Micropulse diode laser versus bevacizumab in chronic central serous chorioretinopathy: a pilot study

Authors

  • Mansur Ali Khan Department of Ophthalmology, AFMC Pune. Maharashtra, India
  • Sadhana Joshi Department of Ophthalmology, Institute of Aerospace Medicine, Bangalore, Karnataka, India
  • Ashutosh Gupta Department of Ophthalmology, AFMC Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20171920

Keywords:

Chronic central serous chorioretinopathy, Micropulse diode laser, Bevacizumab

Abstract

Background: Central serous chorioretinopathy (CSC) is an idiopathic condition with an illdefined aetiopathogenesis and no clearly effective treatment. The choice of treatment include thermal laser photocoagulation, photodynamic therapy (PDT), subthreshold micropulse laser and anti VEGF.

Methods: In a prospective nonrandomized pilot trial we evaluated two of these modalities subthreshold micropulse laser treatment and intravitreal anti VEGF in 20 consecutive cases of non-resolving CSC of duration 3 to 6 months with vision below 6/12 treated with either Bevacizumab for leakage close to fovea or subthreshold micropulse 810 diode laser for extrafoveal leakage (10% duty cycle, 100 µ spot size) as seen on fluorescein angiography.

Results: At 6 months follow up complete resolution was seen in 9/10 in laser and 6/10 in Avastin group. The mean visual acuity improved from  Log MAR 0.61 ± 0.17  at baseline to Log MAR 0.07± 0.11  post treatment in laser group and from Log MAR 0.59 ± 0.17  to Log MAR 0.18 ± 0.09   in the Avastin group . Similarly mean central macular thickness decreased from 607 µ ± 162.1 to 206 µ ± 55   in laser group and from 601 µ ± 182 to 262 µ ± 75 in those receiving Avastin. Both visual outcome and resolution of serous detachment was better with Micropulse laser as compared to Bevacizumab.  

Conclusions: Micropulse diode laser treatment of CSC has higher rate of resolution and better visual outcome as compared to Bevacizumab injections.

Author Biography

Mansur Ali Khan, Department of Ophthalmology, AFMC Pune. Maharashtra, India

Professor

Department Of Ophthalmology

References

Nicholson B, Noble J, Forroghian F, Meyerle C. Central Serous Retinopathy: Update on Pathophysiology and Treatment.

Alexander R, Adam R, Qureshi M. Review and update of central serous chorioretinopathy. Current Opin Ophthalmol. 2011;22(3):166-73.

Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinoapthy: an update on pathogenesis and treatment. Eye. 2010;24:1743-56.

Yap E Y, Robertson DM. The long term outcome of central serous chorioretinopathy. Arch Ophthalmol. 1996;114(6):689-92.

Robertson DM, Iistrup D. Direct,indirect and sham laser photocoagulation in the management of central serous chorioretinopathy. Am J Ophthalmol. 1983;95:457-6.

Brancato R, Scialdone A, Pece A, Coscas G, Binaghi M. Eight year follow-up of central serous chorioretinopathy with and without laser treatment. graefes Arch clin exp ophthalmol.1987;225:166-8.

Chan WM, Lai TYY, Ricky YK, Liu DTL, Lam DSC. Half dose Verteporfin photodynamic therapy for acute central serous chorioretinopathy : One year results of a randomized controlled trial. Ophthalmology. 2008;115(10):1756-65.

Roisman L, Magalhaes FP, Lavinsky D, Moraes N, Horai FE, Cardillo JA, Farah ME. Micropulse diode laser treatment for chronic central serous chorioretinopathy: a randomized pilot trial. Ophtlamic Surg laser Imaging retina 2013;44(5):465-70.

Gunther JB, Altaweel MM. Bevacizumab for the treatment of ocular disease. Surv Ophthalmol. 2009;372-400.

Wang MS, Sander B, Larsen M. Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2002;133(6):787-93.

Quin G, Liew G, Ho IV, Gillies M, Fraser‐Bell S. Diagnosis and interventions for central serous chorioretinopathy: review and update. Clin & Exp Ophthalmol. 2013;41(2):187-200.

Leaver PE, Williams CH. Argon laser photocoagulation in the treatment of central serous retinopathy. B J Ophthalmol. 1979;63(10):674-7.

Lai FH, Ng DS, Bakthavatsalam M et al. A Multicenter Study on the Long-term Outcomes of Half-dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy. Am J of Ophthalmol. 2016;170:91-9.

Lavinsky D, Palanker D. Non damaging photothermal therapy for the retina: initial clinical experience with chronic central serous retinopathy. Retina. 2015;35(2):213-22.

Huang WC, Chen WL, Tsai YY, Chiang CC, Lin JM. Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eye. 2009;23(2):488-9.

Artunay O, Yuzbasioglu, Rasier Rifat, Sengul A, Bahcecioglu H. Intravitreal Bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy : A Prospective , Controlled clinical study. Current Eye Res. 2010;35(2):91-8.

Kim GA, Rim TH, Lee SC, Byeon SH, Koh HJ, Kim SS, Lee CS. Clinical characteristics of responders to intravitreal bevacizumab in central serous chorioretinopathy patients. Eye. 2015;29(6):732-41.

Chung YR, Seo EJ, Lew HM, Lee KH. Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy: meta-analysis and review. Eye. 2013;27(12):1339-46.

Li Z, Song Y, Chen X, Chen Z, Ding Q. Biological Modulation of Mouse RPE Cells in Response to Subthreshold Diode Micropulse Laser Treatment. Cell biochemistry and biophysics. 2015;73(2):545-52.

Palanker D, Lavinsky D, Dalal R, Huie P. Non-damaging laser therapy of the macula: titration algorithm and tissue response. InSPIE BiOS. 2014: 893016.

Gupta B, Elagouz M, McHugh D, Chong V, Sivaprasad S. Micropulse diode laser photocoagulation for central serous chorio-retinopathy. Clin Exp Ophthalmol. 2009;37:801-5.

Malik KJ, Sampat KM,Mansouri A,Steiner JN,Glaser BM. Low- intensity/highdensity subthreshold micropulse diode laser for chronic central serous chorioretinopathy. Retina. 2015;35:532-6.

Luttrull JK. Low-intensity/high-density subthreshold diode micropulse laser for central serous chorioretinopathy. Retina. 2016;36(9):1658-63.

MJ Koss MJ, Berger I, Koch FH. Subthreshold diode laser micropulse photocoagulation versus intravitreal injections of Bevacizumab in the treatment of central serous chorioretinopathy. Eye. 2012;26:307-14.

Lavinsky D, Sramek C, Wang J, Huie P, Dalal R, Mandel Y, Palanker D. Subvisible retinal laser therapy: titration algorithm and tissue response. Retina. 2014;34(1):87-97.

Scholz P, Ersoy L, Boon CJ, Fauser S. Subthreshold micropulse laser (577 nm) treatment in chronic central serous chorioretinopathy. Ophthalmologica. 2015;234(4):189-94.

Downloads

Published

2017-04-26

Issue

Section

Original Research Articles