Limits...
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

Scatter plot of reflectometry and optoacustic dosimetry demonstrating the value of each test spot. In this study, 68 of 73 test spots showed hyperfluorescence on fundus fluorescein angiography (FFA) and no overtreatment was observed in any of the selective retina therapy (SRT) spots. Spots without cell damage (FFA invisible; red circles) and selective damaged retinal pigment epithelium cells (FFA visible; green circles) are shown. The energy of treatment spots was chosen among FFA-positive spots within the range of the blue rectangle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998269&req=5

Figure 2: Scatter plot of reflectometry and optoacustic dosimetry demonstrating the value of each test spot. In this study, 68 of 73 test spots showed hyperfluorescence on fundus fluorescein angiography (FFA) and no overtreatment was observed in any of the selective retina therapy (SRT) spots. Spots without cell damage (FFA invisible; red circles) and selective damaged retinal pigment epithelium cells (FFA visible; green circles) are shown. The energy of treatment spots was chosen among FFA-positive spots within the range of the blue rectangle.

Mentions: Since SRT spots are not discernable as grey or white lesions during irradiation, both optoacoustic and reflectometric dosimetry could be used as SRT endpoint references. Briefly, optoacoustic method detects microbubble-related pressure transients from the damaged RPE.18–20 On the other hand, reflectometry detects signals of the back-scattered light, providing an optical feedback value (OFV). The endpoint of SRT is selective RPE cell damage, produced by laser-induced intracellular microbubble formation. Overtreatment can be indicated by high OFV with large bubbles, while the absence of microbubbles demonstrates undertreatment.20,21 Although the dosimetry values were not used as treatment endpoints in this study, 2 dosimetry values of test spots were analyzed in association with therapeutic endpoints including ophthalmoscopically invisible and FFA visible lesions. We evaluated 73 test spots (from 65 to 120 μJ) of 12 patients to optimize the dosimetry algorithm. We did not include treatment spots (from 65 to 90 μJ) in the analysis because the visibility on FFA could be affected by SRF. In this study, while 68 of 73 test spots showed hyperfluorescence on FFA, no overtreatment was observed in any of the SRT spots. Since 5 of 73 test spots were negative on FFA, we did not consider its energies for treatments (Figure 2).


Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy
Scatter plot of reflectometry and optoacustic dosimetry demonstrating the value of each test spot. In this study, 68 of 73 test spots showed hyperfluorescence on fundus fluorescein angiography (FFA) and no overtreatment was observed in any of the selective retina therapy (SRT) spots. Spots without cell damage (FFA invisible; red circles) and selective damaged retinal pigment epithelium cells (FFA visible; green circles) are shown. The energy of treatment spots was chosen among FFA-positive spots within the range of the blue rectangle.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Scatter plot of reflectometry and optoacustic dosimetry demonstrating the value of each test spot. In this study, 68 of 73 test spots showed hyperfluorescence on fundus fluorescein angiography (FFA) and no overtreatment was observed in any of the selective retina therapy (SRT) spots. Spots without cell damage (FFA invisible; red circles) and selective damaged retinal pigment epithelium cells (FFA visible; green circles) are shown. The energy of treatment spots was chosen among FFA-positive spots within the range of the blue rectangle.
Mentions: Since SRT spots are not discernable as grey or white lesions during irradiation, both optoacoustic and reflectometric dosimetry could be used as SRT endpoint references. Briefly, optoacoustic method detects microbubble-related pressure transients from the damaged RPE.18–20 On the other hand, reflectometry detects signals of the back-scattered light, providing an optical feedback value (OFV). The endpoint of SRT is selective RPE cell damage, produced by laser-induced intracellular microbubble formation. Overtreatment can be indicated by high OFV with large bubbles, while the absence of microbubbles demonstrates undertreatment.20,21 Although the dosimetry values were not used as treatment endpoints in this study, 2 dosimetry values of test spots were analyzed in association with therapeutic endpoints including ophthalmoscopically invisible and FFA visible lesions. We evaluated 73 test spots (from 65 to 120 μJ) of 12 patients to optimize the dosimetry algorithm. We did not include treatment spots (from 65 to 90 μJ) in the analysis because the visibility on FFA could be affected by SRF. In this study, while 68 of 73 test spots showed hyperfluorescence on FFA, no overtreatment was observed in any of the SRT spots. Since 5 of 73 test spots were negative on FFA, we did not consider its energies for treatments (Figure 2).

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