Abstract
Purpose:
To assess safety and clinical efficacy of the non-damaging photothermal therapy of the macula for treatment of the chronic central serous chorioretinopathy (CSR).
Methods:
Nineteen eyes of 18 patients with persistent 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 12 months follow-up. Pre- and post-treatment fluorescein angiography (FA) and fundus autofluorescence (FAF) were also assessed.
Results:
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 by 2 months, and it was sustained during the 12 months follow-up. Central macular thickness decreased from 350μm to 271μm, with central maximum thickness reduction of -79μm. On average, 2.2 treatments per year have been applied to manage recurrent fluid or incomplete resolution. Again, no visible damage to the retina after the retreatments could be seen, but visual acuity and resolution of residual fluid improved. In 79% of the patients fluid was completely resolved, in 21% resolution was partial, and there were no non-responders to the treatment.
Conclusions:
Photothermal therapy using PASCAL laser with EndPoint Management software at 30% energy settings 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 treatment of other macular disorders, and may offer an alternative to conventional laser therapy of the macula and could be combined to anti-VEGF pharmacological treatments of macular diseases.