Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy

Abstract

Purpose: To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes. Methods: Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months. Results: Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022). Conclusion: Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.

Functional Outcomes and Safety Profile of Trans-Foveal Subthreshold Micropulse Laser in Persistent Central Serous Chorioretinopathy

“…Moreover, different duty cycles were used, usually ranging from 5 to 15% [ 13 ]. In some studies, only the area with focal leakage, as seen on angiography, was treated [ 20 ], while in others, all areas under the neurosensory detachment were treated [ 18 ]. We believe that the SML treatment effect is in improving the RPE pump capacity; therefore, we treated our patients with high-density laser spots under the area of neurosensory detachment without sparing the fovea.…”

“…Patients in the SML treatment group had better BCVA [ 19 ] and CS [ 18 , 19 ] outcomes. Moreover, a study comparing mfERG amplitudes and implicit times in acute CSC patients with or without SML treatment showed improved amplitudes in the first and second rings in the treated group at 3 and 6 months [ 20 ]. The SML treatment strategy in this study was treatment to the leakage site only [ 20 ].…”

Multifocal Electroretinography Changes over 12 Months after Resolution of Central Serous Chorioretinopathy: Prospective Observational Study

“…Another limitation of this study is the relatively small number of patients receiving treatment as well as the limited number of treatments received. Previous studies have reported that different types of treatment rendered different results in the functional examination [23][24][25], which means that different types of treatment can lead to different mfERG outcomes. However, there are limitations to revealing the difference in the results of mfERG according to the type of treatment due to the insufficient number of patients and types of treatment.…”

Funduscopy-guided fluorescein angiography-free focal laser photocoagulation for central serous chorioretinopathy

“…The SRF accumulation in acute CSCR causes photoreceptor damage, which is persistent and manifests as decreased contrast sensitivity, micropsia, persistent scotomas even after SRF resolution. [ 7 8 ] Chronic CSCR has a poor long-term visual prognosis due to accompanying RPE atrophy and persistent NSD. [ 8 9 ] Hence, it is crucial to treat CSCR in the acute phase.…”

“…[ 7 8 ] Chronic CSCR has a poor long-term visual prognosis due to accompanying RPE atrophy and persistent NSD. [ 8 9 ] Hence, it is crucial to treat CSCR in the acute phase.…”