Central serous chorioretinopathy treated with navigated retinal laser photocoagulation: visual acuity and retinal sensitivity

Clinical Evaluation of Individualized and Navigated Microsecond Pulsing Laser for Acute Central Serous Chorioretinopathy

BACKGROUND AND OBJECTIVE

A computational model has predicted parameters for using a navigated microsecond pulsing laser system to treat central serous chorioretinopathy (CSC).

PATIENTS AND METHODS

A prospective, single-center, interventional case series was conducted for patients with acute CSC who were enrolled following screening and informed consent. Treatment involved laser pulse duration of 50 μs, 2.4% Duty Cycle, 100 μm spot size, and 10 ms pulse duration.

RESULTS

Average best-corrected visual acuity (decimal) of 12 patients improved from 0.86 ± 0.03 at baseline to 0.97 ± 0.01 at 3 months. Baseline central retinal thickness decreased from 452.58 μm ± 24.53 μm at baseline to 249.25 μm ± 2.92 μm at 3 months. Retinal sensitivity improved from 24.1 dB ± 1.09 dB at baseline to 28.98 dB ± 0.23 dB at 3 months. In all cases, subretinal fluid was resorbed.

CONCLUSION

The parameter sets derived from the computer model can be applied safely and effectively for CSC treatment using the navigated microsecond pulsing laser system. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:512-520.].

Central Serous Chorioretinopathy: Pathogenesis and Management

Central serous chorioretinopathy (CSC) is a common retina disease and has a relative high recurrence rate, etiology, and pathogenesis of which remains largely ambiguous. The effects on the retina are usually self-limited, although some people are left with permanent vision loss due to progressive and irreversible photoreceptor damage or retinal pigment epithelium atrophy. There have been a number of interventions used in CSC, including, but not limited to, laser treatment, photodynamic therapy (PDT), intravitreal injection of anti-vascular endothelial growth factor agents, and subthreshold lasers. It is not clear whether there is a clinically important benefit to treating acute CSC, which often resolves spontaneously as part of its natural history. Of the interventions studied to date, PDT and micropulse laser treatment appear the most promising. 

[Optical coherence tomography in diagnostics and treatment of central serous chorioretinopathy]

PURPOSE

To identify the signs of leakage points in central serous chorioretinopathy (CSC) patients using optical coherence tomography (OCT) allowing focal laser photocoagulation (FLP) to be performed without the need for fluorescein angiography (FA) in their treatment; to evaluate the effectiveness and safety of the approach.

MATERIAL AND METHODS

The retrospective part of the study included 54 patients (54 eyes) with distinctive signs of CSC further confirmed by the presence of a leakage point as could be seen with FA. The number of pigment epithelial detachments (PED), the thickness of the photoreceptor outer segments (PROS) layer, maximum horizontal length of the photoreceptor thinning area, and morphological changes in the outer retinal layers were evaluated with OCT. Using FA for each leakage point, its localization and coincidence with PED were evaluated in retro-mode confocal scanning laser ophthalmoscopy and OCT images, respectively. The prospective part of the study included 11 CSC patients (11 eyes) who underwent en face OCT-guided FLP of the leakage point with NAVILAS 532 system.

RESULTS

The leakage points were found to coincide with PED in 50 eyes (92.6%). Mean distance from the superior border of the retinal detachment area to the leakage point was 28.8±14.1% of the retinal detachment height. In 90.3% of cases the PROS layer in the area above the PED was thinner (23.3±7.8 µm) compared to the area outside the leakage point (64.0±9.4 µm) (p<0.001). FA-free OCT-guided FLP required in average 3.3±0.5 laser burns per leakage point. Complete resolution of subretinal fluid occurred in all treated eyes within 7.5±1.0 weeks after the surgery, and no adverse events were observed.

CONCLUSION

Coincidence of PED in the superior half of the area of retinal detachment with thinning of the PROS layer as seen on OCT can be considered a reliable sign of the leakage point. The FA-free FLP based on OCT appears to be an effective and safe procedure for the treatment of CSC.

Acupuncture for chronic central serous chorioretinopathy: a prospective case series

OBJECTIVE

The aim of this prospective observational study was to evaluate the effects of acupuncture at Erjian on chronic central serous chorioretinopathy (CSC).

STUDY DESIGN

Prospective case series.

METHODS

Nine patients with chronic CSC were recruited and each patient received 12 sessions of acupuncture treatment. Subjective symptom measures included complications, best-corrected visual acuity (BCVA), fluorescein leakage (via fluorescein fundus angiography), and central subfield foveal subretinal fluid (on optical coherence tomography (OCT)) at 3 months. Successful treatment was defined as the complete resolution of subretinal fluid observed by the OCT following completion of treatment.

RESULTS

After 2 months of treatment, two patients showed improvements in visual acuity, a significant reduction in subretinal fluid and an improvement in BCVA to 0.5±0.10 (mean±SD). By contrast, four patients experienced no significant changes. After 3 months of treatment, four patients showed improvements in visual acuity and complete resolution of the subretinal fluid (mean BCVA=0.6), while parameters in two patients remained unchanged. Compared to baseline (before treatment), the proportions of patients experiencing visual improvement at 2 and 3 months were 33% (n=2) and 67% (n=4), respectively. No major complications were observed during the treatment course.

CONCLUSIONS

Acupuncture might be a promising supplementary therapy for patients with CSC. However, this is ultimately only an exploratory study with a small sample size and no untreated comparator group to control for the natural history of the condition. Randomised controlled trials will be needed to demonstrate the efficacy and effectiveness of this approach.

[En face' optical coherence tomography guided focal navigated laser photocoagulation]

Aim - to prove the feasibility of focal navigated laser photocoagulation (LP) for central serous chorioretinopathy (CSC) that relies only on the data provided by optical coherence tomography (OCT) without considering fluorescein angiography (FA).

MATERIAL AND METHODS

Two patients with CSC were treated with focal navigated LP (NAVILAS laser system) basing on macular OCT findings (RTVue 100). Before the procedure, FA was not performed.

RESULTS

In both cases the leaking point was recognized by a solitary focal detachment of the pigment epithelium in 'en face' OCT scans. OCT images were then imported into the laser photocoagulator unit and superimposed on the basic image of the fundus, thus, enabling accurate focal LP. In both cases the serous retinal detachment resolved completely within 9-14 days.

CONCLUSION

In some CSC patients, 'en face' OCT data allow focal navigated laser photocoagulation without prior fluorescein angiography.