Abstract
Purpose. To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC). Methods. Thirty-three eyes of 30 patients with chronic CSC received either PDT (18 eyes) or SMYL (15 eyes) therapy. Best corrected visual acuity (BCVA), subretinal fluid (SRF) height, and central macular thickness (CMT) were evaluated at the baseline visit and one, three, six, nine, and 12 months after the therapy. Results. After 12 months, mean BCVA improved from 67.3 ± 14.2 to 71.5 ± 21.4 ETDRS letters in SMYL group and from 60.7 ± 16.3 to 64.4 ± 24.9 ETDRS letters in PDT group (p = 0.285 and p = 0.440, resp.). Mean CMT decreased from 242.8 ± 80 μm to 156.9 ± 60 μm in the PDT group and from 287.3 ± 126 μm to 138.0 ± 40 μm in the SMYL group (p = 0.098 and p = 0.003, resp.). SRF resolved completely in 72.2% and 80.0% of the eyes in the PDT and SMYL groups, respectively. Mean SRF height decreased from 117.2 ± 58 μm to 31.3 ± 56 μm in the PDT group and from 130.0 ± 104 μm to 12.5 ± 21 μm in the SMYL group (p = 0.031 and p = 0.014, resp.). Conclusions. Subthreshold micropulse yellow wavelength laser seems to be effective in the treatment of chronic CSC without any side effect and results in the resorption of SRF without causing visible retinal scarring.
Highlights
Central serous chorioretinopathy (CSC) is a disorder of unknown etiology characterized by detachment of the neurosensory retina due to accumulation of serous fluid between the retinal pigment epithelium (RPE) and photoreceptor layers
The diagnosis of chronic CSC was confirmed by clinical examination, spectral domain optical coherence tomography (SD-OCT) (Spectralis; Heidelberg Engineering, Inc., Heidelberg, Germany), fundus fluorescein angiography (FA), indocyanine green angiography (ICGA), and fundus autofluorescence (FAF) imaging (Heidelberg Retina Angiograph 2; Heidelberg Engineering, Heidelberg, Germany)
The photodynamic therapy (PDT) group was older than the subthreshold micropulse yellow wavelength laser (SMYL) group (52.7 ± 11.2 years versus 44.7 ± 9.5, resp.; p = 0.037), and the duration of chronic CSC prior to treatment was longer in the PDT group (18.8 ± 13.5 months versus 13.0 ± 9.1 months, resp.; p = 0.330)
Summary
Central serous chorioretinopathy (CSC) is a disorder of unknown etiology characterized by detachment of the neurosensory retina due to accumulation of serous fluid between the retinal pigment epithelium (RPE) and photoreceptor layers. In chronic CSC, the longterm persistence (longer than six months) of subretinal fluid (SRF) can result in atrophy of the RPE, cystoid retinal degeneration, choroidal neovascularization, and permanent vision loss [1, 2]. It has been reported that PDT with verteporfin induces the resorption of SRF by reducing choroidal vascular hyperpermeability [9, 10]. It has the potential for serious side effects, such as choroidal ischemia, RPE atrophy, and iatrogenic choroidal neovascularization [11, 12]. Newer PDT protocols, including half-dose [13] and low-fluence [14] applications, have been developed
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