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Klin Monbl Augenheilkd 2024; 241(04): 489-495
DOI: 10.1055/a-2229-2298
Klinische Studie

Efficacy of Subthreshold Micropulse Laser for Central Serous Chorioretinopathy

Effektivität der Subthreshold-Micropulse-Laser-Therapie bei der Chorioretinopathia centralis serosa
Katrin Fasler   *
1   Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
,
Ferhat Turgut   *
2   Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
3   Ophthalmology, Gutblick Research, Pfäffikon, Switzerland
4   Spross Research Institute, Zürich, Switzerland
9   Department of Ophthalmology, Semmelweis University, Budapest, Hungary
,
Jeanne Martine Gunzinger
1   Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
5   Hunter New England Health, New South Wales, Australia
,
Chiara Sommer
1   Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
2   Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
4   Spross Research Institute, Zürich, Switzerland
,
Daniel Rudolf Muth
1   Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
6   Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
,
Stephan Kinzl
2   Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
4   Spross Research Institute, Zürich, Switzerland
,
Henning Nilius
7   Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland
8   Graduate School for Health Sciences, University of Bern, Bern, Switzerland
,
Sandrine Zweifel    **
1   Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
,
Gabor Mark Somfai    **
2   Ophthalmology, Stadtspital Zürich Triemli, Zürich, Switzerland
4   Spross Research Institute, Zürich, Switzerland
9   Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Abstract

Purpose To evaluate the efficacy of a subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR).

Methods Retrospective clinical study conducted at the Departments of Ophthalmology at a university and a municipal hospital in Zurich, Switzerland. We enrolled acute and chronic CSCR patients with persistent subretinal fluid (SRF) treated with SML. Two treatment protocols (fluorescein/indocyanine green angiography or optical coherence tomography guided) were evaluated for efficacy after 3 and 6 months. The primary outcomes of the study were reduction and percentage of eyes with complete resolution of SRF 3 and 6 months after SML treatment. Secondary endpoints included changes in central subfield thickness (CST) and visual acuity (VA) after 3 and 6 months.

Results The study involved 37 eyes (35 patients, 48.6% chronic). A statistically significant reduction in SRF height and CST could be shown, irrespective of SRF duration, type of CSCR, or chosen guidance after 3 and 6 months: SRF − 40 µm (p < 0.01), CST − 52 µm (p < 0.01). Percentage of eyes with complete resolution of fluid at 3 and 6 months after SML were 24.3 and 21.6%, respectively. No statistically significant functional improvement (VA) could be shown. Multivariable regression and linear mixed regression analyses did not identify statistically significant differences in SRF reduction, CMT change, or VA improvement with respect to the type of CSCR or the treatment plan used (p > 0.05).

Conclusion The effectiveness of SML in CSCR is under continuous debate. Our study findings demonstrate structural but only little functional changes with SML. In view of the shortage of verteporfin for photodynamic therapy, SML remains an important therapeutic option for CSCR patients.

Zusammenfassung

Zweck Die Effektivität der Subthreshold Micropulse-Lasertherapie (SML) bei Patienten mit Chorioretinopathia centralis serosa (CRCS) zu bewerten.

Patienten und Methoden Eine retrospektive klinische Studie, durchgeführt an den Augenkliniken des Universitätsspital Zürich und des Stadtspital Zürich, Schweiz. Akute und chronische CRCS-Patienten mit persistierender subretinaler Flüssigkeit (SRF), die mit SML behandelt wurden, wurden eingeschlossen. Zwei Behandlungsprotokolle (Fluoreszein/Indocyanin-Grün-Angiographie oder optische Kohärenztomographie) wurden auf ihre Wirksamkeit nach 3 und 6 Monaten hin untersucht. Der primäre Endpunkt der Studie war die Reduktion der SRF und der Prozentsatz der Augen mit vollständiger Auflösung der SRF 3 und 6 Monate nach der SML-Behandlung. Sekundäre Endpunkte umfassten Veränderungen der Central Subfield Thickness (CST) und des Visus (VA) nach 3 und 6 Monaten.

Ergebnisse Die Studie umfasste 37 Augen (35 Patienten, 48,6% chronisch). Eine statistisch signifikante Reduktion der SRF-Höhe und CST konnte unabhängig von der Dauer der SRF, dem CRCS-Typ oder des Behandlungsprotokoll nach 3 und 6 Monaten gezeigt werden: SRF − 40 µm (p < 0,01), CST − 52 µm (p < 0,01). Der Prozentsatz der Augen mit vollständiger Flüssigkeitsauflösung nach drei und sechs Monaten nach SML betrug 24,3% bzw. 21,6%. Es konnte keine statistisch signifikante funktionelle Verbesserung des Visus (VA) gezeigt werden. Multivariable Regressions- und lineare Mixed-Regressionanalysen identifizierten keine statistisch signifikanten Unterschiede in der SRF-Reduktion, der CMT-Veränderung oder der VA-Verbesserung in Bezug auf den CRCS-Typ oder das verwendete Behandlungsprotokoll (p > 0,05).

Konklusion Die Wirksamkeit von SML bei CRCS ist Gegenstand anhaltender Diskussion. Die Ergebnisse unserer Studie zeigen statistisch signifikante strukturelle, aber nur geringfügige funktionelle Veränderungen durch SML. Angesichts des Mangels an Verteporfin für die photodynamische Therapie bleibt SML eine wichtige therapeutische Option für CSCR-Patienten.

Key words

central serous chorioretinopathy - subthreshold micropulse laser - photodynamic therapy

Schlüsselwörter

Chorioretinopathia centralis serosa - Subthreshold Micropulse-Laser - photodynamische Therapie

* These authors share the first authorship.


