Effective Focal Laser Photocoagulation for Persistent Central Serous Chorioretinopathy: A Forgotten Technique

Introduction

Central serous chorioretinopathy (CSC) ranks as the fourth most prevalent nonsurgical maculopathy. It is characterized by a thickened choroid, pigment epithelium (RPE) irregularities, and accumulation of subretinal fluid (SRF) [1], [2]. In acute CSC cases, visual impairment is typically confined to the area of SRF accumulation and improves once the SRF resolves [3]. In chronic CSC, where SRF fluids persists for at least 6 months, vision loss can become irreversible, potentially leading to severe visual impairment or even legal blindness [4]. Currently, there is no consensus on the duration of SRF persistence required to cause irreversible vision loss. The first treatment modality described for CSC was focal laser photocoagulation (FLP), targeting the site of focal leakage observed during fluorescein angiography (FA) [5], [6]. FLP involves utilizing a green or yellow laser beam to induce coagulation of tissue at and around the leaking area, effectively sealing the site of leakage [5]. Burumcek et al. demonstrated that CSC patients treated with focal FLP experienced faster resorption of SRF and improved visual acuity (VA) compared to those following a natural course [5]. A significant disadvantage of focal FLP is the possibility of treating only extrafoveal areas of leakage [7]. Moreover, scotoma and secondary choroidal neovascularization (CNV) have been described in CSC patients following treatment with FLP [8]. With the emergence of new treatment modalities, such as half-dose/fluence photodynamic therapy (PDT) [9], subthreshold micropulse laser (SML) treatment [9], and oral spironolactone/eplerenone treatment [10], FLP has largely fallen out of use. Large multicenter trials have compared half-dose PDT, SML, and mineralocorticoid receptor antagonists against each other [9], [11], demonstrating the superiority of PDT. Moreover, a study showed that eplerenone was not superior over a placebo in chronic CSC following a 12-month treatment period [12]. However, FLP has not been directly compared to alternative treatment modalities in big multicenter prospective trials. Although half-dose/fluence PDT is unequivocally the most effective treatment modality for chronic CSC, it is associated with high costs and limited availability due to a worldwide shortage of verteporfin [13], [14]. In the absence of any other effective treatment and with limited PDT availability, patients are often merely observed, experiencing fluctuating SRF and a steady, yet progressively irreversible, worsening of vision. In our case report, we present a patient with persistent CSC and extrafoveal pigment epithelial detachment (PED), who was on the waiting list to receive half-dose PDT treatment. Due to the extended waiting time, he opted for FLP treatment, which resulted in complete resolution of SRF and vision improvement within 1 month after the treatment.

Publikationsverlauf

Eingereicht: 19. Oktober 2023

Angenommen: 10. Dezember 2023

Accepted Manuscript online:
12. Dezember 2023

Artikel online veröffentlicht:
14. Februar 2024

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