Indocyanine green enhanced subthreshold diode-laser micropulse photocoagulation treatment of chronic central serous chorioretinopathy

Purpose  To assess the efficacy and safety of indocyanine green (ICG) dye-enhanced subthreshold diode-laser micropulse (SDM) photocoagulation in patients with chronic central serous chorioretinopathy (CCSC) with no spontaneous resolution 6 months after the onset of the disease. Study design  Interventional prospective non-comparative case series of seven patients presenting with CCSC with well-defined active leaking sites (ALS) suitable for laser treatment and with serous neuroepithelial detachment persisting for 6 or more months. Methods  SDM treatment was performed 15 minutes after the injection of 25 mg of ICG in 2 cc of 5% glucose solution. ALS were treated with a series of 50 500-ms exposures separated by 500-ms pauses. Each 500-ms exposure delivered a train of 250 micropulses at 10% duty cycle and 500 mW power. ICG angiographic images were taken after the treatment without new ICG injection, to check for the presence of laser-induced spots of background hypofluorescence at the treated leakage sites. Results  Within 7-14 days after treatment, all the patients showed improved visual acuity and reduction of serous neuroepithelial detachment on OCT. No signs of laser lesions were visible at fundus examination and on fluorescein angiography. In a period ranging from 4 to 8 weeks, the neuroepithelial detachment was completely resolved in five patients and reduced in two patients. At the 12-month follow-up visits, no recurrence had occurred in the patients, with resolution of the serous neuro-epithelial detachment, and no worsening of the serous detachment or of VA was noted in the patients with incomplete recovery. Conclusions  These preliminary results suggest that ICG dye-enhanced SMD photocoagulation appears to be an effective treatment, and can represent a viable approach for the management of CSCC with persistent serous neuroepithelial detachment. Post-treatment ICG angiography, without new ICG dye injection, can be used to verify the placement of the SDM laser applications.     

Indocyanine green angiography in central serous chorioretinopathy

Purpose. To analyse images obtained by indocyanine green angiography in central serous chorioretinopathy (CSC). Methods. Ninety patients affected with CSC were examined using indocyanine green angiography. Results. CSC was detected in 127 of the 180 eyes examined. Leakage points were detected in 99 eyes with fluorescein angiography; in 85 of these eyes, they corresponded o hyperfluorescence with indocyanine green angiography, while a hyperfluorescence of the neuroepithelial detachment was seen in 21 eyes. Areas of choriodal hyperpermeability were seen in all 127 eyes with CSC and in 9 fellow eyes. With ICG angiography, the appearance of pigment epithelial detachments was similar to that previously described (early hyperfluorescence and later hypofluorescence), and was seen in 47 eyes. In 103 eyes, hypofluorescence lesions of various sizes, were detected which became more marked in the later stages. These lesions corresponded to retinal pigment epithelium lesions in fluorescein angiography, mainly hyperfluorescence caused by window defect. We were also able to observe RPE atrophic tracts in 31 eyes. These tracts appeared hyperfluorescent in 11 eyes where a minimal amount of RPE atrophy was present and hypofluorescent in 20 eyes in which the tract had marked RPE atrophy. Conclusion. The results obtained confirm the finding of choriodal hyperpermeability and subretinal diffusion of ICG, which indicate involvement of the choroid in CSC. The observation of progressively hypofluorescent lesions corresponding to retinal pigment epithelium alterations suggests that there may be as yet unknown interactions of pigment epithelium and ICG. This revised version was published online in September 2006 with corrections to the Cover Date.     

中心性浆液性脉络膜视网膜病变靛青绿血管造影

目的探讨中心性浆液性脉络膜视网膜病变（ｃｅｎｔｒａｌｓｅｒｏｕｓｃｈｏｒｏｉｄｏｒｅｔｉｎｏｐａｔｈｙ，ＣＳＣ）的发病机理。方法用激光扫描检眼镜（ｓｃａｎｎｉｎｇｌａｓｅｒｏｐｈｔｈａｌｍｏｓｃｏｐｅ，ＳＬＯ）对２０例ＣＳＣ患者进行无赤光（蓝色光）眼底检查、眼底荧光素血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）及靛青绿血管造影观察。结果（１）蓝色光眼底检查可清晰见到ＣＳＣ的神经视网膜脱离及色素上皮脱离的隆起。（２）ＦＦＡ能清晰显示渗漏点，还可见脉络膜背景荧光增强及晚期视乳头的强荧光。（３）ＩＣＧＡ早期可见脉络膜的充盈迟缓、高灌注和小叶扩张，中晚期可见较ＦＦＡ更多的强荧光点，患眼１００％有弥漫性的脉络膜渗漏，患者的“健眼”或以前ＣＳＣ已临床治愈的眼均可见脉络膜强荧光点，此外尚可见涡静脉异常等。结论ＣＳＣ患者有明显的脉络膜循环紊乱。用ＳＬＯ对ＣＳＣ患者进行无赤光、ＦＦＡ和ＩＣＧＡ眼底血管检查，对了解ＣＳＣ的发病机理和对治疗的评价均有重要意义     

Indocyanine green angiography of central serous chorioretinopathy

Indocyanine green angiograms of central serous chorioretinopathy in 30 eyes were evaluated in order to demonstrate the pathologic features of the retinal pigment epithelium. In 5 of the cases, the dye leakage or the pigment epithelial degeneration was seen to be associated with areas of choroidal circulatory insufficiency. This implies that local choroidal ischemia is one of the causes of the pigment epithelial disturbance.     

Indocyanine green angiographic findings in central serous chorioretinopathy

There has been great controversy about the pathogenesis of the focal changes in the retinal pigment epithelium (RPE) causing detachment of the neurosensory retina in central serous chorioretinopathy (CSC). This study was performed to evaluate changes in choroidal perfusion in 15 patients with CSC. Fluorescein and indocyanine green (ICG) angiography was performed in patients with acute or chronic recurrent CSC. In all patients delayed arterial filling followed by capillary and/or venous congestion, in some cases adjacent to ischemic areas, was found in the choroid. Leakage from the RPE in fluorescein angiography was only observed in those areas with choroidal capillary and/or venous congestion. The preliminary results suggest that venous congestion possibly in association with ischemia causes hyperpermeability of choroidal vessels already described in the literature.     

非损伤阈值下微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变

目的探讨非损伤阈值下微脉冲激光(subthreshold micropulse laser,SML)治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSCR)的疗效与安全性。方法前瞻性非随机病例对照研究。慢性CSCR患者60例(60眼),分为3组:非治疗观察(non-therapeutic observation,NTO)组、光动力疗法(photodynamic therapy,PDT)组、SML组,每组20例(20眼)。通过光学相干断层扫描血管成像、自发荧光、黄斑完整评估仪等获取研究前后患眼的最佳矫正视力(best corrected visual acuity,BCVA)、视网膜敏感度(retinal sensitivity,RS)、视网膜下液(subretinal fluid,SRF)高度及消失时间、中心黄斑厚度(central macular thickness,CMT)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)、脉络膜毛细血管血流面积(choriocapillaris...     

中心性浆液性脉络膜视网膜病变的吲哚青绿和荧光素眼底血管造影

目的 观察中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的吲哚青绿血管造影(indocyanine green angiography,ICGA)特征。 方法 用共焦激光扫描眼底血管造影仪对70例CSC患者进行荧光素眼底血管造影(fundus fluorescein angiography,FFA)与ICGA同步检查。 结果 79只眼FFA检查有视网膜色素上皮(retinal pigment epithelium,RPE)渗漏。ICGA检查23只眼的脉络膜血管充盈迟缓;79只患眼有脉络膜血管扩张充血;78只眼的RPE渗漏处有脉络膜血管的通透性增高;27只对侧健眼有同样的改变;19只患眼和6只健眼有RPE脱离;21只眼有RPE的色素脱失、萎缩和/或带状萎缩。 结论 脉络膜血管异常是CSC的基本ICGA特征。(中华眼底病杂志,2000,16:14-16)     

Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study

BACKGROUND: Most patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green (ICG) angiography. A small percentage of patients develop chronic or progressive disease with widespread decompensation of the retinal pigment epithelium and severe vision loss. There is no known treatment for this variant of the disorder. PURPOSE: To study ICG-guided photodynamic therapy (PDT) with verteporfin as a potential treatment for patients with chronic CSC. METHODS: Twenty eyes of 15 patients were studied with fluorescein angiography, optical coherence tomography, and ICG angiography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. PDT with ICG guidance was applied to areas of choroidal hyperpermeability, and the patients were observed to determine the anatomic and functional outcomes. RESULTS: Photodynamic therapy guided by ICG was associated with complete resolution of exudative macular detachments in 12 patients and incomplete resolution in the remaining eight eyes. The vision improved in six eyes and remained unchanged in 14 eyes during a mean follow-up of 6.8 months. Six weeks after treatment, the mean visual acuity improved by 0.55 lines, an amount that was marginally significant. There was a significant inverse correlation between the baseline visual acuity and the amount of improvement in acuity at 6 weeks. No patient had any treatment-related side effects. CONCLUSIONS: Indocyanine green angiography-guided PDT with verteporfin seems to aid in the resolution of exudative detachments in patients with chronic CSC. This treatment was associated with a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.     

Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy

Purpose:To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes.Methods:Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months.Results:Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022).Conclusion:Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.     

中心性浆液性脉络膜视网膜病变的眼底血管造影

目的 观察中心性浆液性脉络膜视网膜病变tcentral seous chorioretinopathv，CSC)在眼底荧光血管造影(fundus fluorescein angiography，FFA)与吲哚青绿血管造影(indocyanirle green angiography．ICGA)中的动态表现．探讨中心性浆液性脉络膜视网膜病变的发病机理。方法 采用海德堡共焦激光扫描系统(Heidelbetg retina angiography，HRA)对46例CSC患者．行双眼FFA及ICGA检查，分析其结果。结果 46只主检眼中34眼在IC-GA早期见到一处或多处脉络膜血管充盈延迟，46只眼显示后极部一处或多处脉络膜异常高荧光；在FFA中．22只眼在相应位置出现低荧光区，44只眼于相应部位出现点或片状高荧光。对侧眼中42只眼在ICGA过程中出现一处或多处点或片状高荧光区，而FFA中，仅29只眼在FFA中见到点或片状高荧光，其病灶数量明显少于ICGA。部分病例在ICGA和FFA中见视网膜色素上皮及神经上皮脱离区，结论 中心性浆液性脉络膜视网膜病变存在脉络膜循环异常、ICGA与FFA比较，前者在诊断上更有价值。ICGA与FFA对认识中心性浆液性脉络膜视网膜病变的病理过程有重要意义。     

激光治疗中心性浆液性脉络膜视网膜病变228例

目的:观察氩绿激光对中心性浆液性脉络膜视网膜病变(中浆)的治疗效果。方法:对228例(232)眼中浆患者在眼底荧光血管造影指导下行氩绿激光光凝治疗。结果:术后观察0.5a以上,所有病例病程明显缩短,视力均值从0.54提高至1.09,视网膜下浆液性渗出吸收,未见严重并发症发生。结论:氩绿激光是治疗中浆的安全而有效方法。     

Efficacy and safety of subthreshold micropulse laser in the treatment of acute central serous chorioretinopathy

