Subthreshold diode micropulse photocoagulation for the treatment of chronic central serous chorioretinopathy with juxtafoveal leakage.
OBJECTIVE
To report the visual and clinical outcomes of subthreshold diode micropulse (SDM) laser photocoagulation for chronic idiopathic central serous chorioretinopathy (ICSC) with juxtafoveal leakage.


METHODS
Prospective, noncomparative, interventional case series.


METHODS
Twenty-six eyes in 25 patients with persistent ICSC and juxtafoveal leakage longer than 4 months' duration.


METHODS
All eyes were assigned to SDM photocoagulation. Eyes were divided into 3 groups based on the findings of fluorescein angiography. Groups 1 and 2 were those patients with source leakage without and with associated retinal pigment epithelial atrophy (RPE), respectively, whereas group 3 consisted of patients with diffuse RPE decompensation with indeterminate source leakage. All patients were followed-up for at least 6 months.


METHODS
The preoperative and postoperative best-corrected visual acuity, number of sessions of SDM photocoagulation, foveal thickness, and resolution of subretinal fluid (SRF) evaluated by ocular coherence tomography (OCT) were recorded. Patients also were tested for the presence or absence of laser-related scotoma with Amsler grid screening.


RESULTS
Groups 1, 2, and 3 consisted of, respectively, 6, 9, and 11 eyes. In group 1, all patients had total SRF resorption after 1 session of SDM photocoagulation. Eight eyes in group 2 had total SRF resorption after 1 to 3 sessions of SMD laser, whereas 1 patient had persistent SRF. In group 3, only 5 eyes had SRF resorption at the end of the follow-up, and the other 6 eyes needed photodynamic therapy for final SRF resorption. At the end of follow-up, the average preoperative foveal thickness was reduced by more than half of its original thickness. A gain of visual acuity of 3 lines or more was achieved in 15 eyes (57.7%), and a gain of between 1 and 3 lines was achieved in 6 eyes (23.1%).


CONCLUSIONS
Subthreshold diode laser is effective in the treatment of ICSC with point source leakage. However, for eyes with diffuse leakage, a less favorable response was noted. A multicenter, randomized clinical trial is needed to ascertain the real efficacy and the appropriate settings of SMD for chronic ICSC.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Chen
San-Ni
SN
Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan, Republic of China. 108562@cch.org.tw
Hwang
Jiunn-Feng
JF
Tseng
Li-Fang
LF
Lin
Chun-Ju
CJ
D000328:Adult; D002199:Capillary Permeability; D002908:Chronic Disease; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D054023:Lasers, Semiconductor; D008297:Male; D011446:Prospective Studies; D012164:Retinal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012171:Retinal Vessels / Q000378:metabolism / Q000601:surgery*; D012607:Scotoma / Q000175:diagnosis; D044967:Serum; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology