Treatment and Management of Chronic CSCR
Verteporfirin photodynamic therapy (PDT) is generally the first recommendation for chronic CSCR. The verteporfirin dye releases free radicals once illuminated that damages the endothelium of the RPE, and is thought to reduce the choroidal vasculature hyperpermeability and extravascular leakage by changing the overall vasculature of the choroid.
Suprathreshold laser photocoagulation delivery to the leakage site was previously a valid treatment option in CSCR. It was used to debride the RPE at the leakage site allowing an ingrowth of the surrounding RPE and accelerating subretinal fluid resolution. However, laser photocoagulation is not feasible for subfoveal detachment due to scarring and subsequent central scotoma and does not reduce the recurrence rate of neurosensory retinal detachment.
Studies have looked into subthreshold micropulse laser (SML) treatment instead, as it only destroys RPE cells, sparing the photoreceptors and preventing scars. Therefore, SML can produce the same biological effect of a suprathreshold laser with fewer side effects.