Funduscopy-guided fluorescein angiography-free focal laser photocoagulation for central serous chorioretinopathy

Purpose: To identify and correlate hypopigmented spots on fundoscopy with the leakage points on fluorescein angiography (FA) in patients with central serous chorioretinopathy (CSCR) to provide criteria for FA?free focal laser photocoagulation (FLP). Methods: Fifty consecutive patients of acute CSCR were evaluated between March and October 2019 confirming the inclusion and exclusion criteria. Colocalization of leakage points with discrete hypopigmented spots on clinical fundoscopy was evaluated using FA. Positive predictive value (PPV) was calculated to identify the status of association between these to formulate criteria for FA?free FLP of CSCR patients in future. Results: Out of the 50 eyes, 38 (76%) had a discrete hypopigmented spot on fundoscopy which coincided with the leakage point on FA. The PPV of finding a leakage point at the area of discrete hypopigmented spot is 95%. Colocalization with a pigment epithelial detachment was found in 25 (65.7%) of these 38 eyes. Retinal pigment epithelial irregularities were found associated in all of these 38 eyes. Subretinal homogenously hyperreflective material was found in 8 (21.05%) of 38 eyes. optical coherence tomography following FLP of leakage point in all cases showed complete resolution of CSCR in 47 (94%) eyes. Conclusion: This study demonstrates that hypopigmented spots on clinical fundus examination in CSCR patients, when present, coincide with the leakage point of FA. This may aid to undergo FA?free FLP treatment in CSCR patients

Photodynamic Therapy and Focal Laser Photocoagulation in Chronic Central Serous Chorioretinopathy

PURPOSE: The aim of this study was to compare the treatment efficacy of photodynamic therapy (PDT) and focal laser photocoagulation in chronic central serous chorio retinopathy (CSC). METHODS: A retrospective study in a clinical practice setting including 40 eyes of 40 patients with chronic CSC which were treated with PDT or focal laser photocoagulation were recruited in this study from March 2011 to December 2013. Mean change in best corrected visual acuity (BCVA), presence or absence of resolution of subretinal fluid (SRF) and pigment epithelial detachment (PED), recurrence rate, and complications were analyzed. RESULTS: PDT was performed in 23 eyes of 23 patients and focal laser photocoagulation was performed in 17 eyes of 17 patients, and all patients were followed up for more than six months. Location of leakage point and appearance of leakage showed no statistically significant difference between the two groups. Both groups showed significant improvement in BCVA at one month and six months after the treatment; however, there was no statistically significant difference in BCVA improvement between the two groups. In both groups, SRF and PED were partially or completely resolved. Resolution of SRF was better in the PDT group at one month after the treatment; however, no statistically significant difference in the resolution period was observed between the two groups. None of the patients experienced adverse events in the PDT group, but one patient developed choroidal neovascularization after treatment in the focal laser photocoagulation group. Two patients showed recurrence in the PDT group and needed retreatment. CONCLUSIONS: Both treatments are beneficial in patients with chronic CSC. Focal laser photocoagulation can be a good treatment option in terms of cost-effectiveness and convenience.

A Case of Focal Laser Photocoagulation Added to Systemic Immunomodulatory Therapy for Bilateral Lupus Chorioretinopathy

PURPOSE: To report a patient diagnosed with bilateral lupus chorioretinopathy who received focal laser photocoagulation. CASE SUMMARY: A 20-year-old female presented with decreased vision in her left eye. She had been treated with systemic corticosteroids, immunosuppressants, plasmapheresis and hemodialysis during systemic lupus erythematosus flare-up. Retinal hemorrhage and cotton wool spots were observed in both eyes on funduscopic examination. Optical coherence tomography showed bilateral serous retinal detachment. Flurorescein angiography (FA) revealed multiple leakages of dye in both maculae. Despite improvements of the systemic disease, subretinal fluid was not resolved. Focal laser photocoagulation was applied to multiple leakage spots identified on FA in both eyes and serous detachment improved. After several months, additional focal laser photocoagulation was performed because there was a small amount of subretinal fluid, which was completely resolved.

Quantitative Analysis of Diabetic Macular Edema after Laser Photocoagulation

PURPOSE: Diabetic macular edema is one of major causes leading to visual loss and it is difficult to be quantified. We investigated a volumetric quantification of retinal thickness change before and after focal laser photocoagulation with Heidelberg Retina Tomograph (HRT). METHODS: Ten patients who were diagnosed as diabetic retinopathy with clinically significant macular edema (CSME) in only one eye and treated with focal laser photocoagulation were studied. The opposite eyes which had no CSME were studied as control group. In the eyes which had CSME, the volume above reference plane (VARP) bounded by three consecutive circle centered at the fovea (diameter 1, 2, and 3 mm) were measured. The retinal thickness of control group was also measured with the same method. We performed focal laser photocoagulation for the eyes which had CSME and measured VARP at 1, 2, and 3 months after laser treatment. RESULTS: Three months after laser treatment, the VARP of treated eyes measured in each diameter was significantly decreased, however, there was no significant difference in control group. There was no significant difference in visual acuity change between before and 3 months after laser treatment. CONCLUSION: From the above results, we concluded that HRT could be used to quantify the change of diabetic macular edema before and after laser treatment.

Laser Photocoagulation in Diabetic Macular Edema

Diabetic macular edema is the leading cause of decreased vision from diabetic retinopathy. The most promising treatment for diabetic macular edema has been photocoagulation and we have reviewed 18 cases, 25 eyes, of macular edema which were treated either by focal laser photocoagulation or grid-pattern photocoagulation between January 1988 to December 1990 and followed for at least 4 months. Visual acuity improved in 8 eyes(57.1%) of 14 eyes treated with focal laser photocoagulation and 4 eyes(36.4%) of 11 eyes treated with grid-pattern photocoagulation. Visual acuity was stable in 6 eyes(42.9%) treated with focal laser photocoagulation and 4 eyes(36.4%) treated with grid-pattern photocagulation. Of 3 eyes(27.3%) with diffuse macular edema was worsened visual acuity although treated with grid-pattern photocoagulation.

Laser Photocoagulation in Diabetic Macular Edema

Diabetic macular edema is the leading cause of decreased vision from diabetic retinopathy. The most promising treatment for diabetic macular edema has been photocoagulation and we have reviewed 18 cases, 25 eyes, of macular edema which were treated either by focal laser photocoagulation or grid-pattern photocoagulation between January 1988 to December 1990 and followed for at least 4 months. Visual acuity improved in 8 eyes (57.1 %) of 14 eyes treated with focal laser photocoagulation and 4 eyes (36.4%) of 11 eyes treated with grid-pattern photocoagulation. Visual acuity was stable in 6 eyes (42.9%) treated with focal laser photocoagulation and 4 eyes (36.4%) treated with grid-pattern photocagulation. Of 3 eyes (27.3%) with diffuse macular edema was worsened visual acuity although treated with grid-pattern photocoagulation.