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Kenneth Herzl Levin, David Ellenberg, Ian Kirchner, Philip Henry Scharper; Pars Plana Vitrectomy with Internal Limiting Membrane Removal, Silicone Oil Placement and Face-Down Positioning for Refractory Chronic Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3734.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) removal, silicone oil (SO) placement and face-down positioning for treatment of refractory chronic central serous chorioretinopathy (CSCR).
A retrospective study was performed looking at patients diagnosed with CSCR since 2012. Eyes with non-active CSCR and those which responded to treatment were excluded. Eyes with chronic, refractory CSCR that underwent PPV, ILM removal, placement of 5000 centistokes of SO and face-down positioning for 7 days were included. Snellen visual acuity (VA), cube average thickness (CAT), and cube volume (CV) were analyzed immediately prior to surgery and at 3 months follow up.
64 patients with CSCR were identified. Of these, 3/64 met the inclusion criteria. Mean onset of symptoms before PPV was 5 months. At 3 months post-operatively, 1 of 3 eyes (33%) experienced improvement of VA. Two of 3 eyes (67%) showed complete resolution of sub-RPE and sub-retinal fluid on HD-OCT. Mean CAT decreased by mean 23.3 µm at 3 month follow up with a mean preoperative CAT of 293.3 µm, and a 3 months post-operative CAT of 270.0 µm. Mean CV decreased by 0.83 mm3 at 3 month follow up with a mean pre-operative CV of 11.20 mm3 and 3 month post-operative CV of 9.67 mm3. 3/3 eyes (100%) experienced cataract progression. All patients reported an improvement in metamorphopsia.
Refractory CSCR is challenging for patients and physicians. Our results demonstrate that PPV, ILM removal, SO placement and face-down positioning may be an effective last resort treatment for symptomatic, refractory CSCR. SO’s long-term tamponade effect may facilitate the resolution of sub-retinal fluid similar to its mechanism in retinal detachment repair. ILM removal assures release of potentially contributory vitreous traction. Cataract progression accounts for the VA results. Larger prospective studies are necessary.
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