Subthreshold micropulse laser treatment – a procedure to resolve subretinal fluid in chronic central serous chorioretinopathy

Introduction
Chronic central serous chorioretinopathy is a serious therapeutic problem, as it may lead to significant visual impairment. To date, various invasive and non-invasive treatment methods have been tried with only moderate success.

Aim
To evaluate the efficacy of subthreshold micropulse laser treatment in different morphological types of chronic central serous chorioretinopathy.

Material and methods
A total of 29 patients with chronic central serous chorioretinopathy lasting for more than 6 months, underwent up to two sessions of subthreshold micropulse laser treatment, following which change in functional and morphological retinal parameters were measured (visual acuity, retinal thickness, maximum subretinal fluid height or maximum retinal pigment epithelial detachment). Results were analyzed separately for the two morphological types of chronic central serous chorioretinopathy: predominant subretinal fluid and pure retinal pigment epithelial detachment.

Results
In the group with predominant subretinal fluid, total resorption of the fluid was noted in 16 cases (75%). In the group with pure pigment epithelial detachment total flattening of the detachment was noted in 2 cases only (22%). Despite good morphological results, only a minor improvement in visual acuity in subretinal fluid group was noted. There was no visual acuity improvement in the pigment epithelial detachment group.

Conclusion
Subthreshold micropulse laser may be considered an option in the treatment of chronic central serous chorioretinopathy in patients with predominant subretinal fluid. To achieve better functional results, the procedure should be used early in the course of the disease. Long-standing chronic serous central chorioretinopathy may result in permanent loss of visual acuity.