First Author: D.Maltsev RUSSIA
Co Author(s): A. Kulikov
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Nowadays, optical coherence tomography (OCT) allows to confirm the great majority of characteristic findings in central serous chorioretinopathy (CSC), except for leakage point. At the same time, identification of leakage point is a critical step for focal laser photocoagulation (FLP). Fluorescein angiography (FA)-free identification of leakage point appears to be attractive since it could significantly reduce the need for FA in CSC patients. The purpose of the study was to describe the first clinical experience with the application of the FA-free OCT guided navigated FLP to the treatment of patients with CSC.
This prospective interventional study was conducted at Military Medical Academy, St. Petersburg, Russia.
Only symptomatic patients with non-resolved CSC were included in the study. Inclusion criteria were: (1) duration of CSC >4 months; (2) presence of a single retinal pigment epithelium detachment (PED); (3) location of the PED in upper half of retinal detachment area; (4) presence of photoreceptor outer segments (PROS) thinning area overlapping with the PED. In all patients, an OCT examination was performed using RTVue-100. En face images were produced to point out the PED which coincided with presumed leakage point. Presence of leakage in presumed leakage point was confirmed by identification of PROS thinning. En face image with presumed leakage point shown was imported into the NAVILAS 532 system. Laser spot marks were placed at the site of presumed leakage point with spot size 100 μm, burn spacing of 1 burn-widths apart and pulse duration 100 ms. Primary outcome measure was subretinal fluid resolution time on OCT. Secondary outcome measures included change in best corrected visual acuity (BCVA) score after subretinal fluid resolution compared to baseline and total number of shots for each leakage point.
Eight patients (7 men and 1 women) ranging between 34 and 60 years (mean: 43.9 ± 6.0 years) with unilateral acute non-resolving symptomatic SCS were included in this prospective interventional study. Of the eight eyes, six were emmetropic and two were hyperopic. The mean duration of symptoms before diagnosis was 14.7 ± 9.0 weeks. All patients were undergoing FA-free FLP of presumed leakage point that include a mean 3.3 ± 0.5 laser burns applied in the area of presumed leakage point. During the follow-up, complete resolution of subretinal fluid occurred in all treated eyes within mean time of 7.3 ± 1.0 weeks. BCVA before treatment and at the end of mean follow-up of 28.6 ± 26.1 weeks was 0.13 ± 0.07 and -0.01 ± 0.06 LogMAR, respectively. During the follow-up, there were no adverse events associated with laser application.
This study showed that, PED located to upper half of the retinal detachment area and overlapping with PROS thinning area, appears to be a reliable indicator of leakage point in eyes with CSC. This study also demonstrated effectiveness and safety of FA-free OCT guided approach for planning of navigated FLP of leakage point in CSC treatment. Nevertheless, selection of patients and strict adherence to algorithm of identification of presumed leakage point are critical for this procedure. This procedure was easy to perform using navigated laser system but also can be replicated by most laser surgeons using conventional laser systems. We believe that this surgical technique is a good option for a significant number of CSC patients.