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The Personalized Approach to the Chronic Central Serous Chorioretinopathy Treatment Based on the Navigated Micropulse Laser Technology

https://doi.org/10.18008/1816-5095-2018-4-394-404

Abstract

The Purpose — to develop the technology and to evaluate the clinical results of personalized laser treatment of patients with chronic central serous chorioretinopathy (CSC) in a micropulse mode with individual selection of energy parameters on the navigation system Navilas 577s. Patients and Methods. 19 patients (22 eyes) with CSC after micropulse laser treatment were analyzed. The initial best corrected visual acuity (BCVA) was 0.4 to 1.0. According to OCT, the height of the  detachment of the neurosensory retina varied from 83 to 259 microns. Retinal sensitivity of the central zone was from 20.2 to 29.7 dB. Before laser treatment were individually selected the optimal energy parameters for each patient. The treatment was performed on a Navilas 577s laser system. The follow-up were 1 and 3 months. Results. 1 month after treatment the positive dynamics of functional and anatomical results in all patients was observed. Mean BCVA increased in the group to 0.81 ± 0.04. The central retinal sensitivity raised on average in the group up to 25.7 ± 0.6 dB. After 3 months, mean BCVA was 0.96 ± 0.02. Mean central retinal sensitivity increased to 26.4 ± 0.57 dB. The study revealed a high correlation between visual acuity and the central retinal thickness (0.72) and medium correlation between foveal retinal sensitivity and central retinal thickness in fovea (0.60), respectively. The correlation among visual acuity, retinal sensitivity and the symptom’s duration of the disease is negative medium (-0.63) and significant (-0.72), respectively. Conclusions. The developed personalized technology of laser treatment of chronic central serous chorioretinopathy with a micropulse mode with an individual selection of energy parameters on the Navilas 577s navigation system showed high clinical efficiency and safety. It has been established that in the course of the longstanding duration of the disease irreversible changes in the chorioretinal complex structure occured, thinning of the foveal photoreceptors layer leading to a decrease in the central retinal sensitivity and visual acuity, which substantiate the necessity for early and maximally functional-saving treatment.

About the Authors

P. L. Volodin
The S. Fyodorov Eye Microsurgery Federal State Institution
Russian Federation

МD, head of the laser retinal surgery department

Beskudnikovsky blvd, 59a, Moscow, 127486, Russia



A. V. Doga
The S. Fyodorov Eye Microsurgery Federal State Institution
Russian Federation

MD, professor, Deputy General Director for scientific and clinical work

Beskudnikovsky blvd, 59a, Moscow, 127486, Russia



E. V. Ivanova
The S. Fyodorov Eye Microsurgery Federal State Institution
Russian Federation

PhD, ophthalmologist of the laser retinal surgery department

Beskudnikovsky blvd, 59a, Moscow, 127486, Russia



V. A. Pismenskaya
The S. Fyodorov Eye Microsurgery Federal State Institution
Russian Federation

PhD, ophthalmologist of the department of clinical and functional diagnostics

Beskudnikovsky blvd, 59a, Moscow, 127486, Russia



Iu. I. Kukharskaya
The S. Fyodorov Eye Microsurgery Federal State Institution
Russian Federation

postgraduate of the laser retinal surgery department

Beskudnikovsky blvd, 59a, Moscow, 127486, Russia



E. S. Khrisanfova
The S. Fyodorov Eye Microsurgery Federal State Institution
Russian Federation

postgraduate of the laser retinal surgery department

Beskudnikovsky blvd, 59a, Moscow, 127486, Russia



References

1. Щеголева И.В., Будзинская М.В. Этиология и патогенез центральной серозной хориоретинопатии. Вестник офтальмологии. 2010:3;55–58 [Shegoleva I.V., Budzinskaya M.V. Etiology and pathogenesis of central serous chorioretinopathy. Annals of Ophthalmology = Vestnik oftal’mologii. 2010:3;55–58 (In Russ.)].

2. Elsner H., Pörksen E., Klatt C., Bunse A., Theisen-Kunde D., Brinkmann R., Birngruber R., Laqua H., Roider J. Selective retina therapy in patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol. 2006 Dec;244(12):1638–1645. DOI: 10.1007/s00417-006-0368-5

3. Framme C., Walter A., Berger L., Prahs P., Alt C., Theisen-Kunde D., Kowal J., Brinkmann R. Selective Retina Therapy in Acute and Chronic-Recurrent Central Serous Chorioretinopathy. Ophthalmologica. 2015;234(4):177–188. DOI: 10.1159/000439188

4. Piccolino F.C., De La Longrais R.R., Manea M., Cicinelli S. Posterior cystoid retinal degeneration in central serous chorioretinopathy. Retina. 2008 Jul-Aug;28(7):1008–1012. DOI: 10.1097/IAE.0b013e31816b4b86

5. Breukink M.B., Dingemans A.J., den Hollander A.I., Keunen J.E., MacLaren R.E., Fauser S., Querques G., Hoyng C.B., Downes S.M., Boon C.J. Chronic central serous chorioretinopathy: long-term follow-up and vision-related quality of life. Clin Ophthalmol. 2016. Dec 20;11:39–46. DOI: 10.2147/OPTH.S115685

6. Злобина А.Н., Малышев В.В., Юрьева Т.Н., Щуко А.Г., Букина В.В. Показания и эффективность различных методов лечения хронической центральной серозной хориоретинопатии. Современные технологии в офтальмологии. 2015;1:66–67 [Zlobina A.N., Yurieva T.N., Shuko A.G., Bukina V.V. Сlassification criteria of central serous chorioretinopathy. Modern Technologies in Ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2015;1:66–67 (In Russ.)].

