title: Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy.
abstract: OBJECTIVE
  Selective retina therapy (SRT), the confined laser heating and destruction of retinal pigment epithelial cells, has been shown to treat acute types of central serous chorioretinopathy (CSC) successfully without damaging the photoreceptors and thus avoiding laser-induced scotoma. However, a benefit of laser treatment for chronic forms of CSC is questionable. In this study, the efficacy of SRT by means of the previously used 1.7-µs and shorter 300-ns pulse duration was evaluated for both types of CSC, also considering re-treatment for nonresponders.
  
  
  METHODS
  In a two-center trial, 26 patients were treated with SRT for acute (n = 10) and chronic-recurrent CSC (n = 16). All patients presented with subretinal fluid (SRF) in OCT and leakage in fluorescein angiography (FA). SRT was performed using a prototype SRT laser system (frequency-doubled Q-switched Nd:YLF-laser, wavelength 527 nm) with adjustable pulse duration. The following irradiation settings were used: a train of 30 laser pulses with a repetition rate of 100 Hz and pulse durations of 300 ns and 1.7 µs, pulse energy 120-200 µJ, retinal spot size 200 µm. Because SRT lesions are invisible, FA was always performed 1 h after treatment to demonstrate laser outcome (5-8 single spots in the area of leakage). In cases where energy was too low, as indicated by missing FA leakage, energy was adjusted and the patient re-treated immediately. Observation intervals were after 4 weeks and 3 months. In case of nonimprovement of the disease after 3 months, re-treatment was considered.
  
  
  RESULTS
  Of 10 patients with active CSC that presents focal leakage in FA, 5 had completely resolved fluid after 4 weeks and all 10 after 3 months. Mean visual acuity increased from 76.6 ETDRS letters to 85.0 ETDRS letters 3 months after SRT. Chronic-recurrent CSC was characterized by less severe SRF at baseline in OCT and weaker leakage in FA than in acute types. Visual acuity changed from baseline 71.6 to 72.8 ETDRS letters after 3 months. At this time, SRF was absent in 3 out of 16 patients (19%), FA leakage had come to a complete stop in 6 out of 16 patients (38%). In 6 of the remaining chronic CSC patients, repeated SRT with higher pulse energy was considered because of persistent leakage activity. After the re-treatment, SRF resolved completely in 5 patients (83.3%) after only 25 days.
  
  
  CONCLUSIONS
  SRT showed promising results in treating acute CSC, but was less effective in chronic cases. Interestingly, re-treatment resulted in enhanced fluid resolution and dry conditions after a considerably shorter time in most patients. Therefore, SRT including re-treatment if necessary might be a valuable CSC treatment alternative even in chronic-recurrent cases.
authors.affiliation: University Eye Hospital, Medical School Hannover, Hannover, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Framme
authors.forename: Andreas
authors.initials: A
authors.lastname: Walter
authors.forename: Lieselotte
authors.initials: L
authors.lastname: Berger
authors.forename: Philipp
authors.initials: P
authors.lastname: Prahs
authors.forename: Clemens
authors.initials: C
authors.lastname: Alt
authors.forename: Dirk
authors.initials: D
authors.lastname: Theisen-Kunde
authors.forename: Jens
authors.initials: J
authors.lastname: Kowal
authors.forename: Ralf
authors.initials: R
authors.lastname: Brinkmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D001813:Blood-Retinal Barrier; D002199:Capillary Permeability; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D005451:Fluorescein Angiography; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008875:Middle Aged; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology