Aim To evaluate transpupillary thermotherapy (TTT) for the treatment of subfoveal focal leaks in central serous chorioretinopathy (CSC). Methods The patients presenting with long-standing CSC, but without the features of chronicity, were offered the options of TTT, photodynamic therapy (for subfoveal leaks), photocoagulation (for extrafoveal leaks), or observation. The patients who opted for TTT or observation were enrolled in this study. TTT was performed using a spot diameter of 0.5 mm for 1 min. Best-corrected visual acuity (BCVA), status of macular detachment, and fluorescein angiographic status were evaluated at 1, 3, and 6 months. Results This study included 39 patients (40 eyes) with CSC between 4 and 12 months, of whom 25 patients (25 eyes) opted for TTT for subfoveal leaks. Fourteen patients (15 eyes) were followed up without treatment. The groups were comparable in age, sex, and baseline BCVA. Minimum follow-up was 6 months. Within 3 months, TTT resulted in the resolution of the serous detachment in 24 (96%) eyes with a single session; one eye required a repeat treatment. Eight control eyes demonstrated persisting CSC at the last follow-up. Visual acuity improved in 23 (92%) treated and five (33%) control eyes; the difference in outcome was statistically significant (Po0.001). One case developed choroidal neovascularization, which resolved with visual recovery to 20/20 after repeat-TTT. Conclusion TTT resulted in the resolution of CSC with subfoveal angiographic leaks with significant improvement in visual outcome, in comparison to the natural history of persistent CSC.

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OCT identified a potential anatomic basis for unusual angiographic leakage pattern in all three cases of CSC evaluated.

the retinal pigment epithelium (RPE), enables the selective treatment of the choroidal lesions along with sparing of the overlying neurosensory retina. TTT that also uses the diode laser has been used successsfully to treat CNV in age-related macular degeneration (AMD). 4 It has been suggested that TTT causes closure of the choroidal vasculature by hyperthermia-induced endothelial damage. 5 We thought we could use this property of TTT and the longer wavelength of diode laser to close selectively the choroidal vascular network of the leaking juxtapapillary PCV in this case. We did not do PDT in this case since the patient could not afford it. We did not treat the hyperfluorescent lesions superior and superonasal to the fovea since they were not clearly defined in the ICGFA. The disappearance of the leaking polypoidal lesions following treatment has been seen following laser photocoagulation and PDT as well. 1-3 Our case illustrates the efficacy of TTT in the management of PCV. We do concede the need for future prospective randomised controlled studies to establish clearly the safety and efficacy of TTT in the management of PCV. References Eye S Milenkovic´,Milenkovic´Milenkovic´, N Kosanovic´-Kosanovic´Kosanovic´-Jakovic´,Jakovic´Jakovic´, S Djuric´,Djuric´Djuric´, D RisimicándRisimic´Risimicánd M Ivanč evic´-evic´evic´-Milenkovic´Milenkovic´

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