Low Fluence Photodynamic Therapy Versus Graded Subthreshold Transpupillary Thermotherapy for Chronic Central Serous Chorioretinopathy: Results From a Prospective Study.

BACKGROUND AND OBJECTIVE: The authors compare low fluence photodynamic therapy (PDT) against graded subthreshold transpupillary thermotherapy (TTT) for chronic central serous chorioretinopathy (CSC). PATIENTS AND METHODS: Forty-two eyes of 42 patients with chronic CSC were included in this prospective, nonrandomized, interventional trial. All patients were offered PDT as an initial intervention. If they declined PDT, TTT was offered. RESULTS: Twenty patients underwent PDT and 22 underwent TTT. The difference in best-corrected visual acuity between the TTT and PDT groups at baseline and at 6 months after treatment was not significant (P = .728). The mean foveal thickness decreased significantly in both groups (P = .001). However, patients in the TTT group required more treatments (P = .013) and longer time for resolution of the CSC (P = .013). CONCLUSIONS: Both PDT and TTT may be equally effective in the treatment of chronic CSC. Graded subthreshold TTT may be a cost-effective and safe alternative for PDT. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:334-338.].

Graded subthreshold transpupillary thermotherapy for chronic central serous chorioretinopathy.

BACKGROUND AND OBJECTIVE: To study the safety and efficacy of "graded" subthreshold transpupillary thermotherapy (TTT), a novel treatment protocol for chronic central serous chorioretinopathy (CSC) and an alternative to photodynamic therapy (PDT). PATIENTS AND METHODS: This retrospective pilot study included 10 eyes with chronic CSC that underwent TTT with 810-nm continuous diode laser treatment using a subthreshold power (60% reduced from threshold) for 60 seconds. Treatment was repeated at 20% increase in power from the baseline if submacular fluid persisted on optical coherence tomography (OCT) after 1 month (graded fashion). RESULTS: The mean chronic CSC duration was 20.3 ± 8.3 months. Eight eyes (80%) showed resolution of CSC on OCT. Mean number of TTT sittings required was 1.5. Although 5 eyes (50%) had 3 or more lines of improvement in Snellen visual acuity, 3 eyes (30%) had up to 2 lines of improvement. None of the patients developed macular burn or scar. CONCLUSION: The safety enhanced graded subthreshold TTT was beneficial in patients with chronic CSC.

Combination therapy of low-fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane in choroidal osteoma.

Choroidal osteoma is an unusual form of intraocular calcification seen in otherwise healthy eyes. It is a benign idiopathic osseous tumor of the choroid, typically seen in young females. Choroidal neovascular membrane (CNVM) is a complication seen in one-third of these patients and carries a poor visual outcome. We report a case of a 25-year-old hyperthyroid female with choroidal osteoma and subfoveal CNVM in her left eye which was successfully treated using low-fluence photodynamic therapy (PDT) with verteporfin followed by a single injection of intravitreal ranibizumab.

Combination treatment of low fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane secondary to angioid streaks in Paget's disease - 12 month results.

Angioid streaks also called Knapp striae are small breaks in the Bruch's membrane and have been reported with a host of systemic diseases. Rupture of streaks or development of secondary choroidal neovascular membrane (CNVM) carries a dismal visual prognosis. We report the successful treatment of CNVM secondary to Paget's disease using low fluence photodynamic therapy (PDT) and intravitreal ranibizumab.

Idiopathic pediatric retinal artery occlusion.

We report a case of branch retinal artery occlusion (BRAO) in a healthy young girl. An eight-year-old girl presented with sudden loss of vision in her left eye. She had a pale retina with macular edema consistent with extensive BRAO. A thorough workup was performed to determine any etiologic factor. All test results were within normal limits. Her visual acuity improved from finger counting to 20/40 over two weeks, on immediate treatment with intravenous steroids (methyl prednisolone). This case suggests that BRAO can occur in healthy children without any detectable systemic or ocular disorders and a dramatic improvement may be achieved with prompt treatment with intravenous steroids.

Fulminate retinopathy of prematurity - clinical characteristics and laser outcome.

PURPOSE: To analyse the clinical characteristics and treatment outcome of zone 1 Fulminate type of Retinopathy of Prematurity (ROP) and compare it to Conventional ROP. METHODS: Preterm infants from two neonatal intensive care units (NICU) born between July 2002 and November 2003 were screened for ROP. Cases with Conventional ROP were classified according to the International Classification of Retinopathy of Prematurity (ICROP) while that of Fulminate ROP according to Shapiro's classification. Threshold disease was kept the cut off for treatment for Conventional ROP and stage 3A for Fulminate ROP. RESULTS: Of the 54 cases that had treatable ROP, 36 (66.67%) had Fulminate type. The mean gestational age and birth weight was higher in Fulminate ROP compared to Conventional disease (31.75 weeks and 1554 gms vs 31 weeks 1387 gms) whereas the mean postnatal age at laser was lower (4.62 weeks vs 6.3 weeks). The average number of laser spots given was 3036.6 for Fulminate disease. CONCLUSION: Fulminate ROP had an atypical morphology which was difficult to classify according to ICROP classification and we would like to lay stress upon the importance of screening of premature infants from the age of 4 weeks and to start treatment immediately once Fulminate ROP has been diagnosed.