Central serous chorioretinopathy: Treatment.

Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.

Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity.

AIM: To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity (ROP). METHODS: Premature infants who received diode laser treatment for ROP (n=68) and premature infants with spontaneous regressed ROP without treatment (n=50) were performed longitudinal ocular biometric measurements including anterior chamber depth, lens thickness and axial length as follows: 1d prior to laser treatment, and 3, 6, 9, and 12mo after the laser treatment. RESULTS: The mean birth weight, gestational age and initial examination time values were 936.53±302.07 g, 26.66±2.42wk, 36.26±2.73wk in the treatment group and 959.78±260.08 g, 27.28±2.10wk, 36.56±2.54wk in the control group. There was no statistically significant difference in these demographic characteristics of the groups. Anterior chamber depth, lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups (P<0.001 for each). There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment. Measurements of the lens thickness at 9th and 12th months (9th month 3.70±0.22 vs 3.60±0.21 mm, P=0.017; 12th month 3.81±0.21 vs 3.69±0.22 mm, P=0.002) and the axial length at 12th month (19.35±0.79 vs 19.13±0.54 mm, P=0.031) after laser treatment were statistically higher in the treatment group. CONCLUSION: Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.

Retinal choroidal and retinal nerve fiber layer thickness in former preterm and full-term infants aged 4 to 8 years.

PURPOSE: To compare the retinal thickness at the fovea center, peripapillary retinal nerve fiber layer (RNFL) thickness and choroidal thickness (CT) in former preterm and full-term infants. METHODS: A total of 121 healthy children aged 4-8 years were divided 4 groups: group 1; children born on time, group 2; preterm children without a history of retinopathy of prematurity (ROP), group 3; preterm children with a history of spontaneously regressed ROP and group 4; preterm children who underwent diode laser photocoagulation for ROP. The retinal thickness at the fovea, peripapillary RNFL thickness at global, superior, inferior, nasal and temporal quadrants and submacular CT at 7 different points were measured by using spectral-domain optical coherence tomography. RESULTS: The mean retinal thickness at the fovea center was statistically higher, whereas the mean RNFL thickness values in global, nasal, superior and inferior quadrants were statistically lower in group 4. No difference was found in the mean submacular CT value of any point between the groups. CONCLUSION: Transpupillary diode laser photocoagulation treatment for ROP seems to cause an increase in macular thickness and a decrease in RNFL thickness.

Comparison of Nd:YAG laser (532 nm green) vs diode laser (810 nm) photocoagulation in the treatment of retinopathy of prematurity: an evaluation in terms of complications.

PURPOSE: To compare the anterior and posterior segment complications of diode (810 nm) laser photocoagulation (LPC) and Nd:YAG (532 nm green) LPC in the treatment of retinopathy of prematurity (ROP). PATIENTS AND METHODS: The 84 eyes of 43 patients treated with diode LPC (group 1) and 58 eyes of 31 patients treated with Nd:YAG LPC (group 2) for ROP in our clinic were enrolled in the study. Medical records of all patients were investigated retrospectively. The patients in each group were examined in terms of birth weights, gestational weeks, stage of retinopathy, number of lasers pots, laser parameters, and anterior and posterior complications of LPC. RESULTS: The mean birth weeks of group 1 patients were postmenstrual 27.7 ± 2.5 (23-33), while the mean birth weights were 1006.0 ± 334.5 (540-1980) grams. The mean birth weeks of group 2 patients were postmenstrual 27.4 ± 2.6 (23-33), while the mean birth weights were 1073.8 ± 329.2 (480-1720) grams. The mean numbers of laser spots were 1036.0 ± 515.2 (430-2410) in group 1 per eye, while the mean numbers of laser spots were 1085.4 ± 526.0 (445-2530) in group 2 per eye (p ≥ 0.05). Additional laser application was performed in four eyes (4.8%) in group 1 and four eyes (6.9%) in group 2. Four eyes (4.8%) treated with diode LPC and one eye (1.7%) treated with Nd:YAG laser developed retinal detachment. Two eyes of a patient (3.4%) applied Nd:YAG LPC developed cataract. CONCLUSION: Cataract may develop when Nd:YAG laser is used; however, posterior segment complications may be more likely to appear with the use of diode laser in these cases.

