Abstract
Purpose :
There is an ongoing controversial debate about the effectiveness of subthreshold laser treatments in chronic central serous chorioretinopathy. We performed a prospective non-randomized interventional study to learn about the effects of subthreshold laser treatment (Topcon Endpoint Management®) in patients with chronic central serous chorioretinopathy (CSCR).
Methods :
A total of 27 eyes of 25 patients with chronic CSCR were treated with Endpoint Management® (EpM) laser therapy according to the non-damaging retinal therapy protocol (30% laser energy, macula pattern, n=400 spots with sparing of the fovea) utilizing the PASCAL Synthesis 577 system (Topcon Medical Systems Inc., Oakland, New Jersey, USA). The study protocol included patients with a minimum duration of symptoms of 4 months and allowed for quarterly re-treatment in case of persistent of subretinal fluid. Exclusion criteria was, any other macular disease, previous surgery and/or intravitreal injections within 6 months before inclusion and an ongoing systemic or topical steroid therapy. Best corrected visual acuity (BCVA, ETDRS letters), macular function (MAIA® microperimetry), central retinal thickness (SD-OCT), choroidal thickness (SD-OCT) and fundus autofluorescence were assessed at baseline and at multiple time points within the 12-month follow-up period.
Results :
Mean patient age was 48.6±11.6 years. Mean symptomatic time before inclusion into the study was 34±31 months. Before inclusion into the study 75% of the patients failed to resolve subretinal fluid under a therapy with mineralocorticoid receptor antagonists and 16% had a recurrence of subretinal fluid after half-dose photodynamic therapy. At 3 months follow up after the first subthreshold laser treatment, central retinal thickness decreased from 393±145.8µm to 322±78.6µm (p<0.05), microperimetry-derived macular function improved from 19.4±5.32dB to 21.0±4.79dB (p<0,05) and mean BCVA improved by 6±8.1 ETDRS letters (p<0.01). A complete resolution of subretinal fluid was observed in 23% of the patients. No RPE damage as monitored by fundus autofluorescence was encountered.
Conclusions :
Our 3-month follow-up data suggests that subthreshold laser treatment with Endpoint Management® might lead to functional improvements of visual acuity and macular sensitivity in patients with chronic therapy-refractory CSCR.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.