Navigated laser photocoagulation in patients with non-resolving
and chronic central serous chorioretinopathy
Antonia M. Joussen
Received: 30 January 2018 /Revised: 29 May 2018 /Accepted: 31 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose To evaluate the efficacy of navigated focal laser photocoagulation in patients with chronic central serous
chorioretinopathy (CSCR) and active leakage on fluorescein angiography (FA).
Methods Thirty-two eyes of 32 patients (age 48 ± 11, m/f = 24/8) with persistent or recurrent CSCR (> 3 months) who received
navigated laser photocoagulation (Navilas®) of leaking point(s) between June 2013 and 2016 were included in this retrospective
case series. Outcome parameters after 4 weeks and 3 months were the number of patients presenting with complete resolution of
subretinal fluid, the volume of subretinal fluid measured on SD-OCT (Spectralis Heidelberg Engineering©), and best corrected
visual acuity (BCVA/ (Snellen equivalent).
Results Complete resolution of subretinal fluid was achieved in 17 eyes (50%) after 4 weeks and in 24 eyes (75%) after 3 months
with an average number of 1.3 laser procedures (range 1–3). Five eyes displayed a nearly complete resolution with a reduction of
over 80% of the subretinal fluid compared to baseline. Three eyes showed no reduction in subretinal fluid. BCVA improved from
median 0.58 (range 0.16–1.25) to 0.66 (0.16–1.0) (p = 0.001). The seven patients who had been treated within the central 1 mm of
the ETDRS-OCT Grid but outside the avascular foveal zone showed an improvement of BCVA from median 0.6 (range 0.2–1.0)
to 0.8 (0.2–1.0). No patient experienced a treatment-induced visual loss.
Conclusions Laser treatment with Navilas® using eye tracking and FA-based planning is a safe and effective alternative therapy
in patients with chronic CSCR.
Keywords Central serous chorioretinopathy
Navigated laser photocoagulation
Central serous chorioretinopathy (CSCR) is a common disorder
of the posterior pole with a circumscribed imbalance of the outer
retina-blood barrier, the retinal pigment epithelium. It is charac-
terized by accumulation of subretinal fluid from one or more
focal leaking points demonstrating in fluorescein angiography.
Single acute CSCR with spontaneous regression has a good
prognosis with respect to visual acuity. Chronic and recurrent
CSCR, however, is one of the most common causes of per-
manent loss of visual acuity in middle-age adults, due to pho-
toreceptor and retinal pigment epithelial atrophy .
The incidence is reported to be at 9.9 per 100,000 in men
and 1.9 in women . Although the pathogenesis of CSCR
still remains to be determined, the dysregulation of choroidal
blood flow has been associated to elevated serum glucocorti-
coid and mineralocorticoid levels, local and systemic steroid
exposure, and psychopathological/emotional distress [2–7].
In patients with non-resolving, persistent, and recurrent
CSCR, treatment options are sparse and remain ineffective
or associated with side effects. Administration of
carboanhydrase inhibitors or recently mineralocorticoid re-
ceptor antagonists is usually the first option, followed in case
of ineffectiveness by focal laser photocoagulation of the
leaking point(s) on RPE or photodynamic therapy [8–11].
Laser photocoagulation bears the risk of scar and CNV induc-
tion, when areas of leakage are treated immediately after fluo-
rescein injection using the blue light filter of the laser slit lamp.
To improve safety and predictability especially in the treat-
ment of peri- and juxtafoveal lesions, the NAVILAS® laser
system provides the option to plan the treatment beforehand
* Bert Müller
Department of Ophthalmology, Charité Universitätsmedizin Berlin,
Augustenburger Platz 1, 13353 Berlin, Germany
Graefe's Archive for Clinical and Experimental Ophthalmology