Treatment Modalities and Outcomes of Acute and Chronic Cases of Central Serous Chorioretinopathy
Geta Eye Hospital, Geta, Kailali, Nepal
*Corresponding Author: Senny Chapagain, Geta Eye Hospital, Geta, Kailali, Nepal.
October 13,2021 ; Published: November 23, 2021
Purpose: To assess the visual outcome of different types of central serous chorioretinopathy and to evaluate the effect of treatment modalities for acute, chronic and recurrent central serous chorioretinopathy. Also, to quantify macular thickness (MT) changes after observation and follow up for acute central serous chorioretinopathy without any intervention, after treatment with intravitreal bevacizumab or laser for chronic and recurrent cases.
Methods: This Cross sectional, interventional study examined the eyes of patients with central serous chorioretinopathy including the fundus evaluation, Spectral Domain optical coherence tomography, fundus fluorescein Angiography, prior to and 1, 3 and 6 months after treatment. Best corrected visual acuity, intraocular pressure, detail fundus examinations were done. Clinical and tomographic features of the macula were also assessed during the follow-ups.
Results: 55 eyes of 55 patients were enrolled in the study. 100% of acute cases, that is, 61.81% of the total (n = 34) were treated with topical NSAIDS and observation. For chronic cases 16.36% (n = 9) of the cases were treated with focal laser and 20% (n = 11) of the cases were given injection Avastin. At 6 month, 98.18% (n = 54) had visual acuity between 6/6 to 6/18. 1.82% (n = 1) had visual acuity between 6/18-6/60 whereas none of the patients had visual acuity worse than 6/60. The average macular thickness was 435.47 ± 153.55 μm at presentation which improved to 218.36 ± 67.57 μm at the end of 6th month. The difference in CMT at the baseline and at the end of 6 months was statistically significant (p = 0.005). The subretinal fluid was resolved at 1 month in 12.72% (n = 7) whereas SRF resolved in 56.36% (n = 31) of the cases in the 3rd month. In 21.81% (n = 12) of the cases the SRF resolved in the 6th month and in 9.09% (n = 5) of the cases the subretinal fluid remained unresolved at the end of 6th month. The resorption of SRF was in maximum number of cases at the end of 3 months.
Conclusion: In treatment of CSCR, additional benefits from the use of NSAIDS along with observation accentuates the resolution of Subretinal fluid and improvement of visual acuity for the acute cases. The chronic cases accounted for 27.7% and 14.55% cases were recurrent. Intravitreal bevacizumab (avastin) is more effective in the treatment of chronic and recurrent CSCR as compared to the laser therapy. No serious complications were encountered by treatment with any of the modalities. The efficacy of the intravitreal Avastin and its comparison needs to be further studied and evaluated to establish the proper treatment guidelines in cases of chronic and recurrent CSCR.
Keywords: Chorioretinopathy; Chronic Cases; Central Serous Chorioretinopathy (CSCR)
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