To summarize the literature addressing subthreshold or nondamaging retinal laser therapy (NRT) for central serous chorioretinopathy (CSCR) and to discuss results and trends that provoke further investigation.
Analysis of current literature evaluating NRT with micropulse or continuous wave lasers for CSCR.
Sixteen studies including 398 patients consisted of retrospective case series, prospective nonrandomized interventional case series, and prospective randomized clinical trials. All studies but one evaluated chronic CSCR, and laser parameters varied greatly between studies. Mean central macular thickness decreased, on average, by ∼80 μm by 3 months. Mean best-corrected visual acuity increased, on average, by about 9 letters by 3 months, and no study reported a decrease in acuity below presentation. No retinal complications were observed with the various forms of NRT used, but six patients in two studies with micropulse laser experienced pigmentary changes in the retinal pigment epithelium attributed to excessive laser settings.
Based on the current evidence, NRT demonstrates efficacy and safety in 12-month follow-up in patients with chronic and possibly acute CSCR. The NRT would benefit from better standardization of the laser settings and understanding of mechanisms of action, as well as further prospective randomized clinical trials.
All available studies addressing the use of nondamaging retinal laser therapy (NRT) with micropulse and continuous wave laser (often called “subthreshold”) for central serous chorioretinopathy (CSCR) were evaluated. Based on the current clinical evidence, NRT demonstrates efficacy and safety in short-term (up to 12 months) follow-up in patients with chronic and possibly acute CSCR.
Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
Reprint requests: Edward H. Wood, MD, Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303; e-mail: firstname.lastname@example.org
D. V. Palanker is a consultant to Topcon Medical Laser Systems Inc. The other authors have no financial/conflicting interests to disclose.