A variant of combined treatment for chronic central serous chorioretinopathy complicated by type 1 choroidal neovascularization

Abstract

Purpose: to evaluate the effectiveness of combined treatment of chronic central serous chorioretinopathy (CSCRP) complicated by type 1 choroidal neovascularization (CNV) by subthreshold micropulse laser exposure (SMILE) and intravitreal injection of angiogenesis inhibitors ( IIAI). Material and methods. 37 patients (20 men and 17 women) with monolateral chronic recurrent CSCRP complicated by type 1 CNV, aged 35 to 57 (ave. 43.6 ± 6.7 yrs.) at the moment of first referral, were divided into two groups. The retrospective group included 15 patients (15 eyes) whose first phase of treatment consisted in IIAI (up to 5 injections with an interval of one month). Those who showed no treatment effect were given a SMILE procedure one day before the 6th injection. If neurosensory retinal detachment persisted, the combined treatment (SMILE + IIAI) was repeated monthly until the neurosensory retina could be fully attached, whereupon the patients were transferred to monotherapy with anti-VEGF injections, gradually increasing the interval between the injections. The main group included 22 patients (22 eyes), whose treatment began with a single IIAI. If no neurosensory retinal detachment resorption occurred, the patients received a SMILE procedure one day before the second IIAI injection. The combined treatment was repeated monthly until neurosensory retinal detachment completely resorbed, then the treatment continued with IIAI alone with a gradual increase of intervals between the injections. Results. The number of IIAI in the main group (5 to 8, ave. 6.1 ± 0.8) was significantly lower than in the retrospective group (8 to 10, ave. 8.8 ± 0.77). Best corrected visual acuity increased in both groups, but the main group showed a better central photosensitivity, which is associated with the faster reattachment of neurosensory retina. By the end of the follow-up period, the area of type 1 CNV, and the thickness of the choroid were significantly lower in the main group as compared to the retrospective group. The combined treatment did not cause a single case of complication. Conclusion. The proposed combination of laser exposure followed by IIAI is a safe method for treating complicated forms of CSCRP, which quickens the resorption of subretinal fluid and reduces the number of treatment procedures.

Keywords

• chronic central serous chorioretinopathy
• subthreshold micropulse laser exposure
• intravitreal injection of angiogenesis inhibitors