Subthreshold laser compared to spironolactone in treatment of chronic central serous retinopathy

Abstract

AbstractPurposeTo compare clinical and morphological outcomes of Subthreshold Laser and Spirolonactone in treatment of chronic central serous retinopathy (CSR).MethodsPatients with chronic CSR (visual symptoms > 6 months) treated either with Subthreshold Laser or Spirolonactone were recruited. Patients data were recorded at four time points: at initiation of treatment, at 1 month, at 3 months and at the last follow up possible. Main outcome measures included best‐corrected visual acuity (BCVA), central macular thickness (CMT), location and height of subretinal fluid (SRF), degree of photoreceptors outer segments (POS) damage, presence of pigmented epithelium detachment (PED), integrity of retinal pigmented epithelium (RPE).ResultsForty‐seven eyes of 45 patients and 45 eyes of 42 patients were included in the Subthreshold Laser and Spirolonactone groups, respectively. Mean number of sessions of Subthreshold Laser per patient was 1.36 ± 0.5, while mean number of Spirolonactone cycles was 1.66 ± 1.0. In patients undergoing Subthreshold Laser, BCVA did not significantly improve at all timepoints, while patients undergoing Spirolonactone showed increased visual acuity in the long term (p = 0.011), but not at 1 month and at 3 months. Both Subthreshold Laser and Spirolonactone significantly improved CMT, CFT, SRF at all timepoints (all p < 0.05). Spirolonactone allowed a significantly higher CMT and SRF decrease compared to Subthreshold Laser at 3 months (p = 0.048 and 0.036, respectively). Spirolonactone side effects occured in 5 patients (11%), while none of patients in the Subthreshold Laser group developed RPE atrophy.ConclusionsTreatments with Subthreshold Laser and Spirolonactone are effective in fluid reduction at every time point in chronic CSR, while not giving substantial improvement in visual acuity at 1 month and at 3 months. Spirolonactone allows a significantly higher visual recovery in the long term, while allowing a significantly higher fluid reabsorption at 3 months compared to Subthreshold Laser.