AIM: To analyze the efficacy and safety of subthreshold micropulse laser (SML) in the treatment of acute central serous chorioretinopathy (CSC). METHODS: This is a retrospective case analysis study. Totally 58 eyes of 58 patients were enrolled, and they were divided into different groups. And 39 patients were treated with SML (SML group) and 19 patients were only observed (observation group). The follow-up period was 3mo after diagnosis. The best corrected visual acuity (BCVA), central retinal thickness (CRT), superficial retinal vascular density (SRVD), deep retinal vascular density (DRVD), the superficial and deep foveal avascular zone (FAZ) area, retinal light sensitivity (RLS), perfusion area of choroidal capillary layer (CCL), subfoveal choroidal thickness (SFCT) and fundus autofluorescence (FAF) were investigated. RESULTS: The BCVA, CRT, SRVD, DRVD, the superficial and deep FAZ area, RLS, SFCT of SML group were significantly improved at 3mo (all P<0.05). In the observation group, only CRT, DRVD and SFCT were improved (all P<0.05). Other research items in the observation group were not significantly different from baseline (all P>0.05). At the last follow-up, the BCVA and RLS in the SML group were better than those in the observation group, and CRT was lower, SRVD and DRVD, perfusion area of CCL were larger (all P<0.05). On FAF, no change of treatment spots was found after treatment. No structural laser damage was observed on optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), and no choroidal neovascularization was observed. CONCLUSION: SML treatment of acute CSC can improve BCVA, RLS, and perfusion area of CCL, reduce CRT, increase SRVD and DRVD, and is safe.     

微脉冲激光与PDT治疗慢性中心性浆液性脉络膜视网膜病变的疗效比较

目的：比较577nm阈值下微脉冲激光(SML)与光动力疗法(PDT)治疗慢性中心性浆液性脉络膜视网膜病变(cCSC)的效果和安全性。

方法：收集2015-02/2018-04在我院就诊的cCSC患者30例30眼,577nm微脉冲激光治疗组和PDT治疗组各15例15眼。观察治疗后1、3、6mo两组患者BCVA、CMT和并发症发生情况。

结果：治疗后1mo时SML组与PDT组BCVA分别提高到0.37±0.13、0.20±0.11(t=-3.93,P<0.001); CMT分别降低到382.80±76.54、247.60±28.46μm,两组均有显著改善,PDT组优于SML组(t=-6.41,P<0.001)。治疗后3、6mo,两组BCVA和CMT组间均无差异(P>0.05)。随访期间,眼底均未见明显并发症,无复发病例。

结论：577nm SML与PDT治疗cCSC均有效,PDT治疗起效更快,但随着时间延长,两者疗效相近。577nm SML比PDT治疗费用低,且无创、无过敏等风险,可重复治疗。     

氩激光治疗中心性浆液性脉络膜视网膜病变的疗效

目的:观察氩激光视网膜光凝治疗中心性浆液性脉络膜视网膜病变(简称中心性浆液性脉络膜视网膜病变)的疗效。方法:治疗组18例18眼,予氩激光视网膜光凝,同时口服卵磷脂络合碘、维生素B1、肌苷、维脑路通片等药物。对照组18例18眼口服卵磷脂络合碘、维生素B1、肌苷、维脑路通片等药物。分别于治疗前、1mo后、3mo后OCT测量黄斑中心凹厚度及神经上皮层脱离范围,比较两组黄斑中心凹厚度及神经上皮层脱离范围下降值。结果:治疗后1mo,OCT检查中心凹厚度下降值:治疗组256±72μm,对照组82±57μm,两组比较差异有统计学意义(P<0.05);神经上皮层脱离范围下降值:治疗组3548μm±168μm,对照组1520±143μm,两组比较差异有统计学意义(P<0.05)。治疗3mo后复查,OCT检查中心凹厚度下降值:治疗组383±75μm,对照组312±67μm,两组比较差异有统计学意义(P<0.05);神经上皮层脱离范围下降值:治疗组4908±172μm,对照组4211±153μm,两组比较差异有统计学意义(P<0.05)。结论:氩激光视网膜光凝治疗中心性浆液性脉络膜视网膜病变是一有效治疗方法,能明显缩短病程。     

