Factors Predicting Response to Selective Retina Therapy in Patients with Chronic Central Serous Chorioretinopathy

Purpose: To evaluate the efficacy of selective retina therapy (SRT), used in conjunction with real-time feedback dosimetry (RFD), in the treatment of bevacizumab-resistant chronic central serous chorioretinopathy (CSC). Patients and Methods: In this retrospective cohort study, 22 eyes of 22 patients with anti-VEGF-resistant chronic CSC, showing focal or diffuse foveal leakages on fundus fluorescein angiography (FFA), were included. After evaluation of the test spots at temporal arcades, SRT (wavelength, 527 nm; pulse repetition rate, 100 Hz; ramping over maximal 15 micropulses; and spot diameter, 200 µm) using RFD was applied to the leakage sites observed on FFA. Changes in the mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were evaluated at baseline and at 1, 3, 6, 9, and 12 months following treatment. Results: SRF completely resolved in 81.8% (18/22 eyes) cases at 12-months post-treatment. The mean BCVA (logMAR) improved from 0.49 ± 0.29 at baseline to 0.43 ± 0.36 at 12 months (p = 0.067). The mean BCVA gain was 0.06 logMAR, equivalent to 3 ETDRS letters. The CMT significantly decreased from 323 ± 85.6 µm at baseline to 221.5 ± 60.4 µm at 12 months (p < 0.001). The mean SRF height also significantly decreased from 174.6 ± 86.4 µm at baseline to 35.1 ± 75.4 µm at 12 months (p < 0.001). Conclusion: SRT showed favorable visual and anatomical outcomes in patients with bevacizumab-resistant chronic CSC.

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Low-Fluence Photodynamic Therapy versus Subthreshold Micropulse Yellow Wavelength Laser in the Treatment of Chronic Central Serous Chorioretinopathy

Journal of Ophthalmology ◽

10.1155/2016/3513794 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 22

Author(s):

Emin Özmert ◽

Sibel Demirel ◽

Özge Yanık ◽

Figen Batıoğlu

Keyword(s):

Visual Acuity ◽

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Central Macular Thickness ◽

Efficacy And Safety ◽

Chronic Central Serous Chorioretinopathy ◽

Corrected Visual Acuity ◽

Baseline Visit ◽

Best Corrected