Subthreshold Diode Micropulse Photocoagulation for the Treatment of Chronic Central Serous Chorioretinopathy with Juxtafoveal Leakage

Purpose: To report the visual and clinical outcomes of subthreshold diode micropulse (SDM) laser photocoagulation for chronic idiopathic central serous chorioretinopathy (ICSC) with juxtafoveal leakage. Design: Prospective, noncomparative, interventional case series. Participants: Twenty-six eyes in 25 patients with persistent ICSC and juxtafoveal leakage longer than 4 months' duration. Methods: All eyes were assigned to SDM photocoagulation. Eyes were divided into 3 groups based on the findings of fluorescein angiography. Groups 1 and 2 were those patients with source leakage without and with associated retinal pigment epithelial atrophy (RPE), respectively, whereas group 3 consisted of patients with diffuse RPE decompensation with indeterminate source leakage. All patients were followed-up for at least 6 months. Main Outcome Measures: The preoperative and postoperative best-corrected visual acuity, number of sessions of SDM photocoagulation, foveal thickness, and resolution of subretinal fluid (SRF) evaluated by ocular coherence tomography (OCT) were recorded. Patients also were tested for the presence or absence of laser-related scotoma with Amsler grid screening. Results: Groups 1, 2, and 3 consisted of, respectively, 6, 9, and 11 eyes. In group 1, all patients had total SRF resorption after 1 session of SDM photocoagulation. Eight eyes in group 2 had total SRF resorption after 1 to 3 sessions of SMD laser, whereas 1 patient had persistent SRF. In group 3, only 5 eyes had SRF resorption at the end of the follow-up, and the other 6 eyes needed photodynamic therapy for final SRF resorption. At the end of follow-up, the average preoperative foveal thickness was reduced by more than half of its original thickness. A gain of visual acuity of 3 lines or more was achieved in 15 eyes (57.7%), and a gain of between 1 and 3 lines was achieved in 6 eyes (23.1%). Conclusions: Subthreshold diode laser is effective in the treatment of ICSC with point source leakage. However, for eyes with diffuse leakage, a less favorable response was noted. A multicenter, randomized clinical trial is needed to ascertain the real efficacy and the appropriate settings of SMD for chronic ICSC. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2008;115:2229-2234 (C) 2008 by the American Academy of Ophthalmology.