ACCELERATED VISUAL RECOVERY IN CENTRAL SEROUS CHORIORETINOPATHY: EFFICACY OF MEDICAL AND LASER INTERVENTIONS
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Keywords
Central Serous Chorioretinopathy, Visual Outcome, Acetazolamide, Laser Photocoagulation, Nd-YAG, Observation, Retinal Detachment
Abstract
OBJECTIVES: To evaluate and compare the time taken for visual recovery, final visual outcomes, recurrence rates, and complications in patients with Central Serous Chorioretinopathy (CSCR) who were managed with observation, oral acetazolamide, and double-frequency Nd-YAG laser photocoagulation.
METHODS: This prospective, randomised, interventional, and comparative study was conducted over one year at a tertiary care centre. A total of 56 patients diagnosed with CSCR were enrolled; 48 completed the study. Patients were divided into three groups: Group A (observation), Group B (oral acetazolamide), and Group C (laser photocoagulation). All patients underwent baseline and follow-up assessments at 2, 4, 6, and 12 weeks, including best-corrected visual acuity (BCVA), fundus examination, and fluorescein angiography. BCVA was converted to logMAR for statistical analysis. Visual outcomes and intergroup comparisons were analysed using an unpaired Student’s t-test with a significance threshold of p<0.05.
RESULTS: A significant improvement in BCVA was observed earliest in Group C (laser) by 2 weeks (p < 0.001), with sustained improvement at all subsequent follow-ups. Group B (acetazolamide) showed a gradual but significant improvement, beginning at 2 weeks (p < 0.05), which became highly substantial by 4 weeks onward (p < 0.001). Group A (observation) showed considerable improvement only after 6 weeks. At 12 weeks, visual acuity outcomes were statistically similar across all groups. No significant complications were noted; however, mild side effects were observed in the acetazolamide group. Recurrence was reported in Groups A and B (12.5% each), while none occurred in Group C.
CONCLUSIONS: Both acetazolamide and laser photocoagulation expedite visual recovery in CSCR compared to observation alone. Laser treatment offers the fastest improvement but requires specialised infrastructure, while acetazolamide provides a viable, cost-effective alternative.
References
2. Spaide RF, Campeas L, Haas A, et al. Central serous chorioretinopathy in younger and older adults. Ophthalmology. 1996;103(12):2070–2079.
3. Iida T, Hagimura N, Sato T, Kishi S. Evaluation of central serous chorioretinopathy with optical coherence tomography. Am J Ophthalmol. 2000;129(1):16–20.
4. Liao P. Stereoscopic Atlas of Macular Diseases. Diagnosis and Treatment. Yale J Biol Med. 1987 Nov-Dec;60(6):604–5.
5. Berger AR, Olk RJ, Burgess D. Central serous choroidopathy in patients over 50 years of age. Ophthalmic Surg. 1991 Oct;22(10):583-90.
6. Whitcup SM, Csaky KG, Podgor MJ, Chew EY, Perry CH, Nussenblatt RB. A randomized, masked, cross-over trial of acetazolamide for cystoid macular edema in patients with uveitis. Ophthalmology. 1996 Jul;103(7):1054-62; discussion 1062-3. doi: 10.1016/s0161-6420(96)30567-8.
7. Sturm V. Early laser photocoagulation treatment as an option in central serous chorioretinopathy. Ophthalmic Surg Lasers Imaging. 2009 Sep-Oct;40(5):453-60. doi: 10.3928/15428877-20090901-03.
8. Wei ZY, Hu SX, Tang N, Wu J, Zhang QH, Feng JY. [Clinical study of argon laser photocoagulation for central serous chorioretinopathy]. Di Yi Jun Yi Da Xue Xue Bao. 2003 Dec;23(12):1329-31. Chinese.
9. Chhablani J, Rani PK, Mathai A, Jalali S, Kozak I. Navigated focal laser photocoagulation for central serous chorioretinopathy. Clin Ophthalmol. 2014 Aug 18;8:1543-7. doi: 10.2147/OPTH.S67025.
10. Cox SN, Hay E, Bird AC. Treatment of chronic macular edema with acetazolamide. Arch Ophthalmol. 1988;106(9):1190–5.
11. Wolfensberger TJ, Chiang RK, Takeuchi A, Marmor MF. Inhibition of membrane-bound carbonic anhydrase enhances subretinal fluid absorption and retinal adhesiveness. Graefes Arch Clin Exp Ophthalmol. 2000;238(1):76–80.
12. Klein ML, Van Buskirk EM, Friedman E. Experience with non-treatment of central serous choroidopathy. Arch Ophthalmol. 1974;91(4):247–50.
13. Loo RH, Scott IU, Flynn HW Jr, et al. Factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy. Retina. 2002;22(1):19–24.
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Dr. Nisha Bathla
Consultant Ophthalmologist, Niranjana Healthcare, Khatima, Udham Singh Nagar District, Uttarakhand, India.
Dr. Perwez Khan
Professor, Department of Ophthalmology, GSVM Medical College, Kanpur, Uttar Pradesh, India.
Dr. Manni Punyani
Consultant Anaesthetist, Civil Hospital, Khatima, Udham Singh Nagar District, Uttarakhand, India.