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Valerie Chen, Keshav Narain; Subthreshold Focal Grid Laser for Central Serous Chorioretinopathy: Retrospective Review. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5344.
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© ARVO (1962-2015); The Authors (2016-present)
To see if microperimetry (MP) guided, subthreshold, 532 nm, grid laser can be safely used to treat central serous chorioretinopathy (CSR) and improve visual acuity (VA) in patients who failed to respond to lifestyle modification.
Baseline evaluation and diagnosis required dilated exam, OCT, fluorescein angiograph, and MP. 35 eyes of 34 CSR patients were included in this 7-year retrospective review. All patients were encouraged to improve sleep hygiene, reduce stress, and reduce caffeine intake (lifestyle modification) for a period of 1-3 months. 23 eyes of 22 patients (20 male, 2 female) that did not improve received laser. A total of 11 eyes (10 male, 1 female) were placed in the non-laser group due to spontaneous improvement by the second visit or refusal of laser.
Laser treated eyes all showed an overall improvement in VA within six visits over a 9-12 month period. Mean logMAR VA improved from 0.38 ±0.16 (p <0.07) to 0.18±0.06 (p <0.07). The median logMAR VA was 0.3 (20/60) at date of initial diagnosis and logMAR VA 0 (20/20) at final follow up. Of the 23 lasered eyes,14 demonstrated improvement in VA and OCT by the first post-treatment visit. Of the 11 non-treated patients, 8 had spontaneously improved while 3 withheld from treatment. No laser-associated side effects were noted in any of the treated eyes.
Rates of spontaneous improvement without treatment are consistent with reports on natural history of CSR. Visual recovery in 14 out of 23 (60%) laser-treated patients after the first post-treatment visit suggests an earlier therapeutic benefit. Patients that did not resolve spontaneously or receive laser eventually recovered to VA 20/30 or better, but had significant scotomas.Use of laser in CSR patients that do not improve within 1-3 months appears to be safe and effective at stimulating fluid reabsorption, as well as hastening visual recovery and reducing scotomas. Continued follow-up and use of MP and OCT in these cohorts should provide information on late-term consequences of treatment versus non-treatment. We believe the findings support earlier use of subthreshold laser. Additional study is needed to elucidate which patients are likely to benefit from this protocol and what the optimal time to treat would be.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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