Abstract

FR.20.09

Selective Retina Treatment (SRT) of acute and chronic central serous chorioretinopathy

Andreas Walter1, Philipp Prahs1, Roman Regler1, Dirk Theisen-Kunde2, Ralf Brinkmann2, Carsten Framme1
1Universitäts-Augenklinik Regensburg, 2Medizinisches Laserzentrum Lübeck GmbH, Lübeck

Objective
Selective retina treatment (SRT) solely affecting the RPE while sparing of the photoreceptors has been shown to sufficiently treat acute CSC; however, the benefit is still questionable in chronic CSC.
Methods
Twenty patients with acute (n=5; active leakage point and/or duration less than 3 months) and chronic-recurrent (n=15; no typical leakage point; duration more than 3 months) CSC were treated with a prototype of a SRT laser (Medical Laser Center Luebeck GmbH, Germany: Nd:YLF laser; 527nm; 30 pulses at 100Hz; pulse duration 250-300ns or 1700ns). In average, 6 treatment lesions with a diameter of 200µm were applied in the area of leakage after determining proper dosimetry using test lesions at the lower vessel arcade guided by online optoacoustic measurements. All patients had definite subretinal fluid as judged by OCT before treatment.
Results
In all patients with acute CSC subretinal fluid has disappeared following SRT at a mean of 36 days (range 19-71 days). In 5 patients with chronic CSC subretinal fluid disappeared after first treatment, in 2 patients former leakage had angiographically stopped, but subretinal fluid was stable due to a new leakage point (mean 58 days: 14-180 days). In another 6 patients with chronic CSR the subretinal fluid disappeared after second treatment after a mean of 25 days (21-35 days) using increased energy exposures as guided by optoacoustic measurements. In the final 2 patients with chronic CSR no effect of SRT was visible, a second treatment with higher energy was not possible.
Conclusions
SRT is an effective treatment modality in CSC particular for acute cases. For chronic cases primary success (complete fluid resolution) was herein achieved in 5/15 patients (33%), a final success in 11/15 (73%) patients after re-SRT with higher energies in 6 patients. It might be suspected that due to distinct RPE changes in chronic cases energy dosimetry using test lesions at the lower vessel arcade do not adequately reflect proper energies for central treatment; thus, online optoacoustic control guidance seems to be enhanced to “test-lesion-dosimetry” and necessary to achieve more favorable outcomes in chronic CSC.

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