J Korean Ophthalmol Soc.  2012 Jun;53(6):886-894.

Laser-Induced Choroidal Neovascularization in Central Serous Chorioretinopathy: 4 Cases

• Lee SH
• Chung H
• Kim HC

Abstract

PURPOSE
To report the choroidal neovascularization of 4 patients in central serous chorioretinopathy treated with laser treatment.
CASE SUMMARY
We reported 4 patients with central serous chorioretinopathy. Three patients were treated with focal laser photocoagulation, and 1 patient with photodynamic treatment. All patients newly developed choroidal neovascularization (CNV) after treatment at the area of laser treatment. Three patients received intravitreal anti-VEGF injection and 1 patient received argon laser photocoagulation for the treatment of CNV. After the treatment, the CNV was resolved with improved visual acuity.
CONCLUSIONS
Laser treatment may be efficacious tool to achieve rapid resolution in central serous chorioretinopathy until now. However, more caution at the time of treatment and close follow-up after treatment are warranted.

Keyword

Central serous chorioretinopathy; Choroidal neovascularization; Intravitreal anti-VEGF injection; Laser complications

MeSH Terms

Argon
Central Serous Chorioretinopathy
Choroid
Choroidal Neovascularization
Humans
Light Coagulation
Argon

Figure

• 

  Figure 1 Fundus photograph, fluorescein angiography (FA), spectral domain optical coherence tomography (SD OCT), and indocyanine green angiography (ICGA) images of a 53-year-old man (patient 1). (A) Fundus photograph at the first examination showed serous retinal detachment of the right eye. (B) Extrafoveal leaking point was seen on FA (arrow). (C) SD OCT revealed subretinal fluid. (D) Diffuse choroidal hyperpermeability around leaking point on FA was observed on ICGA (arrowheads). (E) Subretinal fluid on SD OCT was resolved at one month after laser photocoagulation. (F) After laser photocoagulation, choroidal neovascularization (CNV, red arrow) at the area of the previous laser photocoagulation was found. (G) One month after three times of intravitreal bevacizumab injection, the subretinal fluid was resolved and the size of CNV was much decreased.

• 

  Figure 2 FA and OCT images of a 45-year-old woman (patient 2). (A) Time domain optical coherence tomography (TD OCT) at the first examination revealed subretinal fluid. (B) FA showed diffuse leakage without focal leaking point. (C) Three months after observation without treatment, serous retinal detachment was aggravated with increased subretinal fluid on SD OCT. So focal laser photocoagulation was performed. (D) FA showed several leaking points at macular area (arrow). (E) One month after focal laser photocoagulation, CNV (red arrow) developed at the area of the previous laser treatment and subretinal fluid was seen on SD OCT. (F) SD OCT at one month later showed completely resolved subretinal fluid and regressed CNV after intravitreal anti-VEGF injection.

• 

  Figure 3 FA and OCT images of a 50-year-old man (patient 3). (A) Subretinal fluid was seen on TD OCT. (B) FA showed two focal leaking points (arrows). (C) Three months after photodynamic therapy, subretinal fluid was resolved. (D) Eight months later, recurrent subretinal fluid was observed on SD OCT. E) One month after half-dose second photodynamic therapy, subretinal fluid was resolved. (F) Fifteen months later, the patient complained of decreased vision. SD OCT showed CNV (red arrow) with subretinal fluid. (G) Hyperfluorescent CNV lesion (arrow) was seen on FA. (H) After three times of intravitreal anti-VEGF injection, the size of CNV was much decreased and subretinal fluid was resolved. (I) Two months later, SD OCT revealed mild subretinal fluid again. (J) Three months after additional anti-VEGF injection, the subretinal fluid was resolved and CNV lesion was stabilized.

• 

  Figure 4 Fundus photograph, FA, and TD OCT images of a 34-year-old woman (patient 4). (A) Fundus photography showed serous retinal detachment. (B) FA revealed extrafoveal focal leaking point. (C) Subretinal fluid was observed on TD OCT. (D) Two weeks after focal laser photocoagulation, TD OCT revealed almost resolved subretinal fluid. (E) One month later, fundus photograph showed the gray-white lesion (arrow) with surrounding subretinal hemorrhage. (F) FA showed the well-demarcated extrafoveal hyperfluorescence (arrow) at the area of previous laser treatment with surrounding hypofluorescence due to subretinal hemorrhage. (G) One month after laser photocoagulation for the treatment of CNV, subretinal hemorrhage was resolved. (H) FA showed hyperfluorescencent area around the laser scar.

