MicroPulse Laser Treatment for Recurrent CSCR
March 14, 2023
2 minutes read
Luo is a retinal surgeon with Bay Area Retina Associates in Walnut Creek, California.
Disclosure: Luo reports that he has consulted for AbbVie, Alimera, Allergan, Genentech, Iridex and Lumenis and has received research grants from Allergan and Lumenis.
A 52-year-old startup CEO presented with a right eye distortion in January 2021. He had a large subfoveal pigment epithelial detachment but no clear subretinal fluid.
He was on testosterone replacement therapy but refused steroids. His measured vision was 20/30 in the right eye with pachychoroid. This did not appear to be active central serous chorioretinopathy (CSCR) as fluorescein angiography (FA) showed no clear leak, but these symptoms, along with a stressful job and ambitious personality, suggested a previous case of CSCR with one of it resulting consequence towards pigment epithelial detachment (PED).
I asked him to stop TRT and encouraged him to reduce stress. I then followed him monthly.
At 3 months, the patient’s PED was unchanged and he continued to report significant visual impairment. His vision reading at this point was 20/40. He desperately sought treatment. While an OCT angiography showed no evidence of type 2 choroidal neovascularization, I attempted an Avastin (bevacizumab, Genentech) injection in April 2021 with discussion of the risk of retinal pigment epithelium rupture.
This was of absolutely no use to the PED. In fact, he then presented in July 2021 with new subretinal fluid and FA showed a classic CSCR chimney leak in the bed of the PED. His measured vision remained stable at 20/40. We discussed his options at this point and decided to proceed with MicroPulse therapy (Iridex).
He returned for follow-up in September 2021 with slightly improved subretinal fluid and stable 20/40 visual acuity. Subjectively, the patient felt that seeing was less disturbing. I was hopeful at this point, but not overly optimistic, and began to consider alternative therapies.
He then presented a month later with dramatic functional and anatomical improvement. His measured vision was 20/50, but he felt significantly more comfortable with his vision. He felt as if he had returned to baseline and had no difficulties at home or at work. This highlights the difference between functional visual acuity, which also includes factors such as distortion and contrast sensitivity, and measured visual acuity.
He last presented to me in October 2022 with a stable OCT and vision of 20/30+1. He remains satisfied with his vision.
This case demonstrates the value of MicroPulse laser treatment in recurrent CSCR.
This was a patient in the prime of his life who really wanted something done, and MicroPulse laser treatment gives us something to offer to these patients. The safety of the treatment allowed me to use it comfortably despite the subfoveal nature of the leak. This case also shows that while we all want the slam dunk, instant gratifying results, MicroPulse Laser Therapy can take some time to show the benefits.