Selective Retina Therapy With Real-Time Feedback-Controlled Dosimetry for Treating Acute Idiopathic Central Serous Chorioretinopathy in Korean Patients

Central serous chorioretinopathy (CSC) is a disorder that is characterized by a localized serous detachment of the neurosensory retina in the posterior pole. Additionally, CSC is often self-limiting and spontaneous resolution of subretinal fluid (SRF) often occurs within several months. Although several treatment modalities (e.g., laser photocoagulation, photodynamic therapy, and anti-vascular endothelial growth factor [VEGF] therapy have been used in CSC patients, a consensus has not yet been reached on the optimal time for intervention.

Selective retina therapy (SRT) selectively disrupts the retinal pigment epithelium (RPE) with minimal damage to the photoreceptors. Previous studies have shown SRT to be effective for resolving SRF, while causing only minimal collateral damage to the retina and vision. However, most patients included in prior studies had chronic CSC (≥3 months symptom duration) and SRT efficacy on acute CSC is not fully known.

When treating CSC patients, it is generally recommended to follow-up several months without any intervention to identify spontaneous resolution of SRF. However, prompt treatment may be beneficial for some patients. For example, metamorphopsia or micropsia associated with CSC can greatly interfere with driving or with work when an occupation requires delicate procedures. Additionally, patients are often psychologically distressed by a CSC diagnosis and the accompanying decrease in vision-related quality of life. In these cases, prompt treatment to reduce SRF may relieve, at least in part, CSC symptoms and their related stress.

The current study evaluated short-term treatment outcomes following SRT with real-time feedback-controlled dosimetry in Korean patients with acute idiopathic CSC.

This study included patients who were diagnosed with treatment-naïve idiopathic CSC and were treated with SRT. The R:GEN device (Lutronic, Goyang-si, South Korea) was used to administer SRT. Inclusion criteria also included SRF involving the fovea (documented by optical coherence tomography [OCT] performed at initial presentation) and symptom duration shorter than 3 months. Patients were excluded from analyses if any of the following were true: (1) age > 55 years, (2) clinical or angiographic features suggestive of choroidal neovascularization, (3) OCT findings suggestive of type 1 neovascularization or polypoidal choroidal vasculopathy (e.g., double layer sign or fibrovascular pigment epithelial detachment), (4) history of macular laser photocoagulation, photodynamic therapy, or anti-VEGF therapy, or (5) history of exogenous corticosteroid treatment for a systemic disease (e.g., Cushing's syndrome or renal disease).