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Jan Klonner, Juliane Schlomberg, Anne Rübsam, Tina Dietrich-Ntoukas, Sibylle Winterhalter, Antonia Joussen, Bert Müller; Navigated retinal photocoagulation (NaviLas®) as an alternative therapy in patients with refractory central serous chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5359.
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© ARVO (1962-2015); The Authors (2016-present)
There are different therapeutic strategies in the treatment of central serous chorioretinopathy (CSC). Laser coagulation of source points visible in the fluorescein angiography is a possibility, usually in patients with chronic CSC (more than 6 months) without improvement, spontaneous, or under treatment with acetazolamide or spironolactone. Due to the risk of photoreceptor damage and possible central scotoma, conventional laser treatmeant is usually not recommended close to the foveal avascular zone. We hypothesize that NaviLas® (OD-OS, Teltow, Germany) offers a safe way of navigated and assisted, FAG image based, lasercoagulation of juxta- and parafoveal source points.
Retrospective analysis of 10 eyes from 10 subjects (mean age 43.4 ± 8.2 years) with chronic refractory CSC, which were treated between 2013-2015 in our clinic with NaviLas® at source points in the macular area, 6 of them juxtafoveal. We analyzed the best-corrected visual acuity (BCVA) before and one month after treatment, as well as the average central retinal thickness (meanCRT) in SD-OCT (Heidelberg Engineering©, Heidelberg, Germany).
Before laser treatment 3 of 10 patients recieved a treatment trial of acetazolamide and spironolactone, 2 patients spironolactone only and 5 patients acetazolamide only. In all of the patients treatet with NaviLas®, with 3 to 5 laserspots per source point, we found a significant improvement in visual acuity from 0.28 ± 0.19 LogMAR to 0.16 ± 0.22 (p = 0.01 at α <0.05) and a significant reduction in mean CRT from 439, 4 ± 116.1 to 273.6 ± 69,1 (p = 0.005 at α <0.05). No patient experienced a treatment-induced visual loss.
Laser treatment with NaviLas® using eye tracking and FA based planning options seems to be a safe and effective alternative therapy in patients with chronic refractory CSC. In the current follow-up period, all patients were stabilized and displayed a lack of recurrence of original symptoms. We found a total resorption of subretinal fluid in 7 of 10 subjects. However, further studies with larger numbers of patients and longer follow-up times are planned to investigate long term effects.
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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