Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of bevacizumab in the treatment of central serous chorioretinopathy

Abstract

Purpose To evaluate the treatment of central serous chorioretinopathy (CSC) with either subthreshold diode laser MicroPulse (SDM) or intravitreal bevacizumab (BCZ). Methods This comparative, controlled, prospective study conducted over a period of 10 months examined 52 eyes of 52 patients with (a) treatment with SDM at the active leakage site guided by fluorescein angiography (FA) (n ¼ 16 eyes), (b) intravitreal injection of 1.25 mg BCZ (n ¼ 10 eyes), or (c) observation (n ¼ 26 eyes). Outcome measures included changes in retinal pigment epithelium (RPE) leakage at FA, central macular thickness (CMT), best-corrected visual acuity (BCVA), and 101 macular perimetry. Results At the end of the study, there was 12.5% persistent leakage in the SDM, compared with 60% in the BCZ and 92% in the control group. Mean CMT decreased by 94 lm in the SDM, 38 lm in the BCZ, and did not change in the control group. Mean BCVA improved more than 6 early treatment of diabetic retinopathy study letters in the SDM, decreased by one letter in the BCZ, and by two letters in the control group. In the SDM 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 in the control group by 0.5. Retreatment was required in 7/16 eyes of the SDM group (43.75%), and in 5/10 eyes of the BCZ group (50%). Conclusion SDM 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.

Comparison of subthreshold micropulse laser (577 nm) treatment and half-dose photodynamic therapy in patients with chronic central serous chorioretinopathy

“…In contrast to our study, previous studies reported a treatment response after SML in up to 100% of patients and complete resolution of SRF in 33-75%, 18,19,[24][25][26] and for PDT a partial resolution of SRF in up to 100% and complete resolution of SRF in 81-100% after PDT. [13][14][15]27,28 This less favorable outcome in our cohort is potentially attributed to the severity of the disease in our patients with often long-standing disease accompanied by chronic retinal and choroidal changes.…”

Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy: meta-analysis and review

“…Foveal thinning occurred more frequently in PDT group than in IVB group in both studies. Subthreshold laser photocoagulation (810 nm infrared diode) resulted superior to the IVB for resolution of SRF and BCVA improvement at 6 and 10 months after treatment in the study by Koss et al 33 Although our study confirmed the lack of efficacy of IVB for CSC over a 6-month period, the outcome of this treatment is still unknown. Despite the considerable available literature providing the possible efficacy of IVB for CSC, the majority of studies was simple interventional case series, and was not randomized.…”

“…Most case series reported no specific complications, although there is always some risk of postinjection endophthalmitis. 49 Most studies reported that IVB might be effective in terms of improving visual acuity and reducing CMT without significant complications and can be considered an optional intervention, 1,2,23,24,28,32,33 but these conclusions should be interpreted cautiously owing to the self-limiting nature of acute and even in chronic CSC. Moreover, it should be noted that the aqueous humor and plasma levels of VEGF were not significantly increased in patients with CSC compared with the healthy control group.…”

“…19,40 Recently, anti-VEGF antibody has been used in CSC as an off-label method. [1][2][3][22][23][24]28,30,32,33,[41][42][43] Bevacizumab is a recombinant humanized full-length monoclonal antibody of VEGF that penetrates the retina and is transported into the photoreceptor outer segments, RPE, and choroid after intravitreal injection. 44 The half-life of bevacizumab in the vitreous is 5.6 days, and it remains in the eye for 4 to 6 weeks.…”

IQ 532 Micropulse green laser treatment for refractory chronic central serous retinopathy

“…The disease in acute phase, is characterized by neurosensory detachment with subretinal fluid that spontaneously resolved with no treatment. But if it becomes chronic (CSCR), it can result in permanent vision loss with extensive RPE atrophy [1][2][3][4].…”