Abstract
Purpose
To assess retinal sensitivity after selective retina therapy (SRT) in patients with central serous chorioretinopathy (CSCR).
Methods
Seventeen eyes of 17 patients with CSCR lasting longer than 3 months were treated with SRT (wavelength 527 nm Nd: YLF laser, 50–150 μJ/pulse, spot diameter 200 μm). Measurement of best-corrected visual acuity (BCVA), optical coherence tomography, fluorescence angiography, and microperimetry (MAIA™) were conducted before, and 1 and 3 months after treatment. Microperimetry was performed in the central 10° of the macula, and at the test spots applied near the vascular arcade for energy titration. In addition to the treatment effect, all test irradiation spots were thoroughly analyzed with regard to their sensitivity changes.
Results
The mean logMAR BCVA had improved from 0.06 to 0.02 after 1 month (p = 0.11) and to 0.03 after 3 months (p = 0.003). Eleven out of 17 eyes (64.7%) showed complete resolution of subretinal fluid after 3 months. Retinal sensitivity in the central 10° increased after 1 month (median: 25.9 dB) and 3 months (26.6 dB) as compared with that before treatment (23.0 dB) (p < 0.001). Analysis of the test spots revealed a slight decrease in retinal sensitivity after 1 month (ΔdB = −0.5 ± 2.1, p = 0.006), while there was no significant difference from baseline after 3 months (ΔdB = −0.3 ± 2.2, p = 0.09). No correlation was found between laser energy and the change in focal retinal sensitivity.
Conclusions
Results suggest that SRT is a safe and effective treatment for persistent CSCR and does not leave permanent scotoma regardless of irradiation energy in the therapeutic range.
Similar content being viewed by others
References
Roider J, Brinkmann R, Wirbelauer C et al (1999) Retinal sparing by selective retinal pigment epithelial photocoagulation. Arch Ophthalmol 117:1028–1034
Brinkmann R, Roider J, Birngruber R (2006) Selective retina therapy (SRT): a review on methods, techniques, preclinical and first clinical results. Bull Soc Belge Ophtalmol 302:51–69
Roider J, Liew SH, Klatt C et al (2010) Selective retina therapy (SRT) for clinically significant diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 248:1263–1272
Schuele G, Elsner H, Framme C et al (2005) Optoacoustic real-time dosimetry for selective retina treatment. J Biomed Opt 10:064022
Neumann J, Brinkmann R (2005) Boiling nucleation on melanosomes and microbeads transiently heated by nanosecond and microsecond laser pulses. J Biomed Opt 10:024001
Elsner H, Porksen E, Klatt C et al (2006) Selective retina therapy in patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 244:1638–1645
Klatt C, Saeger M, Oppermann T et al (2011) Selective retina therapy for acute central serous chorioretinopathy. Br J Ophthalmol 95:83–88
Kang S, Park YG, Kim JR, Seifert E, Dirk TK, Ralf B, Roh YJ (2016) Selective retina therapy in patients with chronic central serous chorioretinopathy: a pilot study. Medicine (Baltimore) 95:e2524. doi:10.1097/MD.0000000000002524
Framme C, Walter A, Berger L, Prahs P, Alt C, Theisen-Kunde D, Kowal J, Brinkmann R (2015) Selective retina therapy in acute and chronic-recurrent central serous chorioretinopathy. Ophthalmologica 234:177–188
Park YG, Kim JR, Kang S, Seifert E, Theisen-Kunde D, Brinkmann R, Roh YJ (2016) Safety and efficacy of selective retina therapy (SRT) for the treatment of diabetic macular edema in Korean patients. Graefes Arch Clin Exp Ophthalmol. doi:10.1007/s00417-015-3262-1
Koinzer S, Elsner H, Klatt C et al (2008) Selective retina therapy (SRT) of chronic subfoveal fluid after surgery of rhegmatogenous retinal detachment: three case reports. Graefes Arch Clin Exp Ophthalmol 246:1373–1378
Yannuzzi LA, Shakin JL, Fisher YL, Altomonte MA (1984) Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy. Ophthalmology 91:1554–1572
