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Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy

View Article: PubMed Central - PubMed

ABSTRACT

We evaluated visual outcomes, changes of maximum macular thickness (MMT) and subretinal fluid (SRF), and safety in patients with chronic central serous chorioretinopathy (CSC) after treatment with selective retina therapy (SRT). Retrospective cohort study of patients with chronic CSC presenting to a university-based hospital from January 2014 through January 2015 was conducted. A total of 12 eyes of 12 patients with chronic CSC lasting for at least 3 months was recruited. The follow-up period ranged from 3 to 12 months. Following evaluation of test spots at temporal arcades, SRT (Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser; wavelength, 527 nm, pulse duration, 1.7 microsececond) was applied to the surrounding areas of leakage observed on fluorescein angiogram and/or pigment epithelial detachment (PED). Changes in best-correct visual acuity (BCVA), MMT, and SRF and macular sensitivity (MS) by microperimetry (MP) were evaluated. Eyes received treatment in a mean of 3.83 spots at the pulse energy of 65 to 90 μJ. Mean BCVA (logMAR) improved from 0.23 ± 0.12 at baseline to 0.14 ± 0.13 at 3 months. MMT decreased from 341.4 ± 85.5 μm at baseline to 236.0 ± 57.9 μm at 3 months. SRF completely resolved in 75% (9 eyes) at 3 months. Large PEDs (2 eyes) were flattened at 3 months. Retreatment was performed in 4 eyes. MP showed no evidence of scotoma around SRT-treated lesions. SRT treatment targeting the surrounding area of leakage point showed favorable visual and structural outcomes in chronic CSC patients without the risk of scotoma.

No MeSH data available.


Related in: MedlinePlus

Representative image of fundus fluorescein angiography showing 8 test spots. Each pulse energy with 70, 75, 80, and 90 μJ was tested in duplicate.
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Figure 1: Representative image of fundus fluorescein angiography showing 8 test spots. Each pulse energy with 70, 75, 80, and 90 μJ was tested in duplicate.

Mentions: Laser treatments were performed with a Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser system (Medical Laser Center Lübeck GmbH, Lübeck, Germany) emitting at a wavelength of 527 nm. The SRT laser uses multiple short laser pulses (30 pulses per spot; pulse duration, 1.7 microsececond; pulse repetition rate, 100 Hz). While SDM lesions are invisible on FFA, SRT spots can be visualized by FFA. The threshold for selective RPE damage can vary between patients and even within regions of the same eye. Therefore, before each SRT treatment, 3 to 10 preliminary test spots were applied away from the macular region and planned treatment area, at the superior or inferior temporal arcade vessels (from 65 to 120 μJ), in order to determine the individually optimal pulse energy for selective RPE damage (Figure 1). Following the test spots, FFA was performed to determine the correlation between the pulse energy and the visibility of the laser spot, determining the required pulse energy for treatment. The minimum pulse energy that allows visible spots on FFA was chosen as the desired treatment energy because of invisibility of SRT spots on ophthalmoscopy. SRT spots were applied immediately adjacent to the sites of foveal leakage or circumferentially around areas of PED, rather than directly targeting the leaking point, or confluent treatment over the area of PED. For treatment of leaks that were present very close to the foveal avascular zone, SRT spots were irradiated in a location up to 300 μm from the center of the fovea.


Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy
Representative image of fundus fluorescein angiography showing 8 test spots. Each pulse energy with 70, 75, 80, and 90 μJ was tested in duplicate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998269&req=5

Figure 1: Representative image of fundus fluorescein angiography showing 8 test spots. Each pulse energy with 70, 75, 80, and 90 μJ was tested in duplicate.
Mentions: Laser treatments were performed with a Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser system (Medical Laser Center Lübeck GmbH, Lübeck, Germany) emitting at a wavelength of 527 nm. The SRT laser uses multiple short laser pulses (30 pulses per spot; pulse duration, 1.7 microsececond; pulse repetition rate, 100 Hz). While SDM lesions are invisible on FFA, SRT spots can be visualized by FFA. The threshold for selective RPE damage can vary between patients and even within regions of the same eye. Therefore, before each SRT treatment, 3 to 10 preliminary test spots were applied away from the macular region and planned treatment area, at the superior or inferior temporal arcade vessels (from 65 to 120 μJ), in order to determine the individually optimal pulse energy for selective RPE damage (Figure 1). Following the test spots, FFA was performed to determine the correlation between the pulse energy and the visibility of the laser spot, determining the required pulse energy for treatment. The minimum pulse energy that allows visible spots on FFA was chosen as the desired treatment energy because of invisibility of SRT spots on ophthalmoscopy. SRT spots were applied immediately adjacent to the sites of foveal leakage or circumferentially around areas of PED, rather than directly targeting the leaking point, or confluent treatment over the area of PED. For treatment of leaks that were present very close to the foveal avascular zone, SRT spots were irradiated in a location up to 300 μm from the center of the fovea.

View Article: PubMed Central - PubMed

ABSTRACT

We evaluated visual outcomes, changes of maximum macular thickness (MMT) and subretinal fluid (SRF), and safety in patients with chronic central serous chorioretinopathy (CSC) after treatment with selective retina therapy (SRT). Retrospective cohort study of patients with chronic CSC presenting to a university-based hospital from January 2014 through January 2015 was conducted. A total of 12 eyes of 12 patients with chronic CSC lasting for at least 3 months was recruited. The follow-up period ranged from 3 to 12 months. Following evaluation of test spots at temporal arcades, SRT (Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser; wavelength, 527 nm, pulse duration, 1.7 microsececond) was applied to the surrounding areas of leakage observed on fluorescein angiogram and/or pigment epithelial detachment (PED). Changes in best-correct visual acuity (BCVA), MMT, and SRF and macular sensitivity (MS) by microperimetry (MP) were evaluated. Eyes received treatment in a mean of 3.83 spots at the pulse energy of 65 to 90 μJ. Mean BCVA (logMAR) improved from 0.23 ± 0.12 at baseline to 0.14 ± 0.13 at 3 months. MMT decreased from 341.4 ± 85.5 μm at baseline to 236.0 ± 57.9 μm at 3 months. SRF completely resolved in 75% (9 eyes) at 3 months. Large PEDs (2 eyes) were flattened at 3 months. Retreatment was performed in 4 eyes. MP showed no evidence of scotoma around SRT-treated lesions. SRT treatment targeting the surrounding area of leakage point showed favorable visual and structural outcomes in chronic CSC patients without the risk of scotoma.

No MeSH data available.


Related in: MedlinePlus