Reference

1. Gass JD, Norton EW, Justice J Jr. Serous detachment of the retinal pigment epithelium. Trans Am Acad Ophthalmol Otolaryngol. 1966. 70:990–1015.

2. Yannuzzi LA. Type-A behavior and central serous chorioretinopathy. Retina. 1987. 7:111–131.

3. Spaide RF, Campeas L, Haas A, et al. Central serous chorioretinopathy in younger and older adults. Ophthalmology. 1996. 103:2070–2079.

4. Huang WC, Chen WL, Tsai YY, et al. Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eye (Lond). 2009. 23:488–489.

5. Niegel MF, Schrage NF, Christmann S, Degenring RF. [Intravitreal bevacizumab for chronic central serous chorioretinopathy]. Ophthalmologe. 2008. 105:943–945.

6. Leaver P, Williams C. Argon Laser photocoagulation in the treatment of central serous retinopathy. Br J Ophthalmol. 1979. 63:674–677.

7. Novak MA, Singerman LJ, Rice TA. Krypton and argon laser photocoagulation for central serous chorioretinopathy. Retina. 1987. 7:162–169.

8. Chan WM, Lam DS, Lai TY, et al. Choroidal vascular remodelling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003. 87:1453–1458.

9. Schatz H, Yannuzzi LA, Gitter KA. Subretinal neovascularization following argon laser photocoagulation treatment for central serouschorioretinopathy: complication or misdiagnosis? Trans Sect Ophthalmol Am Acad OPhthalmol Otolaryngol. 1977. 83:893–906.

10. Watzke RC, Burton TC, Woolson RF. Direct and indirect laser photocoagulation of central serous choroidopathy. Am J Ophthalmol. 1979. 88:914–918.

11. Ha TW, Ham DI, Kang SW. Management of choroidal neovascularization following laser photocoagulation for central serous chorioretinopathy. Korean J Ophthalmol. 2002. 16:88–92.

12. Watzke RC, Burton TC, Leaverton PE. Ruby laser photocoagulation therapy of central serous retinopathy. I. A controlled clinical study. II. Factors affecting prognosis. Trans Am Acad Ophthalmol Otolaryngol. 1974. 78:OP205–OP211.

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

14. Bandello F, Virgili G, Lanzetta P, et al. [ICG angiography and retinal pigment epithelial decompensation (CRSC and epitheliopathy)]. J Fr Ophtalmol. 2001. 24:448–451.

15. Maumenee AE. Macular diseases: clinical manifestations. Trans Am Acad Ophthalmol Otolaryngol. 1965. 69:605–613.

16. Spitznas M. Pathogenesis of central serous retinopathy: a new working hypothesis. Graefes Arch Clin Exp Ophthalmol. 1986. 224:321–324.

17. Miller S, Farber D. Cyclic AMP modulation of ion transport across frog retinal pigment epithelium. Measurements in the short-circuit state. J Gen Physiol. 1984. 83:853–874.

18. Schlingemann RO. Role of growth factors and the wound healing response in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2004. 242:91–101.

19. Kliffen M, Sharma HS, Mooy CM, et al. Increased expression of angiogenic growth factors in age-related maculopathy. Br J Ophthalmol. 1997. 81:154–162.

20. Frank RN, Amin RH, Eliott D, et al. Basic fibroblast growth factor and vascular endothelial growth factor are present in epiretinal and choroidal neovascular membranes. Am J Ophthalmol. 1996. 122:393–403.

21. Taban M, Boyer DS, Thomas EL, Taban M. Chronic central serous chorioretinopathy: Photodynamic therapy. Am J Ophthalmol. 2004. 137:1073–1080.

22. Canakis C, Livir-Rallatos C, Panayiotis Z, et al. Ocular photodynamic therapy for serous macular detachment in the diffuse retinal pigment epitheliopathy variant of idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2003. 136:750–752.

23. Schmidt-Erfurth U, Laqua H, Schlötzer-Schrehard U, et al. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol. 2002. 120:835–844.

24. Cardillo Piccolino F, Eandi CM, Ventre L, et al. Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003. 23:752–763.

25. Olivier S, Harissi-Dagher M, Sébag M. Photodynamic therapy for chronic serous detachment of the retinal pigment epithelium in a young patient. Can J Ophthalmol. 2005. 40:214–216.