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N. Hussain, R. Khanna, A. Hussain, T. Das; Transpupillary Thermotherapy for Chronic Central Serous Chorioretinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4065.
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Purpose:To evaluate the role of Transpupillary thermotherapy in the resolution of neurosensory detachment associated with Chronic central serous chorioretinopathy Methods: A prospective pilot study was done during the period from December 2003 to July 2004. Patients diagnosed to have Chronic CSC characterised by persistent serous elevation of macula > 3 months, recurrent episodes > 3, associated Retinal pigment epithelial window defects and multiple leaks or leaks of undetermined source on FFA, presence of choroidal hyperpermeabilty on ICG and neurosensory detachment of the macula on OCT. All patients underwent LogMAR VA assessment, slit lamp biomicroscopy, applanation tonometry, fundus examination, FFA/ICG and OCT. In the follow up visit, VA assessment and OCT was done. The follow up visit was scheduled at one month, two months and three months following treatment. Success was defined as resolution of neurosensory detachment on OCT at the end of 3 months and failure as persistence of subretinal fluid.TTT was done with duration either 45 or 30 seconds with 810 nm diode laser. The primary outcome measure was resolution of neurosensory detachment on OCT and secondary outcome measure was visual acuity at the end of 3 months. Results: 14 eyes of 13 patients were recruited who completed at least 3 months follow up. The initial VA ranged from 0.2 – 1.0 (mean: 0.5 + 0.25). The ICG characteristics seen were choroidal hyperpermeability, fibrin stain and relative hypofluorescences due to pigment epithelial detachment (PED). FFA showed RPE window defects, multiple leaks and also subfoveal leaks. The TTT power ranged from 90 – 250 mW (Mean: 156.4 + 47.8), spot size: 1.0 – 5.0 mm (mean: 2.2 + 1.1; median: 1.8) and duration: 30 secs (5 eyes); 45 secs (9 eyes). The final VA at 3 months ranged from 0 – 0.9 (mean: 0.2 + 0.24). Following treatment, there was significant difference in VA compared to pretreatment (P=0.005). In 3 eyes, the VA remained the same. In these 2 eyes, there was persisting serous elevation. At month 1, 9 eyes (64.3%) showed complete resolution on OCT (P=0.004), 2 eyes (14.3%) showed decrease in the height of neurosensory elevation suggesting resolving status and 3 eyes (21.4 %) did not show any sign of resolution. At month 2, 11 eyes (78.6%) had complete resolution, which was also seen at month 3 (P=0.001). Conclusions: Transpupillary thermotherapy aids in the rapid resolution of serous detachment associated in patients with chronic CSC.
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