First Author: A.Hamoud UK
Co Author(s): S. Younis C. Quijano
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Chronic central serous chorioretinopathy (CSCR) is disease characterized by localized fluid accumulation underneath the neuroretina. This can cause irreversible visual loss due to progressive and permanent photoreceptor damage and/or RPE atrophy. Yet the effective treatment for CSCR is still unknown. Sub threshold micropulse yellow laser technology controls thermal elevation by cutting a continuous-wave beam into repetitive short pulses have been recently used to treat CSR and have shown some efficacy in CSCR patients with subfoveal and extrafoveal leakage sites. We aim to assess the response and safety of subthreshold micropulse laser 577-nm (SML) treatment in patients with chronic CSCR.
Macula clinic, Western Eye Hospital, Imperial Healthcare NHS Trust, London UK
We performed a retrospective observational review of the clinical notes of 16 eyes of 16 patients diagnosed with chronic CSCR treated with one session of sub threshold yellow laser (Quantel Medical, Supra scan 577nm laser) for their macula condition. Patients received subthreshold micropulse yellow laser photocoagulation at 5% duty cycle at a reduced energy level from the micropulse laser test burs. Laser exposure time was 20 ms, and the spot diameter was 100 microns. Inclusion criteria was CSCR suffered for minimum 6 months, no previous treatment for this condition, loss of vision and subretinal fluid secondary to chronic CSCR when the treatment was performed. The evidence collected from the medical notes included: age, gender, laterality, duration of the CSR, best corrected visual acuity (BCVA) pre- and post-treatment, central macular thickness (CMT) pre- and post-treatment, retina changes post-treatment. Cirrus HD-OCT scan, fundus autofluorescence and fundus colour photos were taken.
Mean age of patients at treatment 47 years old (range 35-54). The mean duration of the CSCR was 26 months (range 9-52). The measurement after treatment was after 6 weeks. Two thirds of the patients responded to treatment, improving the macula profile and reducing the subretinal fluid. The mean CRT measured by OCT pre-treatment changed from 364 ± 84 microns to 279±67 μm post-treatment (P<0.03), showing a 24% average reduction in fluid height. There was no evidence of retinal pigment epithelium or retinal damage on SD-OCT, FFA, or fundus autofluorescence, (3 patients showed changes in the RPE in the autofluorescence) The BCVA changed from 0.35 ±0.27 LogMAR pre-treatment to 0.33 ± 0.31 (P<0.8).
Sub threshold micropluse yellow laser photocoagulation is a safe and effective treatment option for chronic CSCR. There was no evidence of retinal damage after the treatment. The BCVA did not improve significantly and this likely to be because of the chronic nature of the disease in our patients. We may try this treatment with acute CSCR, and in such cases we would expect better results. Future research with larger samples and a longer period of time for treatment is required.