Abstract
This retrospective study aimed to assess the safety and efficacy of selective retina therapy (SRT) with real-time feedback-controlled dosimetry (RFD) for chronic central serous chorioretinopathy (CSC) and to evaluate factors predictive of treatment response. We included 137 eyes of 135 patients with chronic CSC. SRT was performed to cover each of the leakage areas on fundus fluorescein angiography. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were evaluated at baseline and at 3 and 6 months after treatment. Complete SRF resolution was observed in 52.6% (72/137 eyes) and 90.5% (124/137 eyes) at 3 and 6 months, respectively. Mean BCVA (logMAR) significantly improved from 0.41 ± 0.31 at baseline to 0.33 ± 0.31 at month 6 (p < 0.001). Mean CMT significantly decreased from 347.67 ± 97.38 μm at baseline to 173.42 ± 30.95 μm at month 6 (p < 0.001). Mean SRF height significantly decreased from 187.85 ± 97.56 µm at baseline to 8.60 ± 31.29 µm after 6 months (p < 0.001). Baseline SRF height was a significant predictive factor for retreatment requirement (p = 0.008). In conclusion, SRT showed favorable anatomical outcomes in patients with chronic CSC. A higher baseline SRF height was a risk factor for retreatment.
Highlights
Central serous chorioretinopathy (CSC) is characterized by idiopathic neurosensory retinal detachment at the macula with or without retinal pigment epithelium (RPE) alterations [1,2]
We retrospectively reviewed the medical records of CSC patients who underwent selective retina therapy (SRT) with real-time feedback-controlled dosimetry (RFD) between September 2016 and February 2019
Presence of an RPE atrophy area > 500 μm diameter History of conventional laser photocoagulation or PDT for CSC History of intravitreal bevacizumab injection ≤ 12 weeks prior to SRT Media opacity that could interfere with SRT irradiation or adequate acquisition of fundus fluorescence angiography (FFA), indocyanine green angiography, FAF, and optical coherence tomography (OCT) images CSC: central serous chorioretinopathy, SRT: selective retina therapy, SRF: subretinal fluid, OCT: ocular coherence tomography, FFA: fundus fluorescein angiography, AMD: age-related macular degeneration, RPE: retinal pigment epithelium, PDT: photodynamic therapy, FAF: fundus autofluorescence
Summary
Central serous chorioretinopathy (CSC) is characterized by idiopathic neurosensory retinal detachment at the macula with or without retinal pigment epithelium (RPE) alterations [1,2]. Since the adverse effects of conventional laser photocoagulation hamper its use in macular diseases, selective retina therapy (SRT) delivering microsecond pulses (1.7 μs) has been developed to produce selective RPE damage while sparing the photoreceptors and Bruch’s membrane [21]. Considering that no photoreceptor loss has been observed during RPE restoration post-SRT, the use of SRT for treating macular diseases with RPE abnormalities, such as age-related macular degeneration (AMD) and CSC, has been investigated [28,29,30,31,32,33,34,35]. As SRT micropulses disrupt RPE cells by producing short-lived microbubbles in the melanosome, optoacoustic dosimetry and reflectometry have been developed for real-time monitoring of microbubbles as RPE damage indicators.
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