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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.

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Case 7: A 46-year-old woman presented with a 3-month history of distortion of central vision in the right eye. Her right best-correct visual acuity (BCVA) was 20/32. Selective retina therapy (SRT) was applied to the area surrounding the pigment epithelial detachment (PED). Subretinal fluid (SRF) resolved markedly and PED was flattened prominently in 1 week. Both SRF and PED disappeared within 3 months. The BCVA improved to 20/20 in her right eye. (A) Large SRF (white arrowheads) with PED (yellow arrowhead) was observed on fundus fluorescein angiography (FFA) at baseline. (B) FFA demonstrated nine SRT laser spots (yellow arrows) surrounding PED at 1 week after SRT treatment. (C) Microperimetry (MP) performed 4 months after SRT treatment showed no significant decrease or scotoma change at SRT-treated regions. (D) Baseline optical coherence tomography (OCT) showed PED (red arrowhead) and large SRF. (E) PED and SRF were rapidly decreased at 1 week after SRT treatment. (F) The SRF and PED were completely resolved at 3 months after SRT.
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Figure 5: Case 7: A 46-year-old woman presented with a 3-month history of distortion of central vision in the right eye. Her right best-correct visual acuity (BCVA) was 20/32. Selective retina therapy (SRT) was applied to the area surrounding the pigment epithelial detachment (PED). Subretinal fluid (SRF) resolved markedly and PED was flattened prominently in 1 week. Both SRF and PED disappeared within 3 months. The BCVA improved to 20/20 in her right eye. (A) Large SRF (white arrowheads) with PED (yellow arrowhead) was observed on fundus fluorescein angiography (FFA) at baseline. (B) FFA demonstrated nine SRT laser spots (yellow arrows) surrounding PED at 1 week after SRT treatment. (C) Microperimetry (MP) performed 4 months after SRT treatment showed no significant decrease or scotoma change at SRT-treated regions. (D) Baseline optical coherence tomography (OCT) showed PED (red arrowhead) and large SRF. (E) PED and SRF were rapidly decreased at 1 week after SRT treatment. (F) The SRF and PED were completely resolved at 3 months after SRT.

Mentions: The mean MMT improved from 341.4 ± 85.5 μm before SRT treatment to 298.5 ± 69.2 μm at 1 month (P = 0.192), 277.7 ± 59.7 μm at 2 months (P = 0.048), and 236.0 ± 57.9 μm at 3 months after SRT (P = 0.008) (Figure 3C). Changes in MMT from baseline to month 3 are shown in Figure 3D. SRF was completely resolved in all 12 eyes. Among 12 eyes, the complete resolution of SRF periodically occurred in 2 eyes by month 1, 5 eyes by month 2, 9 eyes by month 3, 11 eyes by month 4, and 12 eyes by month 6 after SRT treatment (Figure 4). The mean SRF thickness decreased from 205.7 ± 145.5 μm before SRT treatment to 115.1 ± 78.9 μm at 1 month (P = 0.071), 73.0 ± 76.5 μm at 2 months (P = 0.011), and 30.0 ± 54.8 μm at 3 months after SRT (P = 0.001) (Figure 4). Of the 9 eyes with PED, 4 eyes had PED as the cause of leakage in FFA. After PED was treated circumferentially with SRT, PED disappeared in 2 eyes (Figures 5 and 6) and decreased in size in the other 2 eyes.


Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy
Case 7: A 46-year-old woman presented with a 3-month history of distortion of central vision in the right eye. Her right best-correct visual acuity (BCVA) was 20/32. Selective retina therapy (SRT) was applied to the area surrounding the pigment epithelial detachment (PED). Subretinal fluid (SRF) resolved markedly and PED was flattened prominently in 1 week. Both SRF and PED disappeared within 3 months. The BCVA improved to 20/20 in her right eye. (A) Large SRF (white arrowheads) with PED (yellow arrowhead) was observed on fundus fluorescein angiography (FFA) at baseline. (B) FFA demonstrated nine SRT laser spots (yellow arrows) surrounding PED at 1 week after SRT treatment. (C) Microperimetry (MP) performed 4 months after SRT treatment showed no significant decrease or scotoma change at SRT-treated regions. (D) Baseline optical coherence tomography (OCT) showed PED (red arrowhead) and large SRF. (E) PED and SRF were rapidly decreased at 1 week after SRT treatment. (F) The SRF and PED were completely resolved at 3 months after SRT.
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Figure 5: Case 7: A 46-year-old woman presented with a 3-month history of distortion of central vision in the right eye. Her right best-correct visual acuity (BCVA) was 20/32. Selective retina therapy (SRT) was applied to the area surrounding the pigment epithelial detachment (PED). Subretinal fluid (SRF) resolved markedly and PED was flattened prominently in 1 week. Both SRF and PED disappeared within 3 months. The BCVA improved to 20/20 in her right eye. (A) Large SRF (white arrowheads) with PED (yellow arrowhead) was observed on fundus fluorescein angiography (FFA) at baseline. (B) FFA demonstrated nine SRT laser spots (yellow arrows) surrounding PED at 1 week after SRT treatment. (C) Microperimetry (MP) performed 4 months after SRT treatment showed no significant decrease or scotoma change at SRT-treated regions. (D) Baseline optical coherence tomography (OCT) showed PED (red arrowhead) and large SRF. (E) PED and SRF were rapidly decreased at 1 week after SRT treatment. (F) The SRF and PED were completely resolved at 3 months after SRT.
Mentions: The mean MMT improved from 341.4 ± 85.5 μm before SRT treatment to 298.5 ± 69.2 μm at 1 month (P = 0.192), 277.7 ± 59.7 μm at 2 months (P = 0.048), and 236.0 ± 57.9 μm at 3 months after SRT (P = 0.008) (Figure 3C). Changes in MMT from baseline to month 3 are shown in Figure 3D. SRF was completely resolved in all 12 eyes. Among 12 eyes, the complete resolution of SRF periodically occurred in 2 eyes by month 1, 5 eyes by month 2, 9 eyes by month 3, 11 eyes by month 4, and 12 eyes by month 6 after SRT treatment (Figure 4). The mean SRF thickness decreased from 205.7 ± 145.5 μm before SRT treatment to 115.1 ± 78.9 μm at 1 month (P = 0.071), 73.0 ± 76.5 μm at 2 months (P = 0.011), and 30.0 ± 54.8 μm at 3 months after SRT (P = 0.001) (Figure 4). Of the 9 eyes with PED, 4 eyes had PED as the cause of leakage in FFA. After PED was treated circumferentially with SRT, PED disappeared in 2 eyes (Figures 5 and 6) and decreased in size in the other 2 eyes.

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