Abstract / Summary
Chronic central serous chorioretinopathy is defined as a persistent serous neurosensory retinal detachment more than 3 months. Chronic central serous chorioretinopathy can lead to permanent photoreceptor damage thus permanent loss of central vision. Focal laser photocoagulation guided by fundus fluorescein angiography was the first treatment described for this clinical entity, it aims to photocoagulate the leakage points in the retinal pigment epithelium by argon laser. This review summarizes the pathophysiological basis, angiographic principles, treatment technique, clinical evidence, safety profile and current rule of angiography-guided focal laser in the management of chronic central serous chorioretinopathy. Early randomised trials showed that focal laser photocoagulation can shorten the duration of serous detachment, but long-term follow-up did not demonstrate a consistent impact on final visual acuity or even the rate of recurrency. Later comparative studies found that focal laser achieved better result in eyes with well-defined extrafoveal leaks, but with more recurrency rate than photodynamic therapy. Well-known complications of focal laser photocoagulation include central scotoma, retinal pigment epithelium atrophy and most seriously secondary choroidal neovascularization. Those complications restrict its usage mainly to extrafoveal lesions. Most recent evidence-based guidelines favor half-dose or half-fluence photodynamic therapy as first-line treatment for chronic disease. Fluorescein angiography-guided focal laser remains a practical option for proper patients with extrafoveal leaking points, especially where photodynamic therapy is unavailable or unaffordable.