April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Photothermal Stimulation of the Macula for Treatment of Chronic Central Serous Retinopathy
Author Affiliations & Notes
  • Daniel Lavinsky
    Ophthalmology and HEPL, Stanford University, Stanford, CA
    Ophthalmology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
  • Daniel V Palanker
    Ophthalmology and HEPL, Stanford University, Stanford, CA
  • Footnotes
    Commercial Relationships Daniel Lavinsky, TMLS (C); Daniel Palanker, TMLS (C), TMLS (P)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 6346. doi:
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      Daniel Lavinsky, Daniel V Palanker; Photothermal Stimulation of the Macula for Treatment of Chronic Central Serous Retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6346.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To assess safety and clinical efficacy of the photothermal stimulation of the macula for treatment of the chronic central serous retinopathy (CSR).

 
Methods
 

Sixteen eyes of 16 patients with chronic CSR (longer than 4 months duration) were treated with the PASCAL Streamline (TMLS, USA) at 577nm wavelength, using 200μm retinal spot sizes. Using EndPoint Management Software the laser power was first titrated for a barely visible burn with 15ms pulses, which was defined as a 100% pulse energy. Treatment was then applied over the area of serous retinal detachment and adjacent non-thickened retina, using 30% pulse energy with spot spacing of 0.25 beam diameter. Changes in ETDRS best corrected visual acuity and central macular thickness were measured over 6 months follow-up. Pre- and post-treatment fluorescein angiography (FA) and fundus autofluorescence (FAF) were also assessed.

 
Results
 

On average, 532 spots have been applied per treatment. No visible laser marks could be detected either by clinical observation, OCT, FAF or FA. An average, 12 ETDRS letters gain was achieved at 6 months. Central macular thickness decreased from 350μm to 297μm, with central maximum thickness reduction of -64μm. 37% of the patients resolved after one treatment, however 44% required retreatment after 3 months due to recurrent fluid or incomplete fluid resolution and the remaining patients received a second retreatment. Again, no visible damage to the retina after a second treatment could be seen, but visual acuity and resolution of residual fluid improved.

 
Conclusions
 

Photothermal stimulation using 577nm PASCAL laser with EndPoint Management GUI was safe and it improved visual acuity and resolution of subretinal fluid in chronic CSR. Lack of tissue damage allows periodic retreatment without cumulative scaring characteristic to conventional photocoagulation. This technique should be tested in larger clinical trials and it may offer an alternative to conventional laser therapy of the macula either alone or in association to anti-VEGF pharmacological treatments.

 
 
54 years old male presented with decreased visual acuity OU for 6 months. Visual acuity was 20/100 OD and 20/25 OS and OCT showed bilateral chronic CSR. Figure shows baseline OCT of left eye, one month and two months after photo-thermal stimulation using EndPoint Management software.
 
54 years old male presented with decreased visual acuity OU for 6 months. Visual acuity was 20/100 OD and 20/25 OS and OCT showed bilateral chronic CSR. Figure shows baseline OCT of left eye, one month and two months after photo-thermal stimulation using EndPoint Management software.
 
Keywords: 578 laser • 688 retina • 585 macula/fovea  
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