases the disease is self-limiting, i.e. symptoms disappear within 2 to 5 months. This is how long one should wait. If the symptoms do not disappear, there are various therapeutic options, depending on the course and severity of the disorders. An attempt can be made to flush out the edema with tablets. If the damage leading to the accumulation of water lies outside the retinal center (fovea, yellow spot), laser therapy is possible. In most cases, however, the cause of the edema lies in the retinal center. Then a classical laser therapy is not possible, because the laser treatment in the center of the retina would lead to scars, and an irreparable loss of function (loss of the ability to read). In these cases, therapy with a so-called half dose PDT (photodynamic therapy) is possible.
Photodynamic therapy (PDT) with Visudyne
Photodynamic therapy with Visudyne, is a treatment method that has been tried and tested for many years. It is performed with the light-active agent Verteporfin (Visudyne) and a special laser. Visudyne is an approved drug in Switzerland. The “special” laser is not a classic retinal laser, which is used to create scars on the retina, but an infrared laser. This infrared laser can only trigger a photochemical reaction in combination with the drug Visudyne. Unlike the classic laser, PDT does not cause scarring. Therefore, PDT treatment can also be performed in the retinal center. Furthermore, a repetition of the treatment in the same retinal area is possible.
Therapy is performed in two steps: First, the active ingredient verteporfin is administered through a 10-minute infusion. Next, a drop of a local anesthetic is dropped into the eye, and a contact lens is placed on the eye. Then, the active ingredient in the eye is activated by illuminating the retina with a special red-light laser for 1½ minutes.
BEHAVIOR AFTER TREATMENT
Administration of VisudyneTM causes the skin and eyes to become highly photosensitive. To avoid serious photosensitization reactions, such as those associated with severe sunburn, it is necessary to protect the eyes and skin from direct sunlight and intense illumination for two days. Normal room light is not dangerous. When outdoors, skin and eyes should be protected by wearing appropriate clothing and dark sunglasses during the first 2 days. In addition, one should not expose oneself to strong artificial light, such as solariums or strong halogen lamps, as used by dentists, or in operating rooms. After treatment, somewhat blurred vision will occur, due to the eye drops used. One should wear dark sunglasses to protect the eyes from light. During this time, driving a motor vehicle should be avoided. . We provide patients with suitable sunglasses; big enough, i.e. these sunglasses can be worn over usual glasses.
Like any other drug, VisudyneTM may cause adverse side effects in sensitive individuals, but rarely. Treatment with VisudyneTM may be discontinued at any time, due to ineffectiveness, or intolerance. Pain may occur at the infusion site during, or after infusion; hypersensitivity reactions are rare. Should it occur that the active substance VisudyneTM leaks out of the blood vessels at the infusion site, pain, swelling and/or reddening of the skin will occur at this site. The leakage site must be covered and protected from light until the leaked dye has been completely absorbed by the body – this may take several days.
A small number of treated patients notice back pain during the injection. This sensation disappears as soon as the injection is completed. One or more of the following complaints have also been reported by some patients:
Headache, nausea, dizziness, and drop in blood pressure. Other possible side effects of this treatment may include: temporarily reduced vision, bleeding in the eye, impaired vision, eye pain, and redness of the eye. It is expected that the previously mentioned side effects will occur less frequently because we use a lower dosage of verteporfin. As for visual disturbances, most symptoms are probably due to the underlying disease of retinopathia centralis serosa, itself. All side effects of therapy resolve within hours to days.
The drug verteporfin is approved for age-related macular degeneration, but not officially for the rare disease RCS. Nevertheless, this is not a clinical trial. All records will remain confidential. If any side effects are found, we are obliged to inform the company and/or the health authorities. This will be done with full respect for privacy.
The treating physician will ask about possible liver or biliary diseases before treatment, as they are a contraindication to the therapy.