** These authors share the last authorship.




Publication History

Received: 29 October 2023

Accepted: 12 December 2023

Article published online:
23 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Cheung CMG, Lee WK, Koizumi H. et al. Pachychoroid disease. Eye (Lond) 2019; 33: 14-33
    CrossrefPubMedSearch in Google Scholar
  • 2 Zarnegar A, Ong J, Matsyaraja T. et al. Pathomechanisms in central serous chorioretinopathy: A recent update. Int J Retina Vitreous 2023; 9: 3
    CrossrefPubMedSearch in Google Scholar
  • 3 van Rijssen TJ, van Dijk EHC, Yzer S. et al. Central serous chorioretinopathy: Towards an evidence-based treatment guideline. Prog Retin Eye Res 2019; 73: 100770
    CrossrefPubMedSearch in Google Scholar
  • 4 Berger L, Bühler V, Yzer S. Central Serous Chorioretinopathy – an Overview. Klin Monbl Augenheilkd 2021; 238: 971-979
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Daruich A, Matet A, Dirani A. et al. Central serous chorioretinopathy: Recent findings and new physiopathology hypothesis. Prog Retin Eye Res 2015; 48: 82-118
    CrossrefPubMedSearch in Google Scholar
  • 6 Chhablani J, Cohen FB. Central Serous Chorioretinopathy International Group. Multimodal Imaging-Based Central Serous Chorioretinopathy Classification. Ophthalmol Retina 2020; 4: 1043-1046
    CrossrefPubMedSearch in Google Scholar
  • 7 van Rijssen TJ, van Dijk EHC, Tsonaka R. et al. Half-Dose Photodynamic Therapy Versus Eplerenone in Chronic Central Serous Chorioretinopathy (SPECTRA): A Randomized Controlled Trial. Am J Ophthalmol 2022; 233: 101-110
    CrossrefPubMedSearch in Google Scholar
  • 8 Lotery A, Sivaprasad S, OʼConnell A. et al. VICI trial investigators. Eplerenone for chronic central serous chorioretinopathy in patients with active, previously untreated disease for more than 4 months (VICI): a randomised, double-blind, placebo-controlled trial. Lancet 2020; 395: 294-303
    CrossrefPubMedSearch in Google Scholar
  • 9 Chen SN, Hwang JF, Tseng LF. et al. Subthreshold diode micropulse photocoagulation for the treatment of chronic central serous chorioretinopathy with juxtafoveal leakage. Ophthalmology 2008; 115: 2229-2234
    CrossrefPubMedSearch in Google Scholar
  • 10 Scholz P, Altay L, Fauser S. Comparison of subthreshold micropulse laser (577 nm) treatment and half-dose photodynamic therapy in patients with chronic central serous chorioretinopathy. Eye (Lond) 2016; 30: 1371-1377
    CrossrefPubMedSearch in Google Scholar
  • 11 Scholz P, Altay L, Fauser S. A Review of Subthreshold Micropulse Laser for Treatment of Macular Disorders. Adv Ther 2017; 34: 1528-1555
    CrossrefPubMedSearch in Google Scholar
  • 12 Li X, Long H, Hu Q. Efficacy of subthreshold micropulse laser for chronic central serous chorioretinopathy: A meta-analysis. Photodiagnosis Photodyn Ther 2022; 39: 102931
    CrossrefPubMedSearch in Google Scholar
  • 13 Zhou L, Lai K, Jin L. et al. Subthreshold Micropulse Laser vs. Conventional Laser for Central Serous Chorioretinopathy: A Randomized Controlled Clinical Trial. Front Med (Lausanne) 2021; 8: 682264
    CrossrefPubMedSearch in Google Scholar
  • 14 Chen Q, Zhao X, Yin Q. et al. Subthreshold Micropulse Treatment Laser versus Half-Dose Photo Dynamic Therapy for the Chronic Central Serous Chorioretinopathy with Parafoveal or Subfoveal Leakage STML versus PDT for Treatment of Chronic CSC. J Ophthalmol 2022; 2022: 3627903
    CrossrefPubMedSearch in Google Scholar
  • 15 van Dijk EHC, Fauser S, Breukink MB. et al. Half-Dose Photodynamic Therapy versus High-Density Subthreshold Micropulse Laser Treatment in Patients with Chronic Central Serous Chorioretinopathy: The PLACE Trial. Ophthalmology 2018; 125: 1547-1555
    CrossrefPubMedSearch in Google Scholar
  • 16 Ambiya V, Goud A, Mathai A. et al. Microsecond yellow laser for subfoveal leaks in central serous chorioretinopathy. Clin Ophthalmol 2016; 10: 1513-1519
    CrossrefPubMedSearch in Google Scholar
  • 17 Sramek C, Mackanos M, Spitler R. et al. Non-damaging retinal phototherapy: dynamic range of heat shock protein expression. Invest Ophthalmol Vis Sci 2011; 52: 1780-1787
    CrossrefPubMedSearch in Google Scholar
  • 18 Sadda SR, Chakravarthy U, Birch DG. et al. Clinical endpoints for the study of geographic atrophy secondary to age-related macular degeneration. Retina 2016; 36: 1806-1822
    CrossrefPubMedSearch in Google Scholar
  • 19 Iovino C, Iodice CM, Pisani D. et al. Yellow Subthreshold Micropulse Laser in Retinal Diseases: An In-Depth Analysis and Review of the Literature. Ophthalmol Ther 2023; 12: 1479-1500
    CrossrefPubMedSearch in Google Scholar
  • 20 Chhablani J, Alshareef R, Kim DT. et al. Comparison of different settings for yellow subthreshold laser treatment in diabetic macular edema. BMC Ophthalmol 2018; 18: 168
    CrossrefPubMedSearch in Google Scholar