The Effect of Selective Retina Therapy for Bevacizumab-Resistant Chronic Central Serous Chorioretinopathy

[Treatment of central serous chorioretinopathy in comparison-Micropulse laser versus photodynamic therapy]

The therapeutic management of central serous chorioretinopathy (CSC) remains challenging. Although CSC shows a high rate of self-resorption, frequent recurrences or chronification of the disease can result in irreversible loss of vision. Low-dose photodynamic therapy (half-dose or half-fluence PDT) represents the current standard of care for CSC, although regenerative laser procedures may also offer a safe and effective alternative for the treatment of CSC.

Laser Treatment of Central Serous Chorioretinopathy - An Update

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patient's vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patient's quality of life.

The role of inflammation in central serous chorioretinopathy: From mechanisms to therapeutic prospects

Central serous chorioretinopathy (CSC) is a leading cause of permanent vision loss, ranking fourth among macular diseases, trailing only age-related macular degeneration, diabetic retinopathy, and retinal vein obstruction. While mounting evidence implicates inflammation as a pivotal factor in the onset and advancement of CSC, the specific pathophysiological process and molecular mechanisms underlying inflammation remain incompletely understood. A complex network of cytokines, chemokines, and adhesion molecules interplay to trigger inflammatory and pathological cascades, highlighting the need for a comprehensive comprehension of the inflammation-related mechanisms behind CSC progression. In this piece, we examine the existing comprehension of CSC's pathology and pathogenesis. Additionally, we present an overview of the mechanisms underlying the onset and progression of CSC inflammation, followed by a thorough analysis and discussion of the potential of targeted inflammatory intervention for both preventing and treating CSC.

Selective retina therapy with real-time feedback-controlled technology in central serous chorioretinopathy: a 24-month follow-up real-world prospective study

OBJECTIVE

Although central serous chorioretinopathy (CSC) treatment using selective retinal therapy (SRT) has presented favourable outcomes, no long-term studies with a real-world clinical practice regimen have been conducted.

METHODS AND ANALYSIS

We performed a long-term assessment of CSC treatment using SRT with real-time feedback (RTF) technology. 50 patients (53 eyes) with CSC and more than a 1-month symptom duration were recruited and treated with SRT using a 1.7 µs pulse width, 527 nm neodymium-doped yttrium lithium fluoride (Nd:YLF) laser equipped with an RTF system.

RESULTS

After 6 months of treatment, complete subretinal fluid resolution was achieved in 62% of the eyes. The mean best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution, mean±SD) improved slightly from 0.15±0.18 at baseline to 0.12±0.21 at 6 months (p=0.062). The central retinal thickness (CRT; mean±SD) was reduced significantly from 350.6±100.1 µm at baseline to 268.2±70.6 µm at 6 months (p<0.001). Long-term follow-up revealed significant improvements in BCVA, from 9 months until 24 months, and in CRT, from 1 month until 24 months. No treatment-related adverse events were observed during the 24-month follow-up period.

CONCLUSION

Our results suggest that SRT with RTF technology is a long-term safe treatment with anatomical improvement for patients with CSC.

The Efficacy of Anti-VEGF Therapy for Putative or Visible CNV in Central Serous Chorioretinopathy by Optical Coherence Tomography Angiography

Purpose

To investigate the effect and underlying mechanism of intravitreal antivascular endothelial growth factor (VEGF) in patients with putative or visible choroidal neovascularization (CNV) secondary to central serous chorioretinopathy (CSCR) with optical coherence tomography angiography (OCTA).

Methods

In a retrospective cohort study, 16 eyes of 15 treatment-naïve CSCR patients were included and divided into two groups: a putative CNV group with nonhomogenous hyperreflectivity in the slab of choriocapillaris and a visible CNV group with obvious tangled vascular network in the slab of choriocapillaris in OCTA. Patients were recorded with best-corrected visual acuity (BCVA). The parameters, evaluated by OCTA, included central macular thickness (CMT), the height of subretinal fluid (SRF), the number of hyperreflective foci (HRF), and the area of putative or visible CNV.

Results

Compared with the baseline, visual acuity was improved significantly at the last follow-up, and CMT and the height of SRF were decreased significantly (P < 0.0001). The number of HRF was also declined in the outer retina and the choriocapillaris layer (P=0.0343). Although the visible CNV area in the eyes represented virtually unchanged during anti-VEGF treatment (P=0.4015), the area of putative CNV displayed an obvious reduction (P=0.0081).

Conclusion

Anti-VEGF is effective in treating CSCR coexisting putative or visible CNV. Early initiation of anti-VEGF therapy benefits CSCR patients with putative CNV detected by OCTA. Translational relevance nonhomogenous hyperreflectivity in the choriocapillaris layer in OCTA indicates putative CNV in patients with CSCR, implying early treatment with anti-VEGF.