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Selektive Retina-Therapie bei Retinopathia centralis serosa mit Pigmentepithelabhebung

Selective Retina Therapy in central serous chorioretinopathy with detachment of the pigmentary epithelium

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Zusammenfassung

Hintergrund

Die selektive Retina-Therapie (SRT) ist ein neues innovatives Laserverfahren, welches selektiv das retinale Pigmentepithel (RPE) unter Schonung der Photorezeptoren behandelt. Dieses therapeutische Konzept erscheint besonders zur Behandlung von Patienten mit akuter und chronischer RCS geeignet. Erste Ergebnisse der Behandlung von 5 Patienten mit chronischer RCS und Pigmentepithelabhebung (PED) werden dargestellt.

Patienten und Methode

In diese Fallserie wurden 5 männliche Patienten (Durchschnittsalter 47 Jahre) mit chronischer RCS einhergehend mit einer PED und dadurch bedingter subretinaler Flüssigkeit (SRF) eingeschlossen. Prä- und postoperative Untersuchungen: Visus, Fluoreszeinangiographie, Zeiss OCT III. SRT: Laserung des Leckageareals und der PED (konfluierend) (Nd:YLF-Laser, 527 nm, gepulst, Pulsdauer 1,7 μs, 100 Hz, Energie 150–250 μJ). Kontrolle der Patienten nach 4 und 12 Wochen.

Ergebnisse

Der Visus betrug präoperativ im Mittelwert 0,53, nach 4 Wochen 0,56 und nach 12 Wochen 0,5. Präoperativ bestand bei allen Patienten ein angiographisch sichtbares Leckageareal im Bereich der PED. Nach 4 Wochen war angiographisch bei 4 von 5 Patienten keine Leckageaktivität mehr nachweisbar. Die OCT zeigt präoperativ bei allen Patienten SRF am Rand der PED. Nach 4 Wochen war bei 4 von 5 Patienten keine subretinale Flüssigkeit mehr nachweisbar.

Schlussfolgerungen

Die SRT ist eine sichere und effektive Therapie für Patienten mit chronischer RCS bei denen eine PED Ursache der subretinalen Flüssigkeit ist. Ein Rip-Syndrom konnte trotz konfluierender SRT der PED nicht beobachtet werden. Aufgrund der Schonung der Photorezeptoren ist die Methode besonders bei foveanaher Lokalisation geeignet. Die Ergebnisse weisen darauf hin, dass die SRT zu einer Wiederherstellung der äußeren Blut-Retina-Schranke führt.

Abstract

Background

Selective Retina Therapy (SRT) is a new and innovative laser treatment modality that selectively treats the retinal pigmentary epithelium while sparing the photoreceptors. This therapeutic concept appears to be particularly suitable for treating patients with acute or chronic central serous chorioretinopathy (CSC). We present preliminary results obtained in five patients who had CSC associated with pigmentary epithelium detachment (PED) and serous subretinal fluid (SRF) and who were treated with SRT.

Methods

This case series was made up of five male patients (mean age 47 years) with chronic CSC and SRF resulting from PED. Examinations performed before and at 1 month and 3 months after the treatment were: BCVA, FLA, OCT (Zeiss OCT III). For SRT, confluent treatment of the PED (area of leakage) was carried out using a pulsed frequency-doubled, Q-switched Nd-YLF prototype laser (λ=527 nm, t= 1.7 s, 100 Hz, energy = 150–250 J).

Results

Best corrected visual acuity at baseline was 0.53, while after 4 weeks it was 0.56 and after 12 weeks, 0.5. At baseline leakage was seen at the PED on fluorescein angiography in all patients. After 4 weeks leakage activity was no longer noted on angiography in 4 of 5 patients. OCT at baseline showed SRF at the edge of the PED in all patients, but in 4 of the 5 patients this was no longer detectable after 4 weeks.

Conclusion

SRT is a safe and effective treatment for patients with CSC in which PED has caused SRF. Not a single case of rip syndrome was observed in this study, even though the PED was treated confluently. Since SRT spares the photoreceptors it is particularly suitable for the treatment of CSC, especially when the origin of leakage is located close to the fovea. The results indicate that SRT leads to reconstruction of the outer blood- retina barrier.

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Literatur

  1. Boscia F, Furino C, Sborgia L et al. (2004) Photodynamic therapy for retinal angiomatous proliferations and pigment epithelium detachment. Am J Ophthalmol 138: 1077–1079

    Article  PubMed  Google Scholar 

  2. Bujarborua D, Chatterjee S, Chouhury A et al. (2005) Fluorescein Angiographic features of asymptomatic eyes in central serous chorioretinopathy. Retina 25: 422–429

    Article  PubMed  Google Scholar 

  3. Burumcek E, Mudun A, Karacorlu S et al. (1997) Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up. Ophthalmology 104: 616–22

    PubMed  Google Scholar 

  4. Conrad R, Bodeewes I, Schilling G et al. (2000) Chorioretinopathia centralis serosa und psychische Belastung. Ophthalmologe 97: 527–531

