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A comparative analysis of the efficacy of subthreshold micropulse 577-nm yellow laser versus 577 nm green laser for central serous chorioretinopathy

Session Details

Session Title: New Drug Treatment

Session Date/Time: Saturday 13/09/2014 | 14:30-16:30

Paper Time: 16:06

Venue: Boulevard F

First Author: : A.Rajendran INDIA

Co Author(s): :    V. TP   K. Ramasamy           

Abstract Details

Purpose:

To determine and compare the efficacy of subthreshold micropulse yellow laser (SMYL) with the standard 532 nm green laser (GL) in the treatment of central serous chorioretinopathy (CSCR).

Setting:

A large tertiary retina in Southern India

Methods:

The study was a comparative, interventional case series. Patients included were those with recurrent CSCR or CSCR persistent beyond 3 months and were treatment naïve. All patients underwent a clinical examination, spectral-domain (Spectralis) OCT,FFA, Autofluorescence (AF) at baseline and serial followup visits. Patients (SMYL group) who had undergone focal 577 nm SMYL with a 6-month followup ( July to December 2012) were compared with those (GL gp) who had undergone focal 532 nm Green laser with a 6-month followup in the preceding six months ( January to June 2012). Patients were administered focal subthreshold micropulse yellow laser (SMYL), the IQ 577nm laser -treatment parameters used were -100µm spot size, 5% Duty Cycle, 200ms duration. Preliminary test burns were used to ascertain the power at which a mildly visible (threshold) burn was obtained, a 50% reduction in value of which was used for therapy. Standard treatment with GL involved 50-100µm size, 100 ms laser spots.

Results:

Of the 39 patients in the study, 18 underwent 577nm SMYL and 21 underwent 532nm GL. 34 were males; the average age was 34.8 years. 16 (88.9%) in SMYL group and 18 (85.7%) in GL group had complete resolution of CSCR at the 6-month followup visit. Mean baseline LogMAR best corrected visual acuity (LCVA) in the SMYL group was 0.35 (SD:0.15) and in GL group, 0.41(SD:0.16) and the 2 groups showed no statistically significant difference(p=0.241). Mean 6mth LCVA in the SMYL group was 0.08 (SD:0.10) and in the GL group 0.15(SD:0.13),with an insignificant difference between the 2 (p=0.064). The mean LCVA improvements in both the groups were significant – SMYL (p=0.0003); GL (p=0.0002). A 3-line vision improvement was seen in 4(22.2%) SMYL; 3(14.3%) GL group. The mean baseline subretinal fluid was similar [SMYL-316.7 µm, GL-274.5 µm (p=0.622)]. More patients with final LCVA 6/6 were noted in SMYL group 11(61.1%) ; GL -8 (42.8%). Negligible AF laser spots were noted in the SMYL group.

Conclusions:

Subthreshold Micropulse Yellow Laser ( 577 nm) is safe and efficacious in the treatment of persistent or recurrent CSCR. It compares favourably with the standard of care 532nm Green laser. SMYL had a significantly higher percentage of patients achieving 6/6 corrected vision at final followup and appears to have, on the basis of the low post-treatment AF, minimal tissue-destructive effects. It may be considered, hence, especially for patients with good baseline vision and subfoveal leaks.

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