Comparison of two protocols of subthreshold micropulse yellow laser treatment for non-resolving central serous chorioretinopathy

Purpose:To study the effect of subthreshold micropulse yellow laser treatment on central serous chorioretinopathy (CSC) and to compare two laser protocols. As per our knowledge, there are no studies comparing the two protocols of subthreshold laser.Methods:Twenty-three patients with non-resolving CSC of at least three months duration were treated with subthreshold laser (577 nm). Ten patients were treated with 5% duty cycle (group A) and 13 patients with 10% duty cycle (group B). At one month, best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), choroidal thickness (CT) and choroidal vascularity index (CVI) were evaluated.Results:In group A, BCVA improved from 0.508 ± 504 to 0.174 ± 0.171 (P = 0.0058), CMT improved from 349.8 ± 168.9 micrometers (µm) to 183.3 ± 70.312 µm (P = 0.0093) and SRF reduced from 202.4 ± 158.024 to 43.8 ± 46.599 µm (P = 0.0069). In group B, BCVA improved from 0.437 ± 0.426 to 0.289 ± 0.470 (P = 0.0026), CMT improved from 280.846 ± 72.668 to 196.769 ± 72.62 µm (P = 0.0002) and SRF reduced from 110.385 ± 57.687 µm to 52.538 ± 52.111 µm (P = 0.0064). No significant difference was found in BCVA and CMT between the groups (P = 0.8716 and P = 0.8523, respectively). CSC completely resolved in 50% of cases in group A and in 69.2% of cases in group B. This difference was not statistically significant (0.423); however, the odds ratio of resolution was 2.25 times more with 10% duty cycle. No change was observed on fundus autofluorescence (FAF) following laser.Conclusion:Subthreshold micropulse laser can lead to resolution of SRF in 60.87% of cases (groups A and B combined). Ten per cent duty cycle had higher odds of resolution without causing any RPE damage.     

Argon laser photocoagulation treatment in central serous chorioretinopathy

Central serous chorioretinopathy, a sporadic self-limited disease of young adults, is associated with loss of central vision, image distortion, and imparied dark adaptation. The diagnosis is verified with fluorescein angiography, which demonstrates and expanding point of fluorescein dye leakage under a serous detachment of the sensory retina. Treatment should ordinarily be delayed four or more months but may be considered if there is evidence of microarchitectural changes in the macular retina, if the best corrected visual acuity declines to 20/40 or less, or if there have been multiple recurrences. Argon laser photocoagulation should be directed to the leakage site, using spot sizes of 200 mu in diameter, exposure times of 0.2 seconds, and low-power intensities.     

阈值下导航激光治疗慢性中心性浆液性脉络膜视网膜病变疗效分析

目的:对比分析智能精准靶向导航阈值下能量和微脉冲激光治疗慢性中心性浆液性脉络膜视网膜病变(cCSC)的疗效。方法:回顾性临床研究。2020-01/2021-01于南京医科大学附属眼科医院就诊的cCSC患者36例40眼纳入研究,其中19例23眼接受智能精准靶向导航阈值下能量激光治疗(靶向导航组),17例17眼接受微脉冲激光(SML)治疗(SML组)。两组患者基线资料比较,差异无统计学意义(P>0.05)。对比两组治疗前和治疗后2wk, 1、3、6mo最佳矫正视力(BCVA,LogMAR)、黄斑中心视网膜厚度(CMT)、黄斑中心凹视网膜下积液(SRF)、视网膜浅层毛细血管丛(SCP)、视网膜深层毛细血管丛(DCP)的血流密度和黄斑中心凹无血管区(FAZ)面积。结果:治疗后3、6mo,两组BCVA均较治疗前明显提高(P<0.05)。靶向导航组CMT在治疗后2wk较治疗前明显降低,SML组在治疗后1mo出现降低(P<0.05),治疗后3、6mo较治疗前明显降低(P<0.05),而两组间无明显差异(P>0.05)。两组患者SRF吸收情况有差异(P<0.05),...