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Efficacy and safety of subthreshold micropulse laser compared with threshold conventional laser in central serous chorioretinopathy
摘要： Purpose To compare the efficacy and safety of subthreshold micropulse laser (SML) with threshold conventional laser (TCL) in central serous chorioretinopathy (CSC). Methods Prospective, randomized, double-masked, non-inferiority, 12-week clinical trial. Patients were randomly assigned 1:1 to SML group or TCL group. Patients in the SML group were treated with 577 nm micropulse laser. The spot size was 160 μm, the duty cycle was 5% and exposure time was 0.2 s. The power was 50% threshold tested. Patients in the TCL group were treated with 577 nm continuous laser. The power was 100% threshold tested. The primary outcome was the mean change in best-corrected visual acuity (BCVA) at week 12, with a non-inferiority limit of five letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts. Results Eighty-eight patients were enroled. Seventy-seven patients were male. Forty-four patients were in SML group and 44 in TCL group. At week 12, SML was equivalent to TCL with a gain of 6.23 ± 8.59 and 6.61 ± 6.35 letters, respectively, (SML–TCL difference: ?0.38 letters; 95% confidence interval (CI):?3.58–2.81; Pnon-inferiority = 0.0026). There was no statistically significant difference between the two groups (t = 0.240, P = 0.811). At week 12, the proportion of patients whose SRF had been totally absorbed was 63.63 and 81.82% respectively for SML and TCL groups. There was no statistically significant difference between the two groups (χ2 = 3.67, P = 0.056). Conclusions Both SML and TCL can improve visual acuity in CSC. SML was non-inferior to TCL in the improvement of BCVA.
关键词： efficacy,central serous chorioretinopathy,subthreshold micropulse laser,safety,threshold conventional laser
更新于2025-09-11 14:15:04
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Evaluation of Chronic Central Serous Chorioretinopathy after Subthreshold Yellow Micropulse Diode Laser Photostimulation at a Wavelength of 577 nm
摘要： Objective: This study evaluated the efficacy and safety of subthreshold yellow diode-laser micropulse 577 nm (SDM) in the treatment of chronic central serous chorioretinopathy (CSCR). Methods: 40 eyes of 40 patients with non-resolving CSCR of >12 months duration were treated with SDM yellow laser (577 nm). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured. Amsler grid screening, ophthalmoscopy, fundus autofluorescence (FAF) and SD-OCT were performed. Follow up measurements were recorded from 3 to 12 months. Results: Restoration of normal macular anatomy was obtained in 85.7% of cases with a significant reduction in mean central foveal thickness (CFT). Mean visual acuity gain was 14.95 ETDRS letters, subjective or objective deterioration after treatment was not recorded in any case. Conclusion: The possibility of favouring reabsorption of subretinal liquid by stimulating the retinal pigment epithelium, even at the fovea, without damaging retinal tissue, opens up new frontiers for the therapy of chronic CSCR.
关键词： Optical coherence tomography,Micropulse diode laser 577 nm,Fundus autofluorescence,Central serous chorioretinopathy
更新于2025-09-11 14:15:04
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Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy
摘要： Purpose: To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). Methods: Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumab for chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessful at 3 months. A commercially available image analysis program (Adobe? Photoshop? CS6 [Adobe Systems, Inc., San Jose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energy PDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatment images after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability. Results: The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 ± 8.74) than in the ranibizumab group (6.78 ± 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolution of subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energy PDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5 eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showing poor response (10.31 ± 4.00 vs. 2.74 ± 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significant difference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124). Conclusions: Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC, greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may be attributed to greater influence on choroidal hyperpermeability.
关键词： Choroidal hyperpermeability,Half-energy photodynamic therapy,Intravitreal ranibizumab injection,Chronic central serous chorioretinopathy
更新于2025-09-09 09:28:46
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Abnormal choroidal flow on optical coherence tomography angiography in central serous chorioretinopathy
摘要： Importance: Analyzing choroidal flow in central serous chorioretinopathy (CSC) with novel device Background: To examine the abnormal morphology of choriocapillary flow with optical coherence tomography angiography (OCTA) according to the presence of subretinal fluid (SRF) in CSC. Design: A hospital-based retrospective study Participants: We analyzed OCTA results of 68 eyes (68 patients) diagnosed as CSC with or without SRF (active and resolved CSC, respectively) at the Asan Medical Center. Methods: We classified OCTA choriocapillary images into three pattern groups: mixed perfusion, hyper-perfusion, and normal perfusion. Data analysis included age, follow-up duration, treatment modalities, number of treatments, subfoveal choroidal thickness, and SRF height. Main outcome measure: The relationship between CSC activity and choriocapillary pattern Results: Abnormal choroidal flow (mixed and hyper-perfusion) was more frequently found in eyes with active CSC (100%) than resolved CSC (47.5%, p < 0.001). In active CSC eyes, mixed perfusion was predominant (71.4%), while hyper-perfusion was predominant in those with resolved CSC (73.7%). Eyes with recently resolved CSC (SRF absorption present for <2 months) had abnormal choriocapillary flow more often than the remaining eyes with resolved CSC (83.3% vs. 32.1%, p = 0.005). Resolved CSC eyes with abnormal choriocapillary flow demonstrated more recurrence than eyes with normal choriocapillary flow (42.1% vs 9.5%, p = 0.017). Conclusions and Relevance: The pattern of choriocapillary flow abnormalities on OCTA can indicate CSC disease activity. Because eyes with resolved CSC showing abnormal choroidal flow have a high recurrence rate, they should be carefully followed-up.
