1
|
Zhu D, Shah PP, Zhang C, Wong A, Bouaziz M, Barmas-Alamdari D, Mootz J, Yu A, Tirsi A, Tello C. Outcomes of Micropulse Laser Trabeculoplasty Compared to Selective Laser Trabeculoplasty: A Systematic Review and Meta-Analysis. Clin Ophthalmol 2024; 18:2205-2215. [PMID: 39131544 PMCID: PMC11316492 DOI: 10.2147/opth.s476257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose To perform a meta-analysis and systematic review to compare the efficacy and complications of micropulse laser trabeculoplasty (MLT) and selective laser trabeculoplasty (SLT) in adult patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). Methods We performed a systematic review utilizing PubMed, Embase, and Scopus, on April 8, 2024. Meta-analyses were performed for the mean change in intraocular pressure (IOP) at one-month, six-month, and one-year follow-up visits, rate of IOP spikes (>5 mmHg increase from the pre-procedure baseline IOP), rate of treatment failure (<20% or <3 mmHg reduction in IOP or requiring additional medications or procedures), and mean change in number of medications. Results Six studies, with a total of 593 eyes, were included: 283 underwent MLT, while 310 underwent SLT. A statistically significant difference in the efficacy of MLT versus SLT at one-month and six-month follow-ups was present, with SLT reducing IOP by 0.83 mmHg (95% CI: 0.20, 1.47; P = 0.01) more and 0.55 mmHg (95% CI: 0.02, 1.08; P = 0.04) more than MLT, respectively. At the one-year follow-up, there was no significant disparity in IOP reduction between SLT and MLT (WMD = 0.16; 95% CI: -0.40, 0.71; P = 0.58). There was a significantly lower rate of IOP spikes in the MLT treatment group (RR = 0.37; 95% CI: 0.16, 0.89; P = 0.03). There was no statistically significant difference in the rate of treatment failures (RR = 1.05; 95% CI: 0.68, 1.62; P = 0.84) or number of topical medications reduced (WMD = 0.06; 95% CI: -0.13, 0.26; P = 0.53). Conclusion While SLT may offer greater short-term reductions in IOP, it may be associated with more postoperative IOP spikes when compared to MLT. At one-year follow-up, there were no significant differences in IOP reduction or failure rates between the MLT and SLT groups.
Collapse
Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Paras P Shah
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY, 14203, USA
| | - Amanda Wong
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, 10003, USA
| | - Michael Bouaziz
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Daniel Barmas-Alamdari
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Joseph Mootz
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Austin Yu
- Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Andrew Tirsi
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Celso Tello
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| |
Collapse
|
2
|
Gao S, Ge G, Zhang Y, Zhang M. Subthreshold Micropulse Laser Versus Oral Spironolactone in Chronic Central Serous Chorioretinopathy: A Quasi-Randomized Controlled Trial. Transl Vis Sci Technol 2024; 13:19. [PMID: 39133498 PMCID: PMC11323996 DOI: 10.1167/tvst.13.8.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose To compare the efficacy and safety of subthreshold micropulse laser (SML) and spironolactone therapy for treating chronic central serous chorioretinopathy (CSC). Methods This was a quasi-randomized controlled trial. Eligible patients were quasi-randomized at a 1:1 ratio to receive SML or oral spironolactone and were assessed at 3 months after treatment. Results A total of 84 patients (90 eyes) were randomly assigned to receive SML (n = 45) or spironolactone (n = 39) initially. At last follow-up, 59.5% of patients in the SML group had complete resolution of subretinal fluid (SRF) compared to 43.6% in spironolactone group (P = 0.362). The mean visual acuity did not significantly improve between the two groups (0.38 ± 0.44 vs. 0.43 ± 0.43 logMAR). The central retinal thickness was decreased from 335.06 ± 120.25 µm to 222.15 ± 94.90 µm in the SML group and from 308.02 ± 90.69 µm to 257.27 ± 102.28 µm in the spironolactone group. After treatment, subfoveal choroidal thickness, total choroidal area, and stromal and luminal choroidal area were significantly lower in the spironolactone group as compared to the SML group. During the entire visit, the recurrence rate of SRF was 9.1% in the SML group compared to 35.3% in the spironolactone group. Slight adverse events occurred more frequently in the spironolactone group (0% vs. 16%). Conclusions Both SML and oral spironolactone were effective and safe treatments to ameliorate retinal anatomical structures for chronic CSC. A lower recurrence rate and fewer adverse effects were observed in the SML group, and better choroidal structure recovery was seen in the spironolactone group. Translational Relevance The investigation of SML and oral spironolactone may inform evidence-based clinical decisions for chronic CSC patients.
