Type of publication:
Conference abstract
Author(s):
*Nayak D.; *Sathiaraj S.; Mahon E.; Hanumunthadu D.
Citation:
Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 243), 2025. Date of Publication: 01 Jun 2025.
Abstract:
Introduction: Central Serous Retinopathy (CSR) is a common retinal condition that primarily affects young individuals, characterised by fluid accumulation beneath the retina, leading to blurred vision and potential long-term retinal damage. Traditionally, CSR has been managed through observation, with treatments like photodynamic therapy (PDT) and laser therapy carrying the risk of central vision damage, particularly with repeated use. This study investigates the efficacy of sub-threshold PASCAL laser therapy in CSR, comparing outcomes across grid, focal, and combined laser treatments. Additionally, the study explores whether this treatment provides a solution to the visual disturbances and anxiety related to potential vision loss in young patients, addressing both clinical outcomes and patient quality of life. The study will also suggest an appropriate technique of using grid format of subthreshold laser with Landmark settings on the PASCAL laser. Method(s): Inclusion: 50 patients from each centre with confirmed diagnosis of CSR on FFA/ICG Exclusion: AMD/ other macular, retinal and Optic nerve disease were excluded to reduce bias in outcome Methodology: All patients with confirmed diagnosis had Vision, OCT done at every visit- Baseline, 1, 3 and 6-12 months. It also included a shorts PROMS questionnaire at the end of treatment. Patients were treated with focal, grid and combined approach on PASCAL laser and results were subgrouped. Focal treatment was applied to point of leak on dye test and grid was applied to the pachychoroid seen on OCT and fundoscopy imaging PROMs explored subjective vision, visual symptoms post laser and satisfaction level on a scale of 1-10. Hypertension, use of steroids and type of personality were explored in the study. Technique of laser: Grid approach combining the OCT for pachychoroid spectrum and Colour fundus to visualise dilated choroid. Will be described with fundus photos in future if approved. The use of landmark laser in sub threshold will be elaborated in detail. Result(s): Our findings suggest that subthreshold PASCAL laser therapy is a safe and effective alternative, offering significant benefits for patients with chronic or recurrent CSR by minimizing the risk to central vision. The results show that sub-threshold laser treatment led to significant reduction in subretinal fluid, as confirmed by OCT imaging. At 6 months, 85% of patients demonstrated complete or near-complete resolution of subretinal fluid. Visual acuity improved in 78% of patients, with a mean improvement of 2 lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Recurrence rates were lower with only 12% of patients experiencing a reoccurrence of CSR within the follow-up period. No significant retinal damage or vision-threatening complications were observed in any patient. PROMS reinforced the above outcome. The results also explore and make suggestion on the correct use of grid and focal laser in this pachychoroid spectrum disease. It emphasises on the correct technique of use of sub threshold grid laser using colour fundus and OCT scans. Conclusion(s): PASCAL sub threshold laser using the modality of focal and grid laser can be used to address CSR effectively. Sub-threshold laser therapy is a promising and safe treatment option for patients with chronic or recurrent CSR. It provides a non-invasive approach that offers significant improvement in retinal fluid resolution and visual acuity, with a low risk of complications. Further long-term studies are needed to confirm the durability of these results and to refine treatment protocols for optimal patient outcomes.
DOI: 10.1038/s41433-025-03831-0
