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Lorena LoVerde; Clinical Outcomes after Focal Laser Therapy in Central Serous Retinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3723.
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© ARVO (1962-2015); The Authors (2016-present)
While observation has been the standard of care for most central serous retinopathy (CSR) patients, no clear consensus has emerged for the management of patients with chronic serous retinal detachments. We performed a retrospective longitudinal study to assess the clinical outcomes of focal laser photocoagulation therapy in patients with CSR. The primary outcome is objective changes in visual acuity. Secondary outcomes include changes in subretinal fluid and subjective visual changes.
We performed a multicenter case series of patients with CSR who received focal laser therapy between 2003-2014. Thirty-three cases of chronic CSR, defined as a disease process lasting longer than 3 months, were retrospectively reviewed at each visit. The following parameters were recorded for each subject before and after focal laser therapy: •Objective visual changes recorded by Snellen visual acuity (VA) were converted to logMAR VA. •Subjective visual changes reported by the patient at each visit were recorded as: improved, declined, or unchanged since their last visit. •Subretinal fluid volume changes assessed by optical coherence tomography (OCT). Exclusion Criteria included concomitant chorioretinal pathology and less than 1 month of follow-up. Statistical analysis was perfomed using two-sample t-tests.
We analyzed 33 subjects with a mean age of 48 years. 87% of the subjects were male. The mean time to laser therapy was 5.4 months, with a range of 3-17 months. Before laser therapy the average logMAR VA was 20/63 which improved to 20/50 at post-op month 1 (p = 0.04), 20/40 at month 4 (p<0.01), 20/34 at month 8 (p<0.01), 20/45 at month 12 (p=0.02) and 20/33 at month 24 (p<0.01). Visual improvement was reported in 40% of all subjects post-op month 1, 57% of all subjects at month four. 12% of these patients were able to report continued visual improvement at 10 months.The average central macular thickness (CMT) prior to laser was 415μm and decreased to 240μm one month after laser (p=0.01). The mean change in CMT prior to laser was +86 μm, compared to -64.3 μm after laser (p=0.03)
Many patients with CSR have a benign disease course. However, some CSR patients experience worsening subretinal fluid and decreased vision without intervention. This study illustrates that focal laser therapy can produce significant visual and anatomical improvements in patients with chronic CSR.
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