Collapse
Affiliation(s)
- Sheng Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Ge
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Zhu D, Shah PP, Wong A, Zhang C, Barmas-Alamdari D, Bouaziz M, Tirsi A, Tello C. 180- Versus 360-Degree Selective Laser Trabeculoplasty in Open Angle Glaucoma and Ocular Hypertension: A Systematic Review and Meta-Analysis. J Glaucoma 2024; 33:566-575. [PMID: 38709197 DOI: 10.1097/ijg.0000000000002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
PRCIS This systematic review and meta-analysis found that 360-degree selective laser trabeculoplasty (SLT) is significantly more effective than 180-degree SLT at reducing intraocular pressure at 1-month and 1-year follow-ups without increased serious adverse event risk. PURPOSE To determine the efficacy of 180- versus 360-degree selective laser trabeculoplasty (SLT) in adults with open angle glaucoma (OAG) and ocular hypertension (OHT). METHODS A systematic review was performed using PubMed, Embase, and Scopus databases, from 1995 to December 30, 2023, for studies comparing 180 and 360-degree SLT in adults with OAG and OHT (PROSPERO ID: CRD42024497832). Meta-analyses were performed to calculate nominal percent and raw reductions in intraocular pressure (IOP) between treatment groups at 1-month, 1-year, and 2-year follow-ups, as well as success rates, defined as a 20% or greater IOP reduction. RESULTS Nine studies with 1044 eyes were included; 491 received 180-degree SLT, and 553 received 360-degree SLT. At the 1-month follow-up, 360-degree SLT reduced IOP by 3.45% more (WMD=3.45; 95% CI: 2.02-4.88; P <0.00001) and 0.87 mm Hg more (WMD=0.87; 95% CI: 0.35-1.38; P =0.0010). At the 1-year follow-up, 360-degree SLT reduced IOP by 4.33% more (WMD=4.33; 95% CI: 2.35-6.32; P <0.0001) and 1.15 mm Hg more (WMD=1.15; 95% CI: 0.25-2.04; P =0.01). At 2 years of follow-up, 360-degree SLT reduced IOP by 4.86% more (WMD=4.86; 95% CI: -0.32, 10.0; P =0.07) and 1.25 mm Hg more (WMD=1.25; 95% CI: -0.29, 2.79; P =0.11); however, the difference was not statistically significant. Compared with 360-degree SLT, 180-degree SLT had a significantly lower success rate (OR=0.50; 95% CI: 0.35-0.72; P =0.0002). There was no difference in serious complications between interventions. CONCLUSIONS 360-degree SLT is more effective than 180-degree SLT at lowering IOP at 1-month and 1-year follow-ups as well as achieving successful IOP control without increased risk of serious complications.
