Prasuhn Michelle, Miura Yoko, Tura Aysegül, Rommel Felix, Kakkassery Vinodh, Sonntag Svenja, Grisanti Salvatore, Ranjbar Mahdy
Department of Ophthalmology, University of Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Laboratory for Angiogenesis & Ocular Cell Transplantation, University of Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.
J Clin Med. 2021 May 29;10(11):2418. doi: 10.3390/jcm10112418.
Central serous chorioretinopathy (CSC) is a common macular condition characterized by detachment of the neuroretina and is a frequent cause of central vision loss in adults. Among the various therapeutic strategies, subthreshold microsecond pulsed laser (SML) treatment has become a useful option. Despite the suggested involvement of choroidal circulatory disturbances in CSC, the effects of this treatment on macular microperfusion have not been fully evaluated yet. Herein, we report the impact of SML on retinal and choroidal microvascular flow using non-invasive optical coherence tomography (OCT) angiography (OCTA).
In this study, CSC patients with persistent subretinal fluid (SRF) with or without secondary choroidal neovascularization (CNV) were included (referred to as the pachychoroid neovasculopathy (PNV) group and the CSC group, respectively). SML was conducted using a yellow (577 nm) laser with a duty cycle of 10%, spot size of 200 µm and duration of 200 ms. Best corrected visual acuity (BCVA) as well as OCT and OCTA images were evaluated at baseline and 4 weeks after SML. OCTA parameters of interest included full retinal perfusion (FRP), choriocapillaris perfusion (CCP), Sattler's layer perfusion (SLP), and Haller's layer perfusion (HLP), which were evaluated longitudinally and compared to unaffected fellow eyes.
27 affected eyes and 17 fellow eyes from 27 patients were included. Before treatment, central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) of affected eyes were significantly larger than in fellow eyes. Four weeks after SML, CRT decreased significantly, whereas perfusion parameters did not change. In subgroup analyses, the CSC group showed a significant decrease in SFCT, whereas the PNV group did not despite the decrease in CRT.
Our results suggest that the SML may affect the SFCT of the CSC, but not the PNV patients at least within four weeks following treatment. This effect seems to be independent of the change in choroidal perfusion measured with OCTA.
中心性浆液性脉络膜视网膜病变（CSC）是一种常见的黄斑疾病，其特征为神经视网膜脱离，是成人中心视力丧失的常见原因。在各种治疗策略中，阈下微秒脉冲激光（SML）治疗已成为一种有效的选择。尽管有人认为脉络膜循环障碍与CSC有关，但这种治疗对黄斑微灌注的影响尚未得到充分评估。在此，我们报告使用无创光学相干断层扫描（OCT）血管造影（OCTA）评估SML对视网膜和脉络膜微血管血流的影响。
在本研究中，纳入了伴有或不伴有继发性脉络膜新生血管（CNV）的持续性视网膜下液（SRF）的CSC患者（分别称为厚脉络膜新生血管病变（PNV）组和CSC组）。使用黄色（577 nm）激光进行SML治疗，占空比为10%，光斑大小为200 µm，持续时间为200 ms。在基线和SML治疗后4周评估最佳矫正视力（BCVA）以及OCT和OCTA图像。感兴趣的OCTA参数包括全视网膜灌注（FRP）、脉络膜毛细血管灌注（CCP）、萨特勒层灌注（SLP）和哈勒层灌注（HLP），对这些参数进行纵向评估并与未受影响的对侧眼进行比较。
纳入了27例患者的27只患眼和17只对侧眼。治疗前，患眼的中心视网膜厚度（CRT）和黄斑下脉络膜厚度（SFCT）显著大于对侧眼。SML治疗后4周，CRT显著降低，而灌注参数未改变。在亚组分析中，CSC组的SFCT显著降低，而PNV组尽管CRT降低但SFCT未降低。
我们的数据表明，SML可能会影响CSC患者的SFCT，但至少在治疗后的四周内对PNV患者没有影响。这种影响似乎与用OCTA测量的脉络膜灌注变化无关。
