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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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