Collapse
Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck
- Manhattan Eye, Ear, & Throat Hospital
| | - Paras P Shah
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck
| | - Amanda Wong
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY
| | - Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo
| | - Daniel Barmas-Alamdari
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck
- Manhattan Eye, Ear, & Throat Hospital
| | - Michael Bouaziz
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck
- Manhattan Eye, Ear, & Throat Hospital
| | - Andrew Tirsi
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck
- Manhattan Eye, Ear, & Throat Hospital
| | - Celso Tello
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck
- Manhattan Eye, Ear, & Throat Hospital
| |
Collapse
|
4
|
Samacá-Samacá D, Hernández-Castillo C, Prieto-Pinto L, Rodríguez F, Sardi C, Ocampo H, Kock J, Hernández F. Efficacy and safety of faricimab for neovascular age-related macular degeneration: a systematic review and network meta-analysis. BMJ Open Ophthalmol 2024; 9:e001702. [PMID: 39043575 PMCID: PMC11268043 DOI: 10.1136/bmjophth-2024-001702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of faricimab compared with other anti-vascular endothelial growth factor (anti-VEGF) agents in treating neovascular age-related macular degeneration (nAMD) patients. METHODS AND ANALYSIS A systematic review (SR) was conducted up to January 2023. Network meta-analyses (NMA) were performed, including sensitivity and subgroup analyses for naïve population. Outcomes included changes in visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] letters), anatomical changes, frequency of injections and adverse events. The Cochrane Collaboration guidelines and the Confidence in Network Meta-Analysis framework were used for the SR and the certainty of evidence, respectively. RESULTS From 4128 identified records through electronic databases and complementary searches, 63 randomised controlled trials (RCTs) met the eligibility criteria, with 42 included in the NMA. Faricimab showed a significant reduction in the number of annual injections compared with most fixed and flexible anti-VEGF treatment regimens, while showing no statistically significant differences in visual acuity through ETDRS letter gain, demonstrating a comparable efficacy. Retinal thickness results showed comparable efficacy to other anti-VEGF agents, and inferior only to brolucizumab. Results also showed that more patients treated with faricimab were free from post-treatment retinal fluid compared with aflibercept every 8 weeks, and both ranibizumab and bevacizumab, in the fixed and pro re nata (PRN) assessed schedules. Faricimab showed a comparable safety profile regarding the risk of ocular adverse events and serious ocular adverse events (SOAE), except for the comparison with brolucizumab quarterly, in which faricimab showed a significant reduction for SOAE risk. CONCLUSION Faricimab showed a comparable clinical benefit in efficacy and safety outcomes, with a reduction in annual injections compared with fixed and flexible anti-VEGF drug regimens, representing a valuable treatment option for nAMD patients. PROSPERO REGISTRATION NUMBER CRD42023394226.
Collapse
Affiliation(s)
| | | | | | - Francisco Rodríguez
- FUNDONAL, Bogota, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C, Colombia
| | - Carolina Sardi
- Instituto Nacional de Investigación en Oftalmología, Medellín, Colombia
| | | | - Joshua Kock
- Evidence Generation, Roche Colombia, Bogotá D.C, Colombia
| | | |
Collapse
|
5
|
Huang YT, Tien PT, Chen PY, Yang CL, Chen SN. Comparative efficacy of brolucizumab, half-dose photodynamic therapy, and aflibercept in managing chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:1755-1763. [PMID: 38224344 DOI: 10.1007/s00417-024-06373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
PURPOSE To compare the efficacy of brolucizumab, half-dose PDT, and aflibercept in treating chronic central serous chorioretinopathy (CSC). METHODS A retrospective cohort study with chronic CSC patients who underwent intravitreal injection of one shot of brolucizumab or aflibercept in the first 3 months, followed by pro re nata regimens or a single session of half-dose PDT, was retrospectively reviewed. The primary outcome measure was the proportion of eyes that achieved complete absorption of retinal fluid without requiring any rescue treatment. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and central choroidal thickness (CCT). RESULTS A total of 54 consecutive patients were included in this study with 18 patients in each group. At months 1 and 2, the brolucizumab group exhibited the highest rate of complete retinal fluid resolution (61% and 77%), followed by the half-dose PDT group (56% and 72%), and lowest in the aflibercept group (28% and 33%), with statistically significant differences noted at month 2 (P = 0.012). The brolucizumab group also demonstrated the most significant reduction in CCT at months 1 and 2 among the three groups (P = 0.007 and 0.001). Recurrence of retinal fluid in the brolucizumab groups was predominantly observed at month 3. Conversely, the half-dose PDT group exhibited the most favorable anatomical results starting from month 3. Notably, mild vitritis was observed in one case from the brolucizumab group. CONCLUSIONS Single injection of brolucizumab demonstrates trends of faster regression of persistent residual retinal fluid, greater CCT and CRT decline, and matched BCVA compared to half-dose PDT in the short term.
