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Behandlung der Retinopathia centralis serosa

MicroPulse-Laser vs. Bevacizumab

Treatment of central serous chorioretinopathy

Micropulse photocoagulation versus bevacizumab

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Zusammenfassung

Zielsetzung

Ziel der Studie ist die Evaluation der Behandlung der Retinopathia centralis serosa (RCS) mit dem unterschwelligen MicroPulse (MP)-Laser vs. der intravitrealen Injektion von Bevacizumab (BCZ) nach Pro Re Nata (PRN)-Schema.

Methoden

In dieser vergleichenden, kontrollierten, prospektiven Studie untersuchten wir 52 Augen von 52 Patienten über eine Dauer von 10 Monaten. Die Patienten wurden in 3 Gruppen unterteilt: a) Therapie aktiver Leckagen mit dem MP-Laser in Zusammenschau der Fluoreszenzangiographie (FA) (n = 16 Augen), b) intravitreale Injektion von 1,25 mg BCZ (n = 10 Augen) oder c) Kontrollgruppe ohne Therapie (n = 26 Augen). Als Erfolgskriterien wurden Veränderungen der Leckagen im retinalen Pigmentepithel (RPE), sichtbar in der FA, der zentralen Makuladicke (CMT), des Visus gemessen als „best corrected visual acuity“ (BCVA) und der 10°-Makulaperimetrie, ermittelt.

Ergebnisse

Am Studienende zeigten 12,5% der Patienten der MP-Gruppe persistierende Leckagen, verglichen mit 60% in der BCZ-Gruppe und 92% in der Kontrollgruppe. Die CMT sank um 94 µm in der MP-Gruppe, um 38 µm in der BCZ-Gruppe und ergab keine Änderung in der Kontrolle. Der Visus, gemessen als BCVA, verbesserte sich in der MP-Gruppe um + 6 ETDRS (Early Treatment of Diabetic Retinopathy Study)-Buchstaben, in der BCZ-Gruppe wurde eine Abnahme um 1 und in der Kontrollegruppe um 2 Buchstaben beobachtet. In der MP-Gruppe verminderte sich der mittlere Defekt in der Perimetrie um 1,5 dB und die korrigierte Verlustvarianz um 2,6 dB2. Patienten der BCZ-Gruppe verbesserten sich um 0,6 dB und die der Kontrolle um 0,5 dB. Therapiewiederholungen waren bei 7/16 Augen der MP-Gruppe (43,75%) und 5/10 Augen der BCZ-Gruppe (50%) erforderlich.

Resultat

Die MP-Laserphotokoagulation war der intravitrealen Injektion von 1,25 mg BCZ in der Behandlung der RCS überlegen, resultierend in einer verbesserten Sehschärfe und Makulaperimetrie.

Abstract

Purpose

The aim of this study was to evaluate the treatment of central serous chorioretinopathy (CSC) with either subthreshold diode-laser MicroPulse (MP) or intravitreal bevacizumab (BCZ) using the Pro Re Nata (PRN) scheme.

Methods

This comparative, controlled, prospective study over 10 months examined 52 eyes of 52 patients with either (a) treatment with MP at the active leakage site guided by fluorescein angiography (FA) (n = 16 eyes), (b) intravitreal injection of 1.25 mg BCZ (n = 10 eyes) or (c) passive observation (n = 26 eyes). Outcome measures included changes in retinal pigment epithelium (RPE) leakage at FA, central macular thickness (CMT), best corrected visual acuity (BCVA) and 10° macular perimetry.

Results

At the end of the study there was a 12.5 % persistent leakage in the MP group compared to 60 % in the BCZ group and 92 % in the control group. Mean CMT decreased by 94 µm in the MP, 38 µm in the BCZ and did not change in the control group. Mean BCVA improved by six ETDRS letters in the MP, decreased by one letter in the BCZ and by 2 letters in the control group. In the MP group mean perimetric deficit improved by 1.5 decibels and corrected lost variance by 2.6. In the BCZ it improved by 0.6 and by 0.5 in the control group. Retreatment was required in 7 out of 16 eyes of the SDM (43.75 %), and in 5 out of 10 eyes of the BCZ group (50 %).

Conclusions

MP photocoagulation was superior to intravitreal injections of 1.25 mg BCZ in the treatment of CSC which resulted in enhanced visual acuity and macular perimetry.

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Danksagung

Die Autoren danken der Messer Stiftung in Königstein für deren Unterstützung.

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Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Studienzentrum Retina, Klinik für Glaskörper und Netzhautchirurgie, Zentrum der Augenheilkunde, Klinikum der Johann Wolfgang Goethe-Universität, Theodor Stern Kai 7 (Haus 7c), 60590, Frankfurt am Main, Deutschland

    I. Beger, M.J. Koss MD & F. Koch MD, PhD

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  1. I. Beger
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  2. M.J. Koss MD
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  3. F. Koch MD, PhD
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Correspondence to I. Beger.

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Diese Originalarbeit wurde als Poster auf dem WOC 2010 präsentiert.

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Beger, I., Koss, M. & Koch, F. Behandlung der Retinopathia centralis serosa. Ophthalmologe 109, 1224–1232 (2012). https://doi.org/10.1007/s00347-012-2688-7

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