Diode laser treatment and clinical management of multiple oral lesions in patients with hereditary haemorrhagic telangiectasia.

Hereditary haemorrhagic telangiectasia (HHT) is rare, and characterised by vascular dysplasia that leads to various symptoms including visceral arteriovenous malformations and mucocutaneous telangiectatic lesions. Our aim was to describe the clinical features and options for the treatment of multiple oral lesions, and to illustrate the efficacy of the diode laser in the treatment of early (<2mm) and advanced lesions (2mm or more). We report 24 patients with 1200 oral telangiectatic lesions, which were often associated with regular bleeding (from monthly to daily), superinfection, pain, and swelling, and treated with multiple sessions of laser according to the number and size of the lesions. Early lesions were treated with a single laser impulse in ultrapulsed mode, and advanced lesions with repeated laser impulses in pulsed mode (t-on 200ms/t-off 500ms), at a power of 8W. Early lesions healed completely after laser photocoagulation with no operative or postoperative complications, while advanced lesions improved with a remarkable reduction in size but more discomfort. Protective occlusal plates were sometimes used to reduce the incidence of new lesions caused by dental trauma. The treatment of oral telangiectatic lesions is still being debated, and it is important to improve quality of life for patients. Diode laser surgery could be an effective treatment for oral lesions in those with hereditary haemorrhagic telangiectasia.

Rapid onset anterior segment complication following diode laser photocoagulation for retinopathy of prematurity: a case report.

Laser treatment for retinopathy of prematurity (ROP) has been proven to be beneficial. We present a case of uncommon, progressive anterior eye segment complication treated with diode laser photocoagulation for ROP which subsequently required surgical management. A 1210 g premature infant, born at 28 weeks of gestation, had bilateral stage 3 threshold ROP on his first screening, at 5 weeks of age. Confluent, laser ablation of avascular retina (Iris Medical, OcuLight S) in order to prevent the progression of ROP was applied. On the next ophthalmological examination, only in the right eye, an uncommon complication, not responding to conservative treatment, was noted. It was described as excessive conjunctiva hypertrophy, misdirected toward the center of the cornea. Indispensable surgical excision of hypertrophied conjunctiva was required, yielding a beneficial outcome. Histology revealed the presence of fibrous tissue. Hypertrophy of conjunctiva after diode laser photocoagulation requires surgical removal in order to prevent vision impairment.

Outcome of Diode Laser Photocoagulation for Threshold and Prethreshold Retinopathy of Prematurity

PURPOSE: To compare outcomes after diode laser photocoagulation between threshold and prethreshold retinopathy of prematurity (ROP). METHODS: The outcomes of 133 eyes of 80 infants who received laser treatment with diode laser were retrospectively evaluated. ROP stage was noted upon treatment. Of the eyes studied, 39 were classified as threshold and 94 were prethreshold, and these were further divided into type 1 (72 eyes) and type 2 (22 eyes). Outcomes among the groups were examined, as well as the effects of mean birth weight, gestational age, postconceptional age (PCA) at diagnosis, PCA at treatment, and the interval between diagnosis and treatment RESULTS: Three threshold eyes (7.7%) and 5 prethreshold eyes (5.3%) progressed to unfavorable outcomes. All 5 eyes with prethreshold disease were type 1. Mean birth weight and gestational age were not associated with prognosis. Unfavorable outcomes were related to lower PCA at diagnosis (p=0.022), lower PCA at treatment (p=0.008), and longer intervals between diagnosis and intervention (p=0.015), whereas neither birth weight nor gestational age significantly influenced outcomes. CONCLUSIONS: Unfavorable outcomes occurred in threshold and type 1 prethreshold ROP. Earlier treatment appeared to decrease the incidence of unfavorable outcomes.

