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

Abstract

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.

Laser Treatment of Central Serous Chorioretinopathy – An Update

“…The percentage of optimal morphological response is usually reported at the level of 50-60 % [45,46], with just one study providing very optimistic results of 90 % at 6 months [44]. SRT also has the potential of providing a faster SRF resolution compared to the control group [52].…”

“…We identified just two studies on the subject published in recent 5 years. Kaymak et al reports results of CSCR treatment with a 2RT laser in 3 groups of patients, depending on the extent of RPE defects: 23 eyes with mild RPE defects (group 1) and a duration of symptoms > 3 months, 16 eyes with moderate RPE defects (group 2) and symptoms persisting for > 8 months, and 17 CSC eyes with severe RPE defects (group 3) and a duration of > 24 months [52]. Patients were followed regularly for 12 months post-laser.…”

Update on the Management of Central Serous Chorioretinopathy

“…Retrospective study in acute and chronic CSCR has shown favorable outcomes in visual and anatomic measures, suggesting that nanosecond laser may be an attractive therapy for future study with more robust prospective RCTs and comparison trials. 48,49 ' Mineralocorticoid antagonists Elevated systemic endogenous steroid hormone levels have been demonstrated in CSCR, 50 and the expression of components of the reninangiotensin-aldosterone-system has been demonstrated in retinal tissue. 51 Mineralocorticoid activation may be involved in the process of retinal hydration as aldosterone enhances the expression of retinal ion and water channels as supported by one study where intravitreal injection of aldosterone in rats induced retinal edema.…”

“…Nanosecond laser, a novel type of micropulse therapy for CSCR, iterates on SMPL by delivering even shorter pulses of laser energy which may be even more selective for the RPE and confer less collateral thermal injury risk. Retrospective study in acute and chronic CSCR has shown favorable outcomes in visual and anatomic measures, suggesting that nanosecond laser may be an attractive therapy for future study with more robust prospective RCTs and comparison trials 48,49 …”

OCT biomarkers related to subthreshold micropulse laser treatment effect in central serous chorioretinopathy

“…It is thought SML targets retinal pigment epithelium (RPE) and stimulates functional RPE to drain SRF into choroidal circulation [ 9 ]. One recent study showed the efficacy of SML is related to RPE function [ 16 ]: SML is effective for restoring macular anatomy and visual sensitivity in CSCR cases with mild or moderate RPE defects; in contrast, it has only a minimal outcome in CSCR eyes with severe RPE defects. Moreover, previous studies have shown that older age, higher choroidal thickness, and inner choroid attenuation are related to CSCR duration and visual recovery [ 17 – 19 ].…”