Collapse
Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Yu Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - Chi-Lan Yang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, 40447, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
6
|
Shen X, Kong F, Wen J, Wang X, Huang C. The role of inflammation in central serous chorioretinopathy: From mechanisms to therapeutic prospects. Front Pharmacol 2024; 15:1200492. [PMID: 38835666 PMCID: PMC11148560 DOI: 10.3389/fphar.2024.1200492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Central serous chorioretinopathy (CSC) is a leading cause of permanent vision loss, ranking fourth among macular diseases, trailing only age-related macular degeneration, diabetic retinopathy, and retinal vein obstruction. While mounting evidence implicates inflammation as a pivotal factor in the onset and advancement of CSC, the specific pathophysiological process and molecular mechanisms underlying inflammation remain incompletely understood. A complex network of cytokines, chemokines, and adhesion molecules interplay to trigger inflammatory and pathological cascades, highlighting the need for a comprehensive comprehension of the inflammation-related mechanisms behind CSC progression. In this piece, we examine the existing comprehension of CSC's pathology and pathogenesis. Additionally, we present an overview of the mechanisms underlying the onset and progression of CSC inflammation, followed by a thorough analysis and discussion of the potential of targeted inflammatory intervention for both preventing and treating CSC.
Collapse
Affiliation(s)
- Xiao Shen
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Fanhua Kong
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Wuhan, China
| | - Jing Wen
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Xiao Wang
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Chunlian Huang
- Department of Ophthalmology, Taizhou Central Hospital ( Taizhou University Hospital), Taizhou, Zhejiang, China
| |
Collapse
|
7
|
Kozak I. Editorial to: The effect of nondamaging subthreshold laser therapy in patients with chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:1381-1382. [PMID: 38038727 DOI: 10.1007/s00417-023-06316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Igor Kozak
- Moorfields Eye Hospitals UAE, Abu Dhabi, 62807, United Arab Emirates.
| |
Collapse
|
8
|
Ramamurthy SR, Behera UC, Narula R, Sadda SR, Narayanan R. Intravitreal Brolucizumab for Chronic Central Serous Chorioretinopathy without Choroidal Neovascular Membrane - a Pilot Study. Semin Ophthalmol 2024:1-8. [PMID: 38270124 DOI: 10.1080/08820538.2024.2308808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE To study intravitreal brolucizumab in the management of persistent macular fluid in chronic central serous chorioretinopathy (CSCR) without choroidal neovascular membrane (CNVM). METHODS Retrospective case series which included eyes with chronic CSCR with persistent macular fluid for ≥ 3 months without CNVM. Intravitreal brolucizumab was administered in all eyes. Primary outcome measure was the resolution of intraretinal (IRF) and/or subretinal fluid (SRF) on OCT. RESULTS Five eyes (four patients) with chronic CSCR were included. All eyes showed complete resolution of SRF 1 month following injection. Minimal residual IRF was present in two eyes. Best corrected visual acuity (BCVA) was stable in three eyes, and two eyes showed improvement. Central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) showed reduction. CONCLUSION Intravitreal brolucizumab is effective in the rapid reduction of persistent macular fluid in chronic CSCR without CNVM. Long-term follow-up data are required to study recurrence and adverse effect profile.
