Lasers in the Treatment of Central Serous Chorioretinopathy

Abstract

Central serous chorioretinopathy (CSCR) is a clinical entity that has been well described in medical literature, however its etiology and pathophysiology still remains a medical mystery. Recent advances in retinal and choroidal diagnostics have changed approach to CSCR pathogenesis with the choroid perceived as the origin this disorder and retinal pigment abnormalities as secondary. CSCR is nowadays placed within the spectrum of pachychoroid diseases characterized by the increased choroidal thickness. Moreover, the advent of OCT-angiography has enabled to assess the potential complications of CSCR such as choroidal neovascularization, which is detected frequently with this imaging. All these facts had an impact on therapeutic strategies applied in CSCR. Typically CSCR is treated with different forms of laser, starting from classic photocoagulation (LPC), through subthreshold micropulse laser (SMPLT) and ending at photodynamic therapy (PDT). The therapeutic target of each of these procedures is different, thus the stage and type of CSCR has to be considered before initiation of therapy. LPC is nowadays used in selected cases with single extrafoveal leak. SMPLT as a cheap and safe form of treatment is used commonly in simple CSCR cases, while PDT is preferred in complex and long-standing forms of CSCR. The timing of application of treatment is still a question of debate, however there is a rising body of evidence that early treatment provides better functional results. The chapter contains analysis of available diagnostic and therapeutic modalities used for CSCR with the emphasis on its efficacy in real life studies. Therapeutic questions and dilemmas are presented and discussed, together with the proposed parameters for laser techniques in that entity.