Abstract
Purpose. Subthreshold diode micropulse laser (SDM) treatment is believed to be safe method of treating clinical entities involving retinal edema. We present a case of serous edematous reaction of the retina to SDM treatment. Methods. Case report. Results. A patient with chronic central serous chorioretinopathy (CSCR) was treated with SDM Yellow multispot laser. Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%. The follow-up visit two days after treatment revealed significant central retinal edema and subretinal fluid. Fundus autofluorescence image showed thermal reaction from the RPE in the form of small spots of hyperfluorescence corresponding to the laser multispot pattern used for treatment. Retinal edema resolved after topical bromfenac and single intravitreal bevacizumab injection. Slight pigmentary reaction from the RPE persisted. Conclusion. In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration.
Highlights
Subthreshold diode micropulse laser (SDM) treatment is a relatively new method of therapy of various retinal disorders, involving retinal edema and/or presence of subretinal fluid [1, 2]
Clinical entities to be treated with SDM include diabetic macular edema (DME), central serous chorioretinopathy (CSCR), and cystoid macular edema (CME) in the course of retinal vein occlusion
Presented case report of complication after multispot SDM raises a question of titration method used before this treatment and the extent of the retinal area treated in chronic CSCR
Summary
Subthreshold diode micropulse laser (SDM) treatment is a relatively new method of therapy of various retinal disorders, involving retinal edema and/or presence of subretinal fluid [1, 2]. Thanks to the presence of the intervals between short impulses, retina cools down and in the result there is no photothermal damage to the tissue The effect of this laser treatment is strictly metabolic: it stimulates the retinal tissue to produce mediators that have antiangiogenic and antiedematous action. In chronic CSCR, SDM treatment according to numerous studies helps eliminate subretinal fluid and generally promotes the regression of the disease [3,4,5] Another issue is using subthreshold technique in laser treatment. Luttrull advocates using 810 nm laser as it is much safer for the retina and does not use titration method He sets laser power parameters at 1400 mW based on his empiric experience [9, 10]. We would like to present a case of chronic central serous retinopathy with residual retinal thickening that developed sensory retinal detachment after SDM treatment
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