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Davide Allegrini, Giovanni Montesano, Gabriella Ricciardelli, Chiara Coretti, Mariantonia Ferrara, Mario R Romano; Micropulsed laser treatment of Central Serous Retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5006. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the response to micropulsed laser treatment and its effect on visual outcome in patients with Central Serous Retinopathy (CRS)
We retrospectively analysed data from 15 patients with CRS who underwent micropulsed laser treatment for subertinal fluid (SRF). As per clinical practice, patients were reviewed at 1 and 3 months after the first treatment and then every 3 months, undergoing retreatment in case of relapses. All subjects had a follow up at 9 months (12 months for 5 subjects). Central Macular Thickness (CMT) were used as a surrogate measure for changes in SRF. Response to treatment was defined as the absence of SRF. First responses and complete responses (no fluid at the end of the follow up) were analysed performing a survival analysis. Since the response could have occurred in-between visits, interval censoring was used. Therefore, survival curves are composed of interval estimates of equal likelihood. Correlation of response rate (RR) with baseline conditions was explored via a proportional hazard model.CMT trend was analysed using a linear mixed model (for repeated measurements). Correlations between baseline and outcome CMT and Visual Acuity (VA) were analysed trough simple linear models.
Most of the subjects (75%) had their first response within 1 month (RR = 0.38 [0.04, 0.71], Median [95% CIs]). Eight patients were retreated for relapses. Complete responses occurred at a steadier slower rate over time (RR = 0.18 [0.02, 0.36], Figure 1A). Baseline conditions (VA and CMT) had no significant effect on the response and were similar between retreated and non-retreated eyes.A significant reduction of CMT and increase in VA from baseline (p < 0.05) was achieved at all time points (Figure 2A), with a mean increase in VA at 9 months of 0.3 ±0.24 (decimals). Such an increase was positively correlated (p = 0.038) with baseline CMT (Figure 2B).
Micropulsed laser is a viable option to treat CRS, but retreatments may be necessary. Randomized controlled trials will be needed to assess long-term effects, safety and efficacy over other treatments. Interestingly, baseline CMT is positively correlated with the final visual outcome and may be a useful prognostic parameter. The physiopathological interpretation is, however, unclear.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure 1.Interval survival curve for complete and first response
Figure 2.Time course of CMT (A) and relationship between baseline CMT and VA at 9 months.
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