University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
Graefes Arch Clin Exp Ophthalmol. 2021 Jun;259(6):1401-1410. doi: 10.1007/s00417-020-04999-9. Epub 2020 Nov 18.
Central serous chorioretinopathy (CSC) is a disease presenting with detachment of the neurosensory retina and characteristic focal leakage on fluorescein angiography. The spontaneous remission rate is 84% within 6 months. In this study, the efficacy of selective retina therapy (SRT) was examined in patients with therapy refractory persistent acute CSC defined by symptoms for at least 6 months and persistent subretinal fluid (SRF) despite eplerenone therapy.
This is a prospective, monocentric observational study in 17 eyes (16 patients, mean age 42 years, 2 female). SRT was performed with the approved R:GEN laser (Lutronic, South Korea), a micropulsed 527-nm Nd:YLF laser device, with a train of 30 pulses of 1.7 μs at 100-Hz repetition rate at the point of focal leakage determined by fluorescein angiography (FA) at baseline (BSL). Visits on BSL, week 4 (wk4), and week 12 (wk12) included best corrected visual acuity (BCVA, logMar), central retinal thickness (CRT) on spectral domain optical coherence tomography (SD-OCT), and FA. Statistical analysis was performed by pair-by-pair comparisons of multiple observations in each case with Bonferroni correction for multiple testing. (IBM SPSS Statistics 25®).
Mean CRT at BSL was 387.69 ± 110.4 μm. CRT significantly decreased by 106.31 μm in wk4 (95%-KI: 21.42-191.2; p = 0.01), by 133.63 μm in wk12 (95%-KI: 50.22-217.03; p = 0.001) and by 133.81 μm (95%-KI: 48.88-218.75; p = 0.001) compared to BSL. Treatment success defined as complete resolution of SRF occurred at wk4 in 7/17 eyes (35.3%) and at wk12 in 10/17 eyes (58.8%). Re-SRT was performed in 7/17 eyes (41.2%) after an average of 107.14 ± 96.59 days. Treatment success after Re-SRT was observed in 4/6 eyes (66.6%, 12 weeks after Re-SRT). Mean BCVA did not change significantly from BSL to any later timepoint after adjusting for multiple testing. Notably, eyes with treatment success showed better BCVA at all timepoints and gained more letters compared to failures.
Single or repetitive SRT may be an effective and safe treatment in 2 of 3 patients suffering from acute persistent CSC after 6 months of symptoms or more. We observed complete resolution of SRF in around 60% of eyes 12 weeks after first SRT treatment and also 12 weeks after Re-SRT treatment in eyes with persistent or recurrent SRF. Results on the long-term course after SRT are still pending.
中心性浆液性脉络膜视网膜病变（CSC）是一种以神经感觉视网膜脱离和特征性局灶性渗漏为表现的疾病。自发缓解率为 6 个月内 84%。在本研究中，我们检查了在至少 6 个月的症状和尽管使用依普利酮治疗仍持续存在的脉络膜视网膜下液（SRF）的情况下，对治疗难治性持续性急性 CSC 定义为治疗有反应的选择性视网膜治疗（SRT）的疗效。
这是一项前瞻性、单中心观察性研究，共纳入 17 只眼（16 名患者，平均年龄 42 岁，2 名女性）。SRT 采用经批准的 R:GEN 激光（Lutronic，韩国）进行，这是一种微脉冲 527nm Nd:YLF 激光设备，在基线（BSL）时，根据荧光素血管造影（FA）确定的焦点渗漏点，以 30 个脉冲、1.7μs、100-Hz 重复率进行治疗。BSL、第 4 周（wk4）和第 12 周（wk12）的就诊包括最佳矫正视力（BCVA，logMar）、频域光学相干断层扫描（SD-OCT）上的中央视网膜厚度（CRT）和 FA。采用配对比较的方法对每个病例的多次观察进行统计分析，并对多次检验进行 Bonferroni 校正（IBM SPSS Statistics 25®）。
BSL 时的平均 CRT 为 387.69 ± 110.4μm。wk4 时 CRT 显著下降 106.31μm（95%-KI：21.42-191.2；p=0.01），wk12 时 CRT 进一步下降 133.63μm（95%-KI：50.22-217.03；p=0.001），wk12 时 CRT 进一步下降 133.81μm（95%-KI：48.88-218.75；p=0.001），与 BSL 相比。定义为完全消退 SRF 的治疗成功在 7/17 只眼中（35.3%）在 wk4 时出现，在 10/17 只眼中（58.8%）在 wk12 时出现。在平均 107.14 ± 96.59 天后，7/17 只眼（41.2%）再次进行 SRT。在 6 只眼中（66.6%，再次 SRT 后 12 周）观察到再次 SRT 后的治疗成功。经过多次检验校正后，BCVA 从 BSL 到任何后续时间点均无明显变化。值得注意的是，治疗成功的眼在所有时间点的 BCVA 均较好，与失败相比，视力提高更多。
在症状持续 6 个月或以上的 3 名急性持续性 CSC 患者中，单次或重复 SRT 可能是一种有效且安全的治疗方法。我们观察到首次 SRT 治疗后 12 周，约 60%的眼完全消退了 SRF，在持续或复发 SRF 的眼中，在首次 SRT 治疗后 12 周，也观察到了 12 周的 SRF 消退。SRT 后的长期结果仍有待观察。
