Verteporfin shortage: treatment options and outcomes in chronic non-resolving central serous chorioretinopathy
Reviewed by Sofia Rokerya

Half-dose photodynamic therapy (HD-PDT) with verteporfin has been the therapy of choice in non-resolving central serous chorioretinopathy lasting longer than four months. Since 2021, a worldwide shortage of verteporfin due to manufacturing issues prompted adjustments in treatment practices. This retrospective, cohort study compares the treatment modalities and outcome in 85 eyes of 79 patients, 36 eyes before verteporfin shortage, (group 1) and 49 eyes in the first year of verteporfin shortage, that received a tailored approach (group 2.) The mean age of the total group was 51.9 ±10.7 years, and 20% of patients were women. The mean follow-up time was 6.2 ±2.1 months. There was no significant difference between the groups in time from the start of subjective symptoms to the first visit (p=0.536), in time from the first optical coherence tomography until the first visit (p=0.825) and in the follow-up time (p=0.231). The mean number of visits during follow-up was 3.3 ±0.7, and this was not statistically different between the two groups (p=0.777). At four months after the baseline visit, there was a significant difference in number of performed HD-PDT (89%) and in 45% of the eyes in group 1 and group 2, respectively (p<0.001). Patients in group 2 had to wait significantly longer to receive HD-PDT after the baseline visit. During the shortage, there was also a reduction in performed HD-PDT treatments at the baseline visit. After wait-and-see policy or a treatment at baseline visit, additional treatment was performed in a subset of patients during follow-up. Additional treatment was performed in four eyes (11%) in group 1, and all of these eyes received HD-PDT. In group 2, 12 (25%) eyes received additional treatment during follow-up: nine eyes were treated with HD-PDT, one eye was treated twice with SML (mineralocorticoid receptor antagonists), one eye was treated with prednisolone eye drops and one eye was treated with laser photocoagulation. There was no statistically significant difference regarding subfoveal SRF resolution and complete SRF resolution between group1 and group 2. Subfoveal fluid was resorbed in 67% and 69% and complete SRF resolution occurred in 61% and 55% of the eyes respectively. Visual acuity increased significantly in both groups, with 7.6 ±10.6 (p < 0.001) ETDRS letters in group 1 and with 7.8 ±11.6 (p<0.001) ETDRS letters in group 2. There was no significant difference in the final visual acuity between both groups (p=0.637). Limitations: retrospective design, short follow-up time whereby it remains to be seen if group 2 patients will show a similar disease course, and that the number of recurrences and visual acuity will remain comparable in the long term to group 1 patients.

Dealing with the verteporfin shortage: treatment options and outcomes in patients with chronic and non-resolving central serous chorioretinopathy.
Van den Tillaart FM, Hartgers F, Hoyng CB, Yzer S.
OPHTHALMOLOGICA
2024;1–11. doi:10.1159/000542224 [ePub ahead of print].