Collapse
Affiliation(s)
- Srishti Raksheeth Ramamurthy
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Standard Chartered-LVPEI Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Umesh Chandra Behera
- Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Ritesh Narula
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- LILAC Image Reading Center, LV Prasad Eye Institute, Hyderabad, India
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Raja Narayanan
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research Center (IHOPE), LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
9
|
Bordbar DD, Skrehot HC, Weng CY. Update on the Management of Central Serous Chorioretinopathy. Int Ophthalmol Clin 2024; 64:179-193. [PMID: 38146890 DOI: 10.1097/iio.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
|
10
|
Enríquez-Fuentes JE, Alarcón-García AD, Oribio-Quinto C, Fernández-Vigo JI. Hyperplasia of the retinal pigment epithelium secondary to subthreshold laser treatment in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2023; 44:103896. [PMID: 37984527 DOI: 10.1016/j.pdpdt.2023.103896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To assess the development of hyperplasia of the retinal pigment epithelium (HRPE) secondary to subthreshold laser treatment (STL) in chronic central serous chorioretinopathy (CSCR). METHODS Prospective study including 149 eyes of 146 patients with CSCR with persistent subretinal fluid (SRF) that have undergone STL using the Navilas® device. Visual acuity (VA) optical coherence tomography (OCT) and fundus autofluorescence (FAF) were performed before and after the treatment. The HRPE was identified on OCT as a hyperreflective and dense material at the expense of the RPE that did not exist prior to the treatment. The demographics of the patients as well as the parameters of the STL treatments employed were registered. RESULTS Seven HRPE cases after STL were identified, observing an incidence of 4.7% (7 out of 149 eyes). The mean age was 52.1 ± 3.6 years, being 6/7 males. The mean number of STL sessions was 1.3 ± 0.5. The mean total fluence applied was 52.2 ± 12.4 J/cm2 (range 35.37 to 76.39 J/cm2), using a duty cycle of 10% in all cases. The HRPE was subfoveal in 6 of the 7 cases. The SRF was resolved in 6 of the 7 patients. The mean VA loss was -14.1 ± 14.3 ETDRS letters. CONCLUSION The development of HRPE secondary to STL in CSCR is an uncommon but severe adverse effect, probably related to the excessive energy employed. Further studies are warranted to minimize the incidence and to know the predictors of this complication after STL treatment to optimize the parameters that should be used.
Collapse
Affiliation(s)
- Jacobo Emilio Enríquez-Fuentes
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid 28040, Spain
| | - Antonio Domingo Alarcón-García
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid 28040, Spain
| | - Carlos Oribio-Quinto
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid 28040, Spain
| | - José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid 28040, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| |
Collapse
|
11
|
Katz G, Gur E, Moisseiev J, Leshno A. Early versus delayed photodynamic therapy for chronic central serous chorioretinopathy. Int Ophthalmol 2023; 43:4055-4065. [PMID: 37498446 DOI: 10.1007/s10792-023-02822-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Central serous chorioretinopathy (CSCR) patients are sometimes referred to Photodynamic Therapy (PDT) with very long-term disease. The purpose of this study was to analyze the results of PDT in CSCR eyes with long-standing disease. METHODS The medical records of the patients that underwent PDT for CSCR between 2009 and 2019 were reviewed. Cases were divided into two groups based on the duration of disease before PDT treatment: early treatment (3 to 6 months) and delayed treatment (longer than 6 months). The treatment was defined as successful when the subfoveal fluid was absorbed during follow-up. RESULTS The PDT treatment was successful in 76% and 77% of eyes in the early and delayed treatment groups, respectively. Both groups showed significant improvement in central retina measurements at the 3-months follow-up which persisted to the last follow-up visit. The visual acuity (VA) at baseline was significantly worse in the delayed treatment group (0.5 ± 0.26 vs. 0.3 ± 0.24, P = 0.042) and improved in both groups but remained low in the delayed treatment group during the study. CONCLUSION We suggest that if CSCR is not spontaneously improving over 3 months the patient should be offered PDT, to prevent VA loss from the long-term presence of subretinal fluid in the macula. PDT is not associated with loss of vision in eyes with chronic CSCR, and can be safely used in eyes with relatively good VA.
Collapse
Affiliation(s)
- Gabriel Katz
- Ophthalomology Department, Sheba Medical Center, Tel Hashomer, Israel.
| | - Efrat Gur
- Ophthalomology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Joseph Moisseiev
- Ophthalomology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Ari Leshno
- Ophthalomology Department, Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|