What is central serous retinopathy?
Before we discuss laser for central serous retinopathy, we must ask what is central sero retinopathy. Central serous retinopathy (CSR) is an eye condition associated with loss of vision from water (serous) leakage from the choroid beneath the macula (central retina). Although it may be seen at any age, it is most common among young adult males. The leakage may be initiated by emotional stress and aggravating factors include stimulants (caffeine, cocaine, amphetamines), steroids (cortisone, prednisone, testosterone and other androgens), lack of sleep (sleep apnea), over-the-counter dietary supplements (niacin, body-builders), prescription medications (possibly Viagra and related meds), and medical conditions (Cushing’s syndrome, pheochromocytoma).
What treatment is available?
The first line of treatment is identification and elimination of any factors that are suspected to aggravate CSR. However, if leakage persists, there are a number of treatments that may be helpful. These include a special class of oral diuretics, antiVEGF injections, and lasers. Although thermal lasers may be used in selected cases, often cold lasers are preferred.
How do cold lasers (PDT) work?
Verteporfin photodynamic therapy (PDT) is the cold laser used in ophthalmology for the treatment of retinal problems. It is called “cold” because it does not use heat to cauterize tissue. Verteporfin dye is injected into the vein of the arm after which a laser is aimed into the eye to activate the dye. The activated dye releases highly reactive oxygen radicals, which chemically seal the leaking blood vessels under the retina. PDT is very effective in treating CSR. It is expensive and sometimes not covered by private insurance. PDT rarely causes a blind spot in the vision and this risk is minimized by using a low dose of Verteporfin or low power laser (reduced fluence). After PDT treatment has been completed, it is important to avoid direct sunlight (or exposure to halogen light) for 48 hours to allow time for the Verteporfin to leave the body.
Below are the photos of a 49-year-old man who had blurred vision and some distortion in his left eye for a year. His condition did not improve after a trial off caffeine. He had no medical problems and no other inciting factors were identified.
Color photos revealed some white changes in the retina (arrow) due to permanent degeneration of the retina near center of vision (fovea) due to longstanding leakage. Fundus autofluorescence photos are even more sensitive in showing this damage.
OCT (above) shows fluid under the retina (between the retina and the retinal pigment epithelium).
FA/ICGA photos (above) show the site of active leakage under the retina. Because of the lack of improvement with medical therapy and the threat of permanent loss of central vision due to long-standing leakage, this patient underwent reduce-fluence PDT. He experienced no adverse effects of laser and his vision returned to 20/20 over several months’ time.
The OCT above shows resolved subretinal fluid one month after PDT.
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