Laser Treatment of Central Serous Chorioretinopathy – An Update

Maciej Gawecki; Wiktoria Pytrus; Anna Swiech; Jerzy Mackiewicz; Lyubomyr Lytvynchuk

doi:10.1055/a-2338-3235

Klinische Monatsblätter für Augenheilkunde, Inhaltsverzeichnis

Klin Monbl Augenheilkd 2024; 241(11): 1207-1223
DOI: 10.1055/a-2338-3235

Übersicht

Laser Treatment of Central Serous Chorioretinopathy – An Update

Laserbehandlung der zentralen serösen Chorioretinopathie – ein Update

Maciej Gawecki

¹Ophthalmology, Dobry Wzrok Ophthalmological Clinic, Gdansk, Poland

,

Wiktoria Pytrus

²Ophthalmology, University Hospital Wroclaw, Poland

,

Anna Swiech

³Chair of Ophthalmology, Department of Vitreoretinal Surgery, Medical University of Lublin, Poland

,

Jerzy Mackiewicz

³Chair of Ophthalmology, Department of Vitreoretinal Surgery, Medical University of Lublin, Poland

,

Lyubomyr Lytvynchuk

⁴Department of Ophthalmology, Eye Clinic, Justus Liebig University, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany

› Institutsangaben

Abstract

Laser treatment has been a mainstay for management of central serous chorioretinopathy for a few decades. Different types of lasers have been used and non-damaging retinal laser is the most recent option. The aim of this review is to provide an update on this form of treatment, based on the research published during last 5 years, in comparison with earlier studies published. A MEDLINE database search was performed with a combination of the following terms: central serous chorioretinopathy and laser photocoagulation or subthreshold laser or subthreshold micropulse laser or nanosecond laser or microsecond laser or end-point management or photodynamic therapy. Results were analyzed separately for each modality of laser treatment. Reports published in recent years confirm findings of previous research and do not distinguish treatments of this clinical entity. Among all analyzed laser options, photodynamic therapy provides the fastest and most prominent morphological improvements, including subretinal fluid resorption and reduction of choroidal thickness. This modality is also associated with fewer recurrences than with other treatments. Subthreshold micropulse laser allows the physician to maintain and, in selected cases, improve the patientʼs vision. Conventional photocoagulation is still effective, especially with the introduction of navigated laser systems. Despite the availability of variable laser treatment options, long-term functional improvements in chronic cases are minor for each modality. Long-lasting central serous chorioretinopathy cases with significantly altered retinal morphology do not usually present with functional improvement, despite satisfactory morphological outcomes. Early initiation of treatment has the potential to prevent visual loss and to improve the patientʼs quality of life.

Zusammenfassung

Die Laserbehandlung ist seit einigen Jahrzehnten eine tragende Säule der Behandlung der zentralen serösen Chorioretinopathie. Es wurden verschiedene Arten von Lasern eingesetzt, wobei der nicht schädigende Netzhautlaser die neueste Option darstellt. Ziel dieser Übersicht ist es, ein Update zu dieser Behandlungsform bereitzustellen, basierend auf den in den letzten 5 Jahren veröffentlichten Forschungsergebnissen und durch Vergleich mit etablierten, früher veröffentlichten Studien. Die MEDLINE-Datenbanksuche wurde nach Begriffskombinationen durchgeführt: zentrale seröse Chorioretinopathie und Laserphotokoagulation oder Subthreshold-Laser oder Subthreshold-Mikropulslaser oder Nanosekundenlaser oder Mikrosekundenlaser oder Endpunktmanagement oder photodynamische Therapie. Die Ergebnisse wurden für jede Laserbehandlungsmodalität separat analysiert. In den letzten Jahren veröffentlichte Berichte bestätigen die Ergebnisse früherer Forschungsarbeiten und liefern keine Aufschlüsselung der Therapie für dieses klinische Krankheitsbild. Unter allen analysierten Laseroptionen führt die photodynamische Therapie zu den schnellsten und deutlichsten morphologischen Verbesserungen, einschl. subretinaler Flüssigkeitsresorption und Reduzierung der Aderhautdicke. Der Einsatz dieser Modalität ist im Vergleich zu anderen Behandlungen auch mit einer geringeren Anzahl von Rezidiven verbunden. Der unterschwellige Mikropulslaser ermöglicht die Aufrechterhaltung und in ausgewählten Fällen die Verbesserung des Sehvermögens des Patienten. Die konventionelle Photokoagulation bleibt wirksam, insbesondere mit der Einführung navigierter Lasersysteme. Trotz der Verfügbarkeit unterschiedlicher Laserbehandlungsoptionen sind die langfristigen funktionellen Verbesserungen bei chronischen Fällen bei jeder Modalität gering. Bei langanhaltenden CSCR-Fällen mit deutlich veränderter Netzhautmorphologie kommt es trotz zufriedenstellendem morphologischem Ergebnis i. d. R. nicht zu einer funktionellen Verbesserung. Ein frühzeitiger Behandlungsbeginn hat das Potenzial, Sehverlust zu verhindern und die Lebensqualität des Patienten zu verbessern.

Keywords

central serous chorioretinopathy - laser photocoagulation - micropulse laser - photodynamic therapy

Schlüsselwörter

Mikropulslaser - zentrale seröse Chorioretinopathie - Laserphotokoagulation - Photodynamische Therapie

Volltext

Referenzen

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