Transscleral Diode Laser Photocoagulation for Retinopathy of Prematurity: Five Years' Experience

PURPOSES: We analysed the five-year outcomes and associated complications of transscleral diode laser photocoagulation (TSDLP), used to treat acute proliferative retinopathy of prematurity (ROP), to evaluate the efficacy and safety of this therapy. METHODS: We performed a retrospective analysis of the records of 163 eyes of 82 infants with acute ROP, who were treated with TSDLP by a single surgeon. Follow-up periods ranged from 15 to 278 weeks. RESULTS: The outcome was favorable in 158 eyes (96.9%) and unfavorable in 5 eyes (3.1%) of the 163 eyes that were treated. Vitreous hemorrhage was found to be an indicator of poor prognosis. Of the complications noted, symblepharon was observed in three eyes, hyphema was observed in four eyes, and a complicated cataract was observed in one eye. CONCLUSIONS: The results suggest that TSDLP is a safe and effective in the treatment of ROP. Vitreous hemorrhage should be regarded as a sign of poor prognosis.

Early Laser Treatment of Rush-Type Retinopathy of Prematurity

PURPOSE: We analyse the effect of the early laser treatment of rush-type ROP. METHODS: We performed a retrospective analysis of the records of 34 eyes of 17 premature infants with rush-type ROP, treated with diode indirect laser within 3 days after diagnosis and followed up for at least a year. RESULTS: Mean gestational age was 28+4 weeks, mean birth weight was 1182.9 gm and mean follow-up was 35.8 months. All patients were diagnosed with rush-type ROP at an average of 34+3 weeks and were treated with diode laser photocoagulation within an average of 1.6 days after diagnosis. The retinopathy regressed after photocoagulation in 25 eyes but regressed in 9 eyes so 8 of these eyes underwent secondary treatment. The outcome was favorable in 27 (79.4%) and unfavorable in 8 (20.6%) of the 34 treated eyes. The frequency of unfavorable outcome increased higher as acute stage at the time of treatment increased in severity. Especially in stage 3 threshold, the unfavorable outcome (33.3%) was significantly higher than that of stage 3 prethreshold (0%). CONCLUSIONS: In rush-type ROP, early treatment may be indicated regardless of the degree of EFP (extraretinal fibrovascular proliferation) because the outcome is poor by the time the stage at treatment has reached threshold.

A Comparison of Cryotherapy Versus Transscleral Diode Laser Photocoagulation for the Treatment of Retinopathy of Prematurity

PURPOSE: To determine whether transscleral diode laser photocoagulation is as effective as cryotherapy for the treatment of retinopathy of prematurity (ROP). METHODS: Thirty-six eyes of 18 infants with acute ROP were treated with cryotherapy and 32 eyes of another 16 infants with acute ROP were treated with transscleral diode laser photocoagulation. RESULTS: The transscleral diode laser photocoagulation group had 94% favorable outcome, whereas the cryotherapy group had 78% favorable outcome. CONCLUSIONS: The results suggest that transscleral diode laser photocoagulation is as effective as cryotherapy for the treatment of retinopathy of prematurity.

Comparison of Histologic Changes According to Treatment Method in Experimentally Perforated Rabbit Eyes

Perforation of the choroid and retina during strabismus surgery is fairly common and optimal management of global perforation is contoversial. The authorsinvestigated the histological changes of the rabbit eyes to compare the treatment effects of diode laser photocoagulation, cryotreatment, and nontreatment in experimentally perforated rabbit eyes.We perforated the globe of 6 pigmented rabbits (12 eyes)and treated four eyes with diode laser and four with cryotherapy and did not treat the remaining four.Proliferation of stromal cells and chorioretinal adhesion were seen in untreated eyes. The cryotherapy eyes revealed retinal destruction and pigment-laden cells in all retinal layers.The eyes treated by diode laser showed firm chorioretinal adhesion and relatively well preserved inner layers of retina.We concluded that directed diode laser photocoagulation was a safe and effective method of retinopexy to prevent the retinal detachment after globe perforation durng strabismus surgery.

