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Selective retina therapy (SRT) of chronic subfoveal fluid after surgery of rhegmatogenous retinal detachment: three case reports

Stefan Koinzer, Hanno Elsner, Carsten Klatt, Erk Pörksen, Ralf Brinkmann, Reginald Birngruber and Johann Roider

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Abstract

Background  

Shallow subfoveal fluid accumulation after successful surgery for retinal detachment can be the reason for compromised visual acuity. To date, therapeutical options to tackle this problem have not been established. Selective retina therapy (SRT) is a new laser technology that uses a train of μs-laser pulses to selectively damage retinal pigment epithelial (RPE) cells while sparing retinal structures.

Methods  

We treated three patients with chronic subfoveal fluid accumulation after retinal detachment surgery. The median period between retinal surgery and SRT treatment was 7 months. For SRT, we used a prototype frequency-doubled, Q-switched Nd:YLF laser (λ = 527 nm). Each laser exposition contained 30 pulses (t = 1,7 μs, 100 Hz, E = 100–400 µJ). Two of the three patients were treated subfoveally. OCT III (optical coherence tomography) examinations were performed to evaluate changes in subretinal fluid accumulation.

Results  

In all three patients, we observed complete resolution of subfoveal fluid within 1–5 months. Follow-up has been 16 months to 2 years. Visual acuity improved in all patients. In one patient, cystoid macular edema developed 3 months after treatment. Additional SRT treatments were not necessary.

Conclusion  

SRT is a safe treatment. Visual acuity improved after SRT, even in subfoveal irradiations. SRT is an option to support subretinal fluid reabsorption. In this situation where no other therapeutical options are established, SRT may be a beneficial treatment for chronic subfoveal fluid accumulation after retinal detachment surgery.

Keywords  Retinal detachment - Chronic subretinal fluid - Optical coherence tomography - OCT - Pulsed laser - Nanosecond laser - Subthreshold laser - Selective retina therapy - SRT - Selective photocoagulation - Retinal pigment epithelium - RPE - Foveal reattachment

Financial relationship: This study was supported by Lumenis Ltd., Santa Clara CA, USA. Birngruber, Roider: patent rights.
The authors have full control of all primary data and they agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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