7. Мальцев Д.С., Куликов А.Н. Фокальная лазерная коагуляции точки просачивания при центральной серозной хориоретинопатии без флюоресцентной ангиографии. Современные технологии в офтальмологии. 2017;1:82–85 [Maltsev D.S., Kulikov A.N. Focal laser photocoagulation of the leaking point without fluorescein angiography for central serous chorioretinopathy. Modern Technologies in Ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2017;1:82–85 (In Russ.)].

8. Мирзабекова К.А., Федорук Н.А. Лазеры в лечении центральной серозной хориоретинопатии. В кн.: Вопросы лазерной офтальмологии. М., 2013. С. 249–255 [Mirzabekova К.А., Feforuk N.A. Lasers in the treatment of central serous chorioretinopathy. In: Laser Ophthalmology Issues. Мoscow, 2013. P. 249–255 (In Russ.)].

9. Тахчиди Х.П., Качалина Г.Ф., Желтов Г.И., Касмынина Т.А., Горшков И.М., Иванова Е.В. Эффективность новой лазерной технологии микроимпульсного воздействия в лечении структурно-функциональных нарушений после эндовитреальной хирургии отслойки сетчатки. Офтальмохирургия. 2010;2:35–41 [Takhchidi Kh.P., Kachalina G.F., Zheltov G.I., Kasmynina T.A., Gorshkov I.M., Ivanova E.V. Efficiency of a new laser technique of selective retina therapy (SRT) for treatment of structural and functional abnormalities after vitrectomy for retinal detachment. Fyodorov Journal of Ophthalmic Surgery = Oftal’mokhirurgiya. 2010;2:35–41 (In Russ.)].

10. Володин П.Л., Иванова Е.В. Компьютерное моделирование лазерного воздействия в режиме единичного микроимпульса и реакции белков хориоретинального комплекса для селективного и эффективного воздействия на клетки ретинального пигментного эпителия. Лазерная медицина. 2018;1:61–66 [Volodin P.L., Ivanova E.V. Computer simulation of laser action in the regime of single micropulse and reactions of proteins chorioretinal complex for selective and effective action on the retinal pigment epithelium cells. Laser Medicine = Lazernaya medicina. 2018;1:61–66 (In Russ.)].

11. Качалина Г.Ф., Желтов Г.И., Иванова Е.В. Оптимизация режимов лазера IRIS Medical IQ 577 для избирательного воздействия на пигментный эпителий сетчатки. Офтальмология. Восточная Европа. 2015;27(4):69–77 [Kachalina G.F., Zheltov G.I., Ivanova E.V. Optimization of operating modes of IRIS Medical IQ 577 laser for selective action onto retinal pigment epithelium. Ophthalmology. Eastern Europe = Oftal’mologiya. Vostochnaya Evropa. 2015;27(4):69–77 (In Russ.)].

12. Качалина Г.Ф., Желтов Г.И., Иванова Е.В. Современные подходы применения микроимпульсного режима при лечении заболеваний центральной зоны сетчатки. Таврический медико-биологический вестник. 2012;15:225–227 [Kachalina G.F., Zheltov G.I., Ivanova E.V. Modern approaches for the use of micropulse mode for the treatment of central retinal diseases. Tavrichesky medico-biological vestnik = Tavricheskij mediko-biologicheskij vestnik. 2012;15:225–227 (In Russ.)].

13. Тахчиди Х.П., Качалина Г.Ф., Желтов Г.И., Иванова Е.В. Новая технология восстановления зрительных функций, основанная на избирательном воздействии коротких импульсов лазерного излучения на пигментный эпителий сетчатки. Офтальмология в Беларуси. 2010;4(07):79–83 [Takhchidi Kh.P., Kachalina G.F., Zheltov G.I., Ivanova E.V. A new technology of visual functions restoration, based on the selective effect of short pulses of laser radiation on the retinal pigment epithelium. Ophthalmology in Belarus = Oftal’mologiya v Belarusi. 2010;4(07):79–83 (In Russ.)].

