Large-spot subthreshold transpupillary thermotherapy for chronic serous macular detachment

Abstract

Purpose: To report the effect of subthreshold transpupillary thermotherapy (TTT) in treating serous detachment of the neurosensory retina secondary to chronic central serous chorioretinopathy (CCSC).

Methods: Seven eyes from five patients with CCSC, persistent serous detachment of the neurosensory retina and a clinical course of between 12 and 60 months were treated. All eyes received large-spot TTT guided by indocyanine green angiography (ICGA). Subthreshold TTT was performed using an 810 nm diode laser with a spot size of 3.0 mm (power was set at 350 mW). Treatment was applied for 60 seconds to the areas of choroidal hyperfluorescence on ICGA.

Results: The mean number of TTT sessions was 1.4 ± 0.5. All eyes were followed up for at least 6 months (mean 9.6 ± 3.2 standard deviation; range 6-12 months). The mean logarithm of the minimum angle of resolution best-corrected visual acuity was significantly better compared with baseline. All TTT-treated eyes had stable or improved vision (P < 0.001). Mean optical coherence tomography (OCT) central foveal thickness was significantly lower in all patients (P < 0.001) compared with pretreatment OCT, with a reduction in subretinal fluid and resolution of serous detachment associated with anatomical fovea restoration. No patient had any treatment-related side effects.

Conclusion: Modified subthreshold TTT appears to have a beneficial effect in treating patients with CCSC and persistent neurosensory detachment. The encouraging results and lack of visually significant complications suggest that further investigation is warranted.

Keywords: central serous chorioretinopathy; indocyanine green angiography; neurosensory detachment; transpupillary thermotherapy.

Figure 1

A) Fluorescein angiography (FA) shows multiple focal areas of hyperfluorescence with underlying retinal pigment epithelium (RPE) window defect involving the macula and the peripapillary region before transpupillary thermotherapy (TTT). B) Indocyanine green angiography (ICGA) showing multiple irregular patches of hyperfluorescence before TTT. Black circles indicate the area covered by large-spot subthreshold TTT. C) Optical coherence tomography (OCT) image of line scan through the macula showing macular neurosensory detachment with cystoid macular changes. D) FA showing slow, indistinct staining with absence of active focal leakage after TTT. E) ICGA showing choroidal patch of hyperfluorescence without significant vascular effects, dark zone, or perfusion defects in the choriocapillaris. OCT image showing resolution of the serous detachment and cystoid macular edema after treatment. F) No RPE atrophy or retinal scars were observed in the area covered by the laser spot during the follow-up.

Figure 2

The time course of the height of the foveal detachment in all study eyes. The height was measured by optical coherence tomography. In six cases, the foveal detachment decreased after transpupillary thermotherapy (TTT). The height was significantly lower at 3 and 6 months after treatment (P < 0.01).