Abstract
Purpose :
Limited data exists to evaluate the outcomes of deferred focal laser photocoagulation in the treatment of central serous chorioretinopathy (CSCR). We performed a retrospective case series to examine visual and anatomic outcomes of laser intervention after initial observation.
Methods :
This retrospective review analyzed data from 2005-2018 and enrolled 32 eyes of 30 patients (22 males, 8 females) diagnosed with CSCR with a mean age of 48.35 ± 9.74 years. Patients with no history of treatment underwent focal laser photocoagulation after a period of observation of at least 2 months. Exclusion criteria included lack of follow up, an observation period of less than 2 months, and any treatment for CSCR prior to undergoing focal laser. Outcomes measured included visual acuity (VA), central macular thickness (CMT) in microns, as measured by optical coherence tomography (OCT), recurrence of fluid, and complications. Data were analyzed using paired, two-tailed t-tests.
Results :
Mean pre-laser VA was 0.38 ± 0.31 logMAR (Snellen equivalent 20/48). Average CMT was 375.75 ± 122.17. The median period of observation was 4.50 months. The average best-corrected post-laser visual acuity (BCVA), noted at a median of 4.00 months after laser, was 0.19 ± 0.25 logMAR (Snellen equivalent 20/31) with an average CMT of 243.25 ± 62.52. Final follow up occurred at a median of 9.50 months after laser with a final vision of 0.37 ± 0.65 logMAR (Snellen equivalent 20/47) and a mean CMT of 239.74 ± 58.47. Pre-laser VA to BCVA, pre-laser CMT to CMT at BCVA, and pre-laser CMT to CMT at final follow up significantly improved (p=<0.001). Pre-laser VA to final VA did not significantly improve (p=0.895). Three eyes developed complications of choroidal neovascular membrane (CNVM), and if these 3 were removed from the analysis, then final VA significantly improved (p=0.003). Of 32 eyes, 23 (71.9%) had complete resolution without recurrence, 3 (9.4%) developed recurrent subretinal fluid after resolution, and 6 (18.8%) had persistent subretinal fluid following laser.
Conclusions :
Our results show that deferred focal laser photocoagulation significantly improves VA and CMT, and final visual outcome can be limited by complications such as CNVM. This study demonstrates that focal laser photocoagulation is a viable and less invasive treatment alternative to photodynamic therapy for CSCR that does not improve after initial observation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.