14. Arsan A., Kanar H.S., Sonmez A. Visual outcomes and anatomic changes after subthreshold micropulse yellow laser (577 nm) treatment for chronic central serous chorioretinopathy: long-term follow-up. Eye (Lond). 2018 Apr;32(4):726–733. DOI: 10.1038/eye.2017.293

15. Park Y.G., Kang S., Kim M., Yoo N., Roh Y.J. Selective retina therapy with automatic real-time feedback-controlled dosimetry for chronic central serous chorioretinopathy in Korean patients. Graefes Arch Clin Exp Ophthalmol. 2017 Jul;255(7):1375–1383. DOI: 10.1007/s00417-017-3672-3

16. Володин П.Л., Желтов Г.И., Иванова Е.В., Соломин В.А. Калибровка параметров микроимпульсного режима лазера IRIDEX IQ 577 с помощью компьютерного моделирования и методов диагностики глазного дна. Современные технологии в офтальмологии. 2017;1:52–54 [Volodin P.L., Zheltov G.I., Ivanova E.V., Solomin V.A. Calibration of the parameters of micropulse mode of the IRIDEX IQ 577 laser by computer simulation and diagnostic methods of eye fundus diagnosis. Modern Technologies in Ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2017;1:52–54 (In Russ.)].

17. Желтов Г.И., Глазков В.Н., Иванова Е.В. Селективное действие лазерных импульсов на ретинальный пигментный эпителий. Физические основы. ARS-MEDICA. 2012;58(3):78–85 [Zheltov G.I., Glazkov V.N., Ivanova E.V. Selective action of laser pulses on the retinal pigment epithelium. Physical basics. ARSMEDICA. 2012;58(3):78–85 (In Russ.)].

18. Володин П.Л., Иванова Е.В., Соломин В.А., Письменская В.А., Хрисанфова Е.С. Первый опыт применения селективного микроимпульсного лазерного воздействия (577 нм) с индивидуальным подбором параметров у пациентов с острой центральной серозной хориоретинопатией. Практическая медицина. 2017;110(9)2:55–59 [Volodin P.L., Ivanova E.V., Solomin V.A., Pismenskaya V.A., Khrisanfova E.S. The first experience of the use of selective micropulse laser treatment (577 nm) with individual selection of parameters for acute central serous chorioretinopathy. Practical Medicine = Prakticheskaya meditsina. 2017;110(9)2:55–59 (In Russ.)].

19. Иванова Е.В., Дога А.В., Володин П.Л., Соломин В.А., Хрисанфова Е.С. Персонализированное лечение центральной серозной хориоретинопатии с помощью индивидуального подбора параметров микроимпульсного режима на навигационной лазерной системе Navilas 577s. Современные технологии в офтальмологии. 2018;21(1):162–165 [Ivanova E.V., Doga A.V., Volodin P.L., Solomin V.A., Khrisanfova E.S. Personalized treatment of central serous chorioretinopathy by individual selection of micropulse mode parameters on NAVILAS 577s laser system. Modern Technologies in Ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2018;21(1):162–165 (In Russ.)].

20. Володин П.Л., Иванова Е.В., Соломин В.А. Возможности современных методов диагностики и компьютерной обработки данных с помощью программы Фемтоскан для выявления слабых термических повреждений клеток ретинального пигментного эпителия. Лазерная медицина. 2018;1:52–57 [Volodin P.L., Ivanova E.V., Solomin V.A. The possibilities of modern diagnostic methods and computer data processing using the FemtoScan program to identify weak thermal damage of retinal pigment epithelium cells. Laser Medicine = Lazernaya medicina. 2018;1:52–57 (In Russ.)].

21. Kang S., Park Y.G., Kim J.R., Seifert E., Theisen-Kunde D., Brinkmann R., Roh Y.J. Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy: A Pilot Study. Medicine (Baltimore). 2016 Jan; 95(3):e2524. DOI: 10.1097/MD.0000000000002524

22. Liegl R., Ulbig M.W. Central serous chorioretinopathy. Ophthalmologica. 2014;232(2):65–76. DOI: 10.1159/000360014

23. Dolar-Szczasny J., Święch-Zubilewicz A., Mackiewicz J. Macular Integrity Assessment and Fixation Analysis in Chronic Central Serous Chorioretinopathy. J Ophthalmol. 2018 Mar 14;2018:947–948. DOI: 10.1155/2018/9479848

24. Ojima Y., Tsujikawa A., Yamashiro K., Ooto S., Tamura H., Yoshimura N. Restoration of outer segments of foveal photoreceptors after resolution of central serous chorioretinopathy. Jpn J Ophthalmol. 2010 Jan;54(1):55–60. DOI: 10.1007/s10384-009-0766-4

25. Sugiura A., Fujino R., Takemiya N., Shimizu K., Matsuura M., Murata H., Inoue T., Obata R., Asaoka R. The association between visual function and retinal structure in chronic central serous chorioretinopathy. Sci Rep. 2017 Nov 24;7(1):16288. DOI: 10.1038/s41598-017-16339-9

26. Wang M.S., Sander B., Larsen M. Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2002 Jun;133(6):787–789.


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For citations:


Volodin P.L., Doga A.V., Ivanova E.V., Pismenskaya V.A., Kukharskaya I.I., Khrisanfova E.S. The Personalized Approach to the Chronic Central Serous Chorioretinopathy Treatment Based on the Navigated Micropulse Laser Technology. Ophthalmology in Russia. 2018;15(4):394-404. (In Russ.) https://doi.org/10.18008/1816-5095-2018-4-394-404

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