Early Focal Laser Photocoagulation in Acute Central Serous Chorioretinopathy: A Prospective, Randomized Study

Ambiya, Vikas; Khodani, Mitali; Goud, Abhilash; Narayanan, Raja; Tyagi, Mudit; Rani, Padmaja Kumari; Chhablani, Jay

doi:10.3928/23258160-20170630-07

Cited by 22 publications

(17 citation statements)

References 30 publications

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“…A significant reduction in SRF volume was observed already during the first 3 months. This is consistent with previous studies reporting the applicability of subthreshold laser treatment in acute CSC [7,35,36] for providing a faster visual rehabilitation than the standard of care (observation).…”

Section: Discussionsupporting

confidence: 93%

“…The criteria for selecting the most appropriate therapeutic option and also the long-term outlooks of each treatment option remain under discussion, especially for chronic and more complex forms of CSC [5,6]. The application of a subthreshold laser therapy for acute and chronic CSC has been previously validated [6][7][8][9][10][11][12][13][14][15][16]. There is also scientific evidence that supports the use of subthreshold laser therapy in eyes with chronic CSC and associated RPE defects [17].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of nanosecond laser treatment in central serous chorioretinopathy with and without atrophy of retinal pigment epithelium

Kaymak

Funk²,

Fricke³

et al. 2020

Int J Retin Vitr

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Background: To evaluate the outcomes of subthreshold nanosecond laser treatment of chronic central serous chorioretinopathy (CSC) as a function of the severity of concomitant of retinal pigment epithelium (RPE) defects. Methods: This retrospective study compares data from 23 CSC diagnosed eyes with only mild RPE defects (group 1), 16 CSC eyes with moderate RPE defects (group 2), and 17 CSC eyes having severe RPE defects (group 3). After subthreshold treatment with the standard Ellex 2RT ™ nanosecond laser (Ellex Medical Lasers Ltd, Australia), changes in macular structure and levels of subretinal fluid (SRF) were assessed by OCT-SD, OCT-A, functional integrity of the retina was assessed by corrected distance visual acuity (CDVA) and microperimetry, each at baseline and 1, 3, 6, and 12 months after initial treatment; re-treatment took place in cases of persistent SRF pro re nata. Results: During the 12 months observation period, group 1 and 2 mostly required on initial and one re-treatment (1.9 ± 1.0 treatments; 1.9 ± 1.3 treatments). In contrast, group 3 was subject to three to four treatments (3.7 ± 1.5 treatments). 6 to 12 months after treatment, subretinal fluid (SRF) disappeared in 100% of the eyes of group 1 and in 76.9%, and 42.9% of the eyes of group 2 and group 3, respectively. Retinal sensitivity and CDVA improved in group 1 and 2, but did not change significantly in group 3 during the 12 months period. Conclusions: Subthreshold nanosecond laser treatment is an effective and safe method for the restoration of macular anatomy and sensitivity in acute and chronic CSC cases with only mild or moderate RPE defects. However, this laser treatment has very limited outcome in CSC eyes with more severe RPE defects.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Efficacy of nanosecond laser treatment in central serous chorioretinopathy with and without atrophy of retinal pigment epithelium

Kaymak

Funk²,

Fricke³

et al. 2020

Int J Retin Vitr

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“…In a recent randomized trial, we reported no benefit of early laser photocoagulation, that is, within 2 months of presentation, in acute CSCR. [ 11 ] We found no significant difference between the early laser group and observation group in terms of resolution of subretinal fluid, change in retinal sensitivity, change in visual acuity (VA), and contrast VA at 6-month follow-up.…”

mentioning

confidence: 83%

Change in choroidal vascularity in acute central serous chorioretinopathy

Rasheed

Goud

Mohamed

et al. 2018

Indian J Ophthalmol

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Purpose:This study aims to compare the effect of laser photocoagulation or observation on choroidal vascularity in acute central serous chorioretinopathy (CSCR).Methods:A retrospective analysis of 30 patients with acute CSCR treated either with laser photocoagulation (16 eyes) or sham laser (14 eyes) was performed. Demographic details, visual acuity (VA) assessment, and other relevant clinical data were considered from baseline to the 3rd and 6th month follow-up visits. Participants with chronic CSCR and missing follow-up or inadequate data were excluded. Choroidal analysis including choroidal thickness and choroidal vascularity index (CVI) assessment was done for each visit using Spectral Domain (SD) Optical Coherence Tomography (OCT) images.Results:In laser arm group, there was a statistically significant change in VA, contrast sensitivity and central macular thickness (CMT) and neurosensory detachment (NSD) (P < 0.05) at the 3rd and 6th month visits. However, there was no statistically significant difference in subfoveal choroidal thickens (SFCT) and CVI (P > 0.05) at both the visits. In sham laser group, similarly, there was a significant improvement in VA, contrast sensitivity, CMT, and CVI (P < 0.05) at the 3rd and 6th month visits. There was significant reduction in NSD at the 3rd month; however, it was not statistically significant at the 6th month visit. SFCT did not change significantly at both the visits. There was no significant difference for the changes in parameters between the groups at the 6th month. Regression analysis showed no significant correlation with final VA with any of the baseline parameters.Conclusion:Early laser photocoagulation does lead to change in choroidal morphology, though insignificant, in comparison to observation. The present data, yet again, support no additional benefit of early laser photocoagulation in acute CSCR.

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“…[ 9 10 ] Other studies, however, have suggested that early focal laser photocoagulation was not better than sham laser, therefore suggesting that observation alone is more appropriate in acute CSC. [ 11 ]…”

Section: Treatment Strategies For Central Serous Chorioretinopathymentioning

confidence: 99%

Management of chronic central serous chorioretinopathy

Hanumunthadu

Tan

Singh

et al. 2018

Indian J Ophthalmol

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New treatment modalities for the management of central serous chorioretinopathy (CSC) now exist. While acute CSC generally resolves without the requirement for intervention, chronic CSC has been associated with persistent disruption in visual function. Current treatment approaches include photodynamic therapy, oral aldosterone antagonism and subthreshold multifocal laser. There has also been further investigation into a number of new treatments including antivascular endothelial growth factor treatment. Further investigation using developing optical coherence tomography imaging is helping to determine biomarkers of CSC activity, potential indicators of treatment response and indications of chronicity of disease activity. Further comparative study is required to determine the effectiveness of different forms of treatment in a range of patients with varied demographics, aetiology and chronicity of disease.

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Early Focal Laser Photocoagulation in Acute Central Serous Chorioretinopathy: A Prospective, Randomized Study

Abstract: Early laser photocoagulation is not superior to sham laser for acute CSC; therefore, observation appears to the safest and most effective strategy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:564-571.].

Cited by 22 publications

References 30 publications

Efficacy of nanosecond laser treatment in central serous chorioretinopathy with and without atrophy of retinal pigment epithelium

Efficacy of nanosecond laser treatment in central serous chorioretinopathy with and without atrophy of retinal pigment epithelium

Change in choroidal vascularity in acute central serous chorioretinopathy

Management of chronic central serous chorioretinopathy

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