Spaide RF, Campeas L, Haas A et al (1996) Central serous chorioretinopathy in younger and older adults. Ophthalmology 103:2070–2079, discussion 2079-2080
Schule G, Huttmann G, Framme C et al (2004) Noninvasive optoacoustic temperature determination at the fundus of the eye during laser irradiation. J Biomed Opt 9:173–179
Kandulla J, Elsner H, Birngruber R, Brinkmann R (2006) Noninvasive optoacoustic online retinal temperature determination during continuous-wave laser irradiation. J Biomed Opt 11:041111
Dimitrakos S, Haefliger E, Robert Y (1985) Photocoagulation-induced macular scotoma and automated perimetry (Octopus). Klin Monatsbl Augenheilkd 186:506–509
Kim HD, Han JW, Ohn YH et al (2014) Functional evaluation using multifocal electroretinogram after selective retina therapy with a microsecond-pulsed laser. Invest Ophthalmol Vis Sci 56:122–131
Kube T, Schmidt S, Toonen F et al (2005) Fixation stability and macular light sensitivity in patients with diabetic maculopathy: a microperimetric study with a scanning laser ophthalmoscope. Ophthalmologica 219:16–20
Rohrschneider K, Springer C, Bultmann S, Volcker HE (2005) Microperimetry—comparison between the micro perimeter 1 and scanning laser ophthalmoscope--fundus perimetry. Am J Ophthalmol 139:125–134
Inagaki K, Ohkoshi K, Ohde S et al (2015) Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema. Jpn J Ophthalmol 59:21–28
Malik KJ, Sampat KM, Mansouri A et al (2015) Low-intensity/high-density subthreshold micropulse diode laser for chronic central serous chorioretinopathy. Retina 35:532–536
Lavinsky D, Sramek C, Wang J et al (2014) Subvisible retinal laser therapy: titration algorithm and tissue response. Retina 34:87–97
Miura Y, Klettner A, Noelle B et al (2010) Change of morphological and functional characteristics of retinal pigment epithelium cells during cultivation of retinal pigment epithelium–choroid perfusion tissue culture. Ophthalmic Res 43:122–133
Park YG, Seifert E, Roh YJ et al (2014) Tissue response of selective retina therapy by means of a feedback-controlled energy ramping mode. Clin Exp Ophthalmol 42:846–855
Fujita K, Imamura Y, Shinoda K et al (2015) One-year outcomes with half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy. Ophthalmology 122:555–561
Manabe S, Shiragami C, Hirooka K et al (2015) Change of regional choroid thickness after reduced-fluence photodynamic therapy for chronic central serous chorioretinopathy. Am J Ophthalmol 159:644–651
Siaudvytyte L, Diliene V, Miniauskiene G, Balciuniene VJ (2012) Photodynamic therapy and central serous chorioretinopathy. Med Hypothesis Discov Innov Ophthalmol 1:67–71
Tseng CC, Chen SN (2015) Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy. Br J Ophthalmol 99:1070–1077
Chuang LH, Hwang YS, Wang NK et al (2014) The chorioretinal damage caused by different half parameters of photodynamic therapy in rabbits. J Ocul Pharmacol Ther 30:642–649
Vasconcelos H, Marques I, Santos AR et al (2013) Long-term chorioretinal changes after photodynamic therapy for chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 251:1697–1705
Koss MJ, Beger I, Koch FH (2012) Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy. Eye (Lond) 26:307–314
Yadav NK, Jayadev C, Mohan A et al (2015) Subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy: safety profile and treatment outcome. Eye (Lond) 29:258–264, quiz 65
Acknowledgments
Authors would like to thank Veit Danicke for his technical assistance, and Kerstin Schlott for her support in analytical work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received for this research.
Conflict of Interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Yasui, A., Yamamoto, M., Hirayama, K. et al. Retinal sensitivity after selective retina therapy (SRT) on patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 255, 243–254 (2017). https://doi.org/10.1007/s00417-016-3441-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-016-3441-8