Subthreshold laser therapy with a standardized macular treatment pattern in chronic central serous chorioretinopathy

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 259; no. 11; pp. 3271 - 3281
• Main Authors: Schworm, Benedikt, Siedlecki, Jakob, Keidel, Leonie F., Herold, Tina R., Luft, Nikolaus, Priglinger, Siegfried G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2021; Springer Nature B.V
• Subjects: Acuity; Adult; Aged; Central Serous Chorioretinopathy - diagnosis; Central Serous Chorioretinopathy - drug therapy; Central Serous Chorioretinopathy - surgery; Chronic Disease; Fluorescein Angiography; Humans; Laser Therapy; Lasers; Medicine; Medicine & Public Health; Middle Aged; Ophthalmology; Patients; Photochemotherapy; Photodynamic therapy; Prospective Studies; Retinal Disorders; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Nondamaging laser; Subthreshold laser; Central serous chorioretinopathy; Macular pattern; Chronic central serous chorioretinopathy; Laser treatment; Pachychoroid
• ISSN: 0721-832X; 1435-702X; 1435-702X
• DOI: 10.1007/s00417-021-05256-3

Purpose There is an ongoing controversial debate about the effectiveness of laser treatments in chronic central serous chorioretinopathy (cCSC). We performed a prospective non-randomized interventional study to learn about the effects of a subthreshold laser treatment (Topcon Endpoint Management™, Topcon Healthcare Inc., Tokyo, Japan) in patients with cCSC. Methods Patients with cCSC and a minimum symptom duration of 4 months were included and treated with a standardized laser pattern covering the macular area. Retreatment was performed every 3 months if persistent subretinal fluid was observed. The primary endpoint was resolution of subretinal fluid at 6 months. Further outcome parameters included best corrected visual acuity, microperimetry, central macular and subfoveal choroidal thickness. Results A total of 42 eyes of 39 patients were included. Mean patient age was 48 ± 10.6 years (range 25–67). Mean symptomatic time before inclusion into the study was 134 ± 133.4 weeks (16–518). Before inclusion, 78.6% of the patients had failed to resolve subretinal fluid under mineralocorticoid receptor antagonists and 14.3% had a recurrence after half-dose photodynamic therapy. Complete resolution of subretinal fluid was observed in 42.9% at 6 months and in 53.8% at 12 months after baseline. Central retinal thickness decreased from 398 ± 135 µm to 291 ± 68 µm (p < 0.001), subfoveal choroidal thickness changed slightly (430 ± 116 µm to 419 ± 113 µm, p = 0.026), microperimetry-derived macular function improved by 19.1 ± 4.7 dB to 21.3 ± 4.8 dB (p = 0.008) and mean BCVA improved by 4.9 ± 8.6 ETDRS letters (p < 0.001). Conclusion The results show that the investigated laser treatment is effective in reducing subretinal fluid and leads to an improvement of functional parameters.