Safety-enhanced laser treatment effective for central serous chorioretinopathy
Subthreshold diode micropulse (SDM) laser photocoagulation was found to be effective for chronic idiopathic central serous chorioretinopathy (CSCR) with juxtafoveal point source leakage according to a new research study.
CSCR is characterized by the accumulation of subretinal fluid (SRF) at the macula and is a common condition in young adults, especially in men with a so-called type A personality. Although CSCR generally is considered a self-limiting and benign condition, some patients may experience significant visual impairment caused by recurrent attacks of CSCR, persistent chronic neurosensory retinal detachment, or RPE atrophy. Most episodes of CSCR usually resolve spontaneously within 3 to 4 months. Traditional management has been observation alone. Laser photocoagulation and pharmacological agents have been attempted for treating CSCR. These treatment options serve only to shorten the duration of symptoms and have no effect on the recurrence rate or the final visual acuity.
Traditional continuous wave threshold laser treatment for juxtafoveal lesions may produce undesirable side effects, such as symptomatic scotoma, choroidal neovascularization, foveal distortion, and subretinal fibrosis.
Subthreshold diode micropulse laser treatment is made up of trains of repetitive ultrashort diode laser pulses (microseconds) that create sublethal cellular thermal effect without heat conduction to adjacent tissue. SDM laser rarely induces visible lesions ophthalmoscopically or with fluorescein angiography. SDM photocoagulation has been used successfully in the treatment of macular edema in diabetic retinopathy and branch retinal vein occlusion. This is the first report of SDM laser being used for the treatment of CSCR.
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In this nonrandomized, noncomparative, prospective, consecutive, interventional case series, 26 eyes in 25 patients with CSCR and juxtafoveal leakage longer than 4 months duration underwent SDM photocoagulation. Eyes were divided into 3 groups based on the findings of fluorescein angiography. Group 1 (N = 6) consisted of those patients with point source leakage but without associated retinal pigment epithelial (RPE) atrophy. Group 2 (N = 9) consisted of those patients with point source leakage and associated RPE atrophy. Group 3 (N = 11) consisted of those patients with diffuse fluid leakage.
In the first group (focal leakage without RPE atrophy), all 6 eyes had total SRF resorption after a single session of SDM photocoagulation. In the second group of eyes (focal leakage with RPE atrophy), 8 of 9 eyes had total SRF resorption after 1, 2, or 3 treatment sessions. One eye in group 2 had persistent SRF after 3 treatment sessions. In the third group of eyes (diffuse leakage), only 5 of 11 eyes had SRF resorption at the end of the 6 month follow-up period.
The investigators conclude that SDM laser is effective in the treatment of CSCR with point source leakage. They note that SDM photocoagulation displayed a similar therapeutic effect on CSCR as continuous wave laser without the risk of laser-related scotoma development even after repeated treatment. For eyes with associated RPE atrophy or diffuse RPE decompensation, rapid recurrence is common and PDT may be necessary.
WHAT IT MEANS TO YOU: Most patients with CSCR do not requires any treatment, as the condition will usually resolve spontaneously without any residual vision loss. Unfortunately, there are not any good treatment options for patients with chronic recurrent CSCR. Traditional laser therapy has been beneficial for some patients, but carries a risk of residual vision defects due to laser-induced scarring. This new modality of laser therapy may replace traditional laser in those patients that require laser treatment of lesions near the center of the macula.
CSCR is characterized by the accumulation of subretinal fluid (SRF) at the macula and is a common condition in young adults, especially in men with a so-called type A personality. Although CSCR generally is considered a self-limiting and benign condition, some patients may experience significant visual impairment caused by recurrent attacks of CSCR, persistent chronic neurosensory retinal detachment, or RPE atrophy. Most episodes of CSCR usually resolve spontaneously within 3 to 4 months. Traditional management has been observation alone. Laser photocoagulation and pharmacological agents have been attempted for treating CSCR. These treatment options serve only to shorten the duration of symptoms and have no effect on the recurrence rate or the final visual acuity.
Traditional continuous wave threshold laser treatment for juxtafoveal lesions may produce undesirable side effects, such as symptomatic scotoma, choroidal neovascularization, foveal distortion, and subretinal fibrosis.
Subthreshold diode micropulse laser treatment is made up of trains of repetitive ultrashort diode laser pulses (microseconds) that create sublethal cellular thermal effect without heat conduction to adjacent tissue. SDM laser rarely induces visible lesions ophthalmoscopically or with fluorescein angiography. SDM photocoagulation has been used successfully in the treatment of macular edema in diabetic retinopathy and branch retinal vein occlusion. This is the first report of SDM laser being used for the treatment of CSCR.
Related News
•Update on central serous chorioretinopathy
•Focal laser photocoagulation vs photodynamic therapy for central serous chorioretinopathy
•PDT for steroid-associated central serous chorioretinopathy
In this nonrandomized, noncomparative, prospective, consecutive, interventional case series, 26 eyes in 25 patients with CSCR and juxtafoveal leakage longer than 4 months duration underwent SDM photocoagulation. Eyes were divided into 3 groups based on the findings of fluorescein angiography. Group 1 (N = 6) consisted of those patients with point source leakage but without associated retinal pigment epithelial (RPE) atrophy. Group 2 (N = 9) consisted of those patients with point source leakage and associated RPE atrophy. Group 3 (N = 11) consisted of those patients with diffuse fluid leakage.
In the first group (focal leakage without RPE atrophy), all 6 eyes had total SRF resorption after a single session of SDM photocoagulation. In the second group of eyes (focal leakage with RPE atrophy), 8 of 9 eyes had total SRF resorption after 1, 2, or 3 treatment sessions. One eye in group 2 had persistent SRF after 3 treatment sessions. In the third group of eyes (diffuse leakage), only 5 of 11 eyes had SRF resorption at the end of the 6 month follow-up period.
The investigators conclude that SDM laser is effective in the treatment of CSCR with point source leakage. They note that SDM photocoagulation displayed a similar therapeutic effect on CSCR as continuous wave laser without the risk of laser-related scotoma development even after repeated treatment. For eyes with associated RPE atrophy or diffuse RPE decompensation, rapid recurrence is common and PDT may be necessary.
WHAT IT MEANS TO YOU: Most patients with CSCR do not requires any treatment, as the condition will usually resolve spontaneously without any residual vision loss. Unfortunately, there are not any good treatment options for patients with chronic recurrent CSCR. Traditional laser therapy has been beneficial for some patients, but carries a risk of residual vision defects due to laser-induced scarring. This new modality of laser therapy may replace traditional laser in those patients that require laser treatment of lesions near the center of the macula.
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