Abstract
Purpose :
Pachychoroid spectrum disorders are characterized by attenuation of the choriocapillaris overlying dilated choroidal veins, and associated with progressive retinal pigment epithelium dysfunction and neovascularization, including central serous chorioretinopathy (CSC) and pachychoroid pigment epitheliopathy (PPE). Subthreshold laser therapy is known to have RPE function as its main target. In this study, we evaluated subthreshold photocoagulation treatment for patients diagnosed with CSC and PPE.
Methods :
Participants in this study were 7 patients (7 eyes; 4 males and 3 females) with CSC and PPE, who underwent enhanced depth imaging optical coherence tomography (EDI-OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Subthreshold photocoagulation was performed to treat pigment epithelial detachment (PED) at site of PPE outside of macular, which was performed with the following parameters: 5% duty cycle, 200 ms pulse duration, 160 µm spot size and 50% power of the barely visible threshold. Best corrected visual acuity (BCVA), the central choroidal thickness (CCT), and choroidal thickness (CT) at the lesion site of PPE were measured during follow-up.
Results :
Of 7 eyes with recurrent CSC and PPE (Snellen< 20/40), FFA demonstrated one or multiple focal leaks at the level of RPE in 2 eyes, and multiple indistinct leaks in 5 eyes. ICGA showed multifocal areas of choroidal hyperpermeability as hyperfluorescent patches in the mid phase in all 7 eyes. EDI-OCT revealed macular serous retinal detachment (SRD) and irregular RPE elevation or PED outside of macular, CT increased at the lesion site of SRD and RPE characterized by dilated choroidal vessels in Haller’s layer (pachyvessels), accompanied by attenuation of choriocapillaris. After subthreshold photocoagulation at the site of PPE (e.g. PED) outside of macular, with the recovery of SRD and RPE lesion, CCT and CT decreased significantly (P<0.05).
Conclusions :
In the eyes of recurrent CSC with PPE, subthreshold photocoagulation at the lesion site of PPE can resolve CSC within macular. Simultaneously, pachychoroid at the sites of CSC and PPE also improved. These results may support that PPE and CSC clinically overlap and have a common pathogenic background.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.