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