关键词： Abnormal choroidal flow,central serous chorioretinopathy,optical coherence tomography angiography
更新于2025-09-09 09:28:46
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Pulse Waveform Changes in Macular Choroidal Hemodynamics With Regression of Acute Central Serous Chorioretinopathy
摘要： PURPOSE. To quantitatively evaluate the pulse waveform changes in macular choroidal blood ?ow by using laser speckle ?owgraphy (LSFG) with regression of acute central serous chorioretinopathy (CSC). METHODS. This retrospective observational case series included 20 eyes of 20 patients with acute CSC. Laser speckle ?owgraphy was performed at baseline and after 6 months. On the LSFG monochrome map, automatically divided 5 3 5 grid segments within the macula were classi?ed into predominantly delayed ?lling (PDF) or minimally or no delayed ?lling (MDF) areas according to the degree of choroidal ?lling delay on early-phase indocyanine green angiography. The average mean blur rate (MBR) and the pulse waveform parameters, including the skew and blowout time (BOT), were compared between the total PDF and MDF areas during follow-up. RESULTS. The average MBR signi?cantly decreased in both PDF (P ? 0.005) and MDF (P < 0.001) areas during follow-up; in both areas, the skew decreased (P < 0.001 and P ? 0.006, respectively) and BOT increased (P < 0.001 for each), showing signi?cant reduction in vascular resistance at 6 months. The degree of the changes in the skew and BOT was signi?cantly larger (P ? 0.02 and P < 0.001, respectively) in the PDF area than in the MDF area. CONCLUSIONS. Changes in the skew and BOT, indices for vascular resistance, con?rmed the involvement of circulatory disturbance at the acute stage of CSC. The present ?ndings suggested that the pathogenesis of CSC stems from imbalanced distribution of choroidal blood ?ow due to augmented vascular resistance.
关键词： central serous chorioretinopathy,pulse waveform,skew,blowout time,mean blur rate,laser speckle ?owgraphy,choroidal blood ?ow velocity
更新于2025-09-04 15:30:14
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Central serous chorioretinopathy in elderly subjects: angiographic and tomographic characteristics
摘要： Purpose To investigate the angiographic, tomographic, and clinical characteristics of idiopathic central serous chorioretinopathy (CSC) in elderly patients. Methods The patients were divided into two groups according to a cutoff age of 60 years at baseline. Patients underwent spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Angiographic and tomographic features were compared between the two groups (young vs. elderly group). Results Of 176 patients, 26 patients (15.1%) were 60 years or older. Complete resolution of subretinal fluid after treatment was noted in 72.0% of the elderly group and 90.8% of the young group (P = 0.021). The elderly group showed worse baseline and final vision, more bilateral involvement, and lower male preponderance than the young group (P < 0.05, respectively). The elderly group was also associated with a higher frequency of retinal pigment epithelium depigmentation, foveal thinning, and double-layer sign compared with the young group (P < 0.05, respectively). Conclusion CSC in elderly patients was associated with a lower resolution of serous detachment, increased impairment of retinal pigment epithelial layers, foveal thinning, and worse visual outcome, suggesting a chronic insult to the choroidal vessels involving more severe damage to the outer retinal layers.
关键词： Pachychoroid,Polypoidal choroidal vasculopathy,Fluorescein angiography,Photo dynamic therapy,Imaging,Optical coherence tomography,Indocyanine green angiography,Central serous chorioretinopathy
更新于2025-09-04 15:30:14
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A two-year study of diffused retinal pigment epitheliopathy treated with half-dose photodynamic therapy guided by simultaneous angiography and optical coherence tomography
摘要： Objectives Diffused retinal pigment epitheliopathy (DRPE) is not necessarily the same as chronic central serous chorioretinopathy (CSC), but a severe subgroup under the umbrella of chronic CSC. This study was to evaluate the efficacy and safety of half-dose PDT treating DRPE. Methods A retrospective case series design was used. Forty-eight consecutive patients (48 eyes) with DRPE treated with half-dose PDT underwent follow-up at baseline, 3 months, 6 months, 12 months and 24 months. Simultaneous FA, ICGA and OCT were used for the treatment and follow-up. The primary outcomes were the subretinal fluid and best-corrected visual acuity in optical coherence tomography. Results Complete fluid absorption was achieved in 95.8% of eyes at 3 months and 100.0% of eyes at 24 months. The baseline logarithm of the minimum angle of resolution (logMAR) BCVA, which was 0.51 ± 0.36, significantly improved to 0.43 ± 0.38 (p < 0.001) at 6 months. The boost continued to 0.29 ± 0.37 (p < 0.001) at 12 months and 0.19 ± 0.39 (p < 0.001) at 24 months. The integrities of the ellipsoid zone (EZ) and interdigitation zone (IZ) improved throughout. Regression analyses showed the BCVA in logMAR was inversely correlated with the EZ (p < 0.01) and IZ (p < 0.01). The recurrence rate was 6.3%. No severe complications were witnessed. Conclusions In 48 eyes with DRPE, simultaneous angiography and OCT facilitated a more comprehensive guidance for half-dose PDT treatment and follow-up. The BCVA improvement occurred at 6 months, which may be attributed to the restoration of the outer retinal structure.
关键词： chronic central serous chorioretinopathy,half-dose photodynamic therapy,Diffused retinal pigment epitheliopathy,angiography,CSC,optical coherence tomography,OCT,DRPE,PDT
更新于2025-09-04 15:30:14