Selective Retina Therapy with Real-Time Feedback-Controlled Dosimetry for Treating Acute Idiopathic Central Serous Chorioretinopathy in Korean Patients

Abstract

Purpose: To evaluate short-term treatment outcomes following selective retina therapy (SRT) with real-time feedback-controlled dosimetry in Korean patients with acute idiopathic central serous chorioretinopathy (CSC).

Methods: Sixteen eyes (16 patients) with acute idiopathic CSC (symptom duration < 3 months) were included in this retrospective study. All patients underwent a single session of SRT with real-time feedback-controlled dosimetry. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) before and 3 months after treatment were examined and compared.

Results: The logarithm of minimal angle of resolution BCVA was significantly better 3 months after treatment (0.16 ± 0.18) than at the time of diagnosis (0.27 ± 0.18, P = 0.002). Additionally, subretinal fluid had resolved in all 16 eyes 3 months after treatment and CFT was significantly lower 3 months after treatment (215.6 ± 17.9 μm) than at baseline (441.4 ± 124.8 μm, P < 0.001). No notable SRT-related complications were observed during the study period.

Conclusion: The results of the present study suggest that SRT is a useful therapeutic option for patients with acute idiopathic CSC. Further studies are required to better understand the long-term efficacy of this treatment. This trial is registered with clinical trial registration number NCT03339856.

Figure 1

The laser pulse energy was emitted in a stepwise fashion (an increment of 3.57% for the following micropulse) for every individual spot. When there is an adequate feedback signal from the target retinal pigment epithelial (RPE) cells, the device stops the laser automatically during the 15-pulse set of a shot. If a shot was stopped at or between pulse numbers 4 and 15, the energy level would be deemed adequate for the shot and also adequate for the next shot. If the shot was stopped at earlier pulses, between pulse numbers 1 and 3, the shot's treatment was adequate for that spot by having received desired feedback from RPE, but for the next shot, the device recommends a decreased energy level to ensure the safety of the next shot. Conversely, if the desired feedback from a set of 15 pulses is not achieved, that is, no bubble is detected, then the energy level settings are too low. In this case, the device recommends incremental energy increases to achieve the desired feedback from RPE. ^∗Up only if the laser was not stopped in 15 pulses.

Figure 2

A depiction showing the location of laser spots. Initially, a laser spot was applied to the leakage point (asterisk). Next, several additional laser spots were applied around the leakage point. The distance between the spots was generally set as 0.5 to 1.0 spot diameter (100 to 200 μm). Blue dotted circles indicate the location of laser spots. The numbers (1 to 5) indicate the order of laser spots.

Figure 3

Fundus photographs (a, e) as well as fluorescein angiographic (b) and optical coherence tomographic (OCT) (c, d, f–i) images of a 38-year-old patient with acute central serous chorioretinopathy treated with selective retina therapy (case number 5 in Tables 1 and 2). At diagnosis (a–d), best-corrected visual acuity (BCVA) was 20/25, and the patient complained of metamorphopsia. At the location of leakage, a shallow pigment epithelial detachment (PED) (d) (arrow) was observed adjacent to the pachy vessel (d) (asterisk). Three months after treatment (e–i), subretinal fluid had completely resolved and BCVA had improved to 20/20. A PED had resolved after treatment with thinning of the ellipsoid zone at the location of previous leakage (panel g, arrow). There was no notable treatment-related retinal pigment epithelial damage (f-g). The dotted circles in (b) indicate laser spots. Lowercase letters in panels (a) and (e) indicate OCT scanning lines for panels with the same letters.

Figure 4

Changes in best-corrected visual acuity (BCVA) (a) and central foveal thickness (b) after selective retinal therapy. There was a significant improvement in BCVA accompanied with significant decrease in central foveal thickness after treatment. Asterisks indicate significant difference when compared to the baseline value. logMAR: logarithm of minimal angle of resolution.