Microsecond yellow laser for subfoveal leaks in central serous chorioretinopathy

Abstract

Purpose: To evaluate the role of navigated yellow microsecond laser in treating subfoveal leaks in nonresolving central serous chorioretinopathy (CSC).

Methods: This prospective study included ten eyes of ten consecutive patients with nonresolving CSC with subfoveal leaks. All eyes were treated with 577 nm navigated yellow microsecond laser (5% duty cycle). Key inclusion criteria include a vision loss for a duration of minimum 3 months duration due to focal subfoveal leak on fluorescein angiography. Key exclusion criteria include prior treatment for CSC and any signs of chronic CSC. Comprehensive examination, in addition to low-contrast visual acuity assessment, microperimetry, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, was done at baseline, 1, 3, and 6 months after treatment. Rescue laser was performed as per predefined criteria at 3 months.

Results: The average best-corrected visual acuity improved from 73.3±16.1 letters to 75.8±14.0 (P=0.69) at 3 months and 76.9±13.0 (P=0.59) at 6 months, but was not statistically significant. Low-contrast visual acuity assessment (logMAR) improved from 0.41±0.32 to 0.35±0.42 (P=0.50) at 3 months and 0.28±0.33 (P=0.18) at 6 months. Average retinal sensitivity significantly improved from baseline 18.93±7.19 dB to 22.49±6.67 dB (P=0.01) at 3 months and 21.46±8.47 dB (P=0.04) at 6 months. Rescue laser was required only in one eye at 3 months; however, laser was required in three eyes at 6 months.

Conclusion: Microsecond laser is a safe and effective modality for treating cases of nonresolving CSC with subfoveal leaks.

Keywords: CSC; Navilas®; central serous chorioretinopathy; microsecond yellow laser; navigated laser.

Figure 1

A 42-year-old male presented with blurring of vision for the past 6 months in his left eye and was diagnosed with central serous chorioretinopathy. Notes: His BCVA and LCVA were 80 letters on ETDRS chart and 20/60, respectively. (A) Color fundus photograph of the left eye showing presence of shallow subretinal fluid (arrowheads) and subretinal precipitates (arrow). Fluorescein angiography (B and C) shows the presence of subfoveal leak (arrow in C). Baseline SD-OCT shows presence of neurosensory detachment with hyper-reflective spots suggestive of chronic subretinal fluid (D). Navigated microsecond laser (5% duty cycle) with confluent burns with 340 mW was performed (arrow in B). At 1-month follow-up, the height of neurosensory detachment was reduced (E) and complete resolution was noted at 6 months (F). At 6-month follow-up, his BCVA and LCVA were 85 ETDRS letters and 20/25, respectively. His threshold sensitivity on microperimetry improved significantly from 16 dB at baseline to 25.8 dB at 6-month follow-up. Abbreviations: BCVA, best-corrected visual acuity; ETDRS, Early Treatment Diabetic Retinopathy Study; LCVA, low-contrast visual acuity; SD-OCT, spectral domain optical coherence tomography.