The Effect of Cryotherapy and Laser Photocoagulation for the Retinopathy of Prematurity

It has been generally accepted that cryotherapy is a effective therapy in structural outcome in management of threshold retinopathy of prematurity. Despited of this structural success, several potential complications have been termed ocular damage. The purpose of this study is to determine whether diode laser photocoagulation, which has fewer adverse effect and is easier to administe, is as effective as cryotherapy in treatment of prethreshold and threshold retinophthy of prematurity. Twenty-one eyes received diode laser retinal photocoagulation, ranging from 1090 to 1750 g birth weight, and sixty-two eyes received cryotherapy, from 1000 to 1680 g birth weight. The laser-treated eyes had 14.3% unfavorable outcome, and the eyes threated with cryotherapy is as effective as cryotherapy in the result suggests that diode laser therapy is as effective as cryotherapy in the treatment of prethreshold and threshold retinopathy of prematurity. Our study, however, showed that posterior retinopathy of prematurity in zone I was more aggressive than retinopathy of prematurity in zone II and had 42% unfavorable outcome. This result suggests that posterior retinopathy of prematurity requires a careful follow-up examination and and earlier surgical intervention than threshold retinopathy of prematurity.

The Study on Clinical Characteristics and Therapies of Stage 3+ Retinopathy of Prematurity

We diagnosed 48 babies as retinopathy of prematurity (ROP) among 438 premature infants from April 1995 to March 1996 in Gil General Hospital. Among 48 ROP babies, 16 (30 eyes) infants progressed to stage 3+ ROP. Mean birth weight was 1474.0 gm, mean gestational age was 29.7 weeks and mean oxygen inhalation duration was 471.2 hours. Among 30 eyes of stage 3+ ROP, 25 eyes progressed to threshold stage and 5 eyes regressed spontaneously. Ten eyes were treated with cryotherapy and 15 eyes with diode laser photocoagulation and the treatment depends on random selection. Four eyes progressed to stage 5 ROP in spite of photocoagulation and encircling scleral buckling. Favorable outcome was achieved in all eyes treated with cryotherapy, and in 73. 3% of eyes laser-treated.

Diode Laser Photocoagulation for Retinopathy of Prematurity

Diode laser photocoagulation with laser ophthalmoscope has been shown to be effective and safe for treatment of threshold ROP. The purpose of this study are to deternine whether diode laser photocoagulation is really effective in reducing the likelihood of unfavorable regults in threshold stage. The eyes of neonates with birthweight of 2,500g or less, gestational age of 37 weeks or less, or exposure to increased ambient oxygen between May 1994 and October 1995 were examined, 21 eyes of threshold level of ROP and 2 eyes of prethreshold stage received diode laser photocoagulation. Nineteen(83%) of the 23 eyes that underwent laser photocoagulation had a favorable respons. Retinopathy of prematurity, however progressed to stage 4 in 2 eyes and stage 5 in 2 eyes. Two eyes in stage 4 achieved retinal reattachment after retinal buckling operation, but two eyes in stage 5 did not achieved retina1 reattachment. Regarding complications, one eye had retinal hemorihagic spot and one had presumed Bruch's membrane rupture. All infants had been followed up for minimum of 6 months. The results suggest that diode laser photocoagulation is an effective method in treatment of ROP, technically easier to administer without significant complication.

Diode Laser Photocoagulation for Retinopathy of Prematurity

Diode laser photocoagulation with laser ophthalmoscope has been shown to be effective and safe for treatment of threshold ROP. The purpose of this study are to deternine whether diode laser photocoagulation is really effective in reducing the likelihood of unfavorable regults in threshold stage. The eyes of neonates with birthweight of 2,500g or less, gestational age of 37 weeks or less, or exposure to increased ambient oxygen between May 1994 and October 1995 were examined, 21 eyes of threshold level of ROP and 2 eyes of prethreshold stage received diode laser photocoagulation. Nineteen(83%) of the 23 eyes that underwent laser photocoagulation had a favorable respons. Retinopathy of prematurity, however progressed to stage 4 in 2 eyes and stage 5 in 2 eyes. Two eyes in stage 4 achieved retinal reattachment after retinal buckling operation, but two eyes in stage 5 did not achieved retina1 reattachment. Regarding complications, one eye had retinal hemorihagic spot and one had presumed Bruch's membrane rupture. All infants had been followed up for minimum of 6 months. The results suggest that diode laser photocoagulation is an effective method in treatment of ROP, technically easier to administer without significant complication.