    PubMed  Google Scholar 

  5. Elsner H, Pörksen E, Klatt C et al. (2006) Selective Retina Therapy in patients with central serous chorioretinopathy. Graef Arch Ophthalmol (online publiziert)

  6. Fawzi AA, Holland GN, Kreiger AE et al. (2006) Central serous chorioretinopathy after solid organ transplantation. Ophthalmology 113: 813.e1–5

    Article  Google Scholar 

  7. Garg SP, Dad T, Talwar D et al. (1997) Endogenous cortisol profile in patients with central serous chorioretinopathy. Br J Ophthalmol 81: 962–964

    PubMed  Google Scholar 

  8. Greite JH, Birngruber R (1975) Low intensity argon laser coagulation in central serous retinopathy (csr), Ophthalmologica 171: 214–243

  9. Haimovici R, Rumelt S, Melby J (2003) Endocrine Abnormalities in Patients with Central Serous Chorioretinopathy. Ophthalmology 110: 698–703

    Article  PubMed  Google Scholar 

  10. Heimann H, Kellner U, Foerster MH (2004) Angiographie-Atlas des Augenhintergrundes. Thieme, Stuttgart, New York

  11. Klein ML, Van Buskirk EM, Friedman E (1974) Experience with nontreatment of central serous choroidopathy. Arch Ophthalmol 91: 247–250

    PubMed  Google Scholar 

  12. Lida T, Yannuzzi LA, Spaide RF (2003) Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina 23: 1–7

    Article  PubMed  Google Scholar 

  13. Mandeep SD, Blinder KJ, Tewari A et al. (2006) Retinal Pigment Epithelial Tear Following intravitreal Pegaptanib Sodium. Am J Ophthalmol 141: 752–754

    Article  PubMed  Google Scholar 

  14. Mitarai K, Gomi F, Tano Y (2006) Three-dimensional optical coherence tomographic findings in central serous chorioretinopathy. Graef Arch Ophthalmol (accepted 16 January 2006)

  15. Montero JA, Ruiz-Moreno JM (2005) Optical coherence tomography characterisation of idiopathic central serous chorioretinopathy. Br J Ophthalmol 89: 562–564

    Article  PubMed  Google Scholar 

  16. Nicolo M, Ghiglione D, Lai S et al. (2005) Intravitreal triamcinolone in the treatment of serous pigment epithelial detachment and occult choroidal neovascularization secondary to age-related macular degeneration. Eur J Ophthalmol 15: 415–419

    PubMed  Google Scholar 

  17. Ober MD, Yannuzzi LA, Do DV et al. (2005) Photodynamic therapy for focal retinal pigment epithelial leaks secondary to central serous chorioretinopathy. Ophthalmology 112: 2088–2094

    Article  PubMed  Google Scholar 

  18. Otsuka S, Ohba N, Nakao K (2002) A Long-Term Follow-Up Study of Severe Variant Of Central Serous Chorioretinopathy. Retina 22: 25–32

    Article  PubMed  Google Scholar 

  19. Piccolino FC, de la Longrais RR, Ravera G (2005) The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol 139:87–99

    Article  PubMed  Google Scholar 

  20. Roider J, Brinkmann R, Wirbelauer C et al. (1999) Retinal Sparing by Selective Retinal Pigment Epithelium Photocoagulation. Arch. Ophthalmol 117: 1028–1034

    PubMed  Google Scholar 

  21. Roider J, Brinkmann R, Birngruber R (2003) Selective Retinal Pigment Epithelium Treatment. Lasers in Ophthalmology-Basic, Diagnostics and Surgical Aspects, pp 119–129

  22. Roider J, Hillenkamp F, Flotte F et al. (1993) Microphotokoagulation: Selective effects of short laser pulses. Proc Natl Acad Sci USA 90: 8643–8647

    Article  PubMed  Google Scholar 

  23. Schule G, Huttmann G, Framme C et al. (2004) Noninvasive optoacustic temperature determination at the fundus of the eye during laser irradiation. J Biomed Opt 9: 137–139

    Google Scholar 

  24. Völcker M, Peters S, Inhoffen W et al. (2006) Früher antiexudativer Effekt – OCT-Monitoring nach intravitrealer Bevacizumab-Applikation. Ophthalmologe 103: 476–483

    Article  Google Scholar 

  25. Yannuzzi LA, Slakter JS, Gross NE (2003) Indocynanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: A pilot study. Retina 23: 288–298

    Article  PubMed  Google Scholar 

  26. Yannuzzi LA, Slakter JS, Kaufmann SR, Gupta K (1992) Laser treatment of diffuse retinal pigment epitheliopathy. Eur J Ophthalmol 2: 103–114

    PubMed  Google Scholar 

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Klatt, C., Elsner, H., Pörksen, E. et al. Selektive Retina-Therapie bei Retinopathia centralis serosa mit Pigmentepithelabhebung. Ophthalmologe 103, 850–855 (2006). https://doi.org/10.1007/s00347-006-1415-7

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  • DOI: https://doi.org/10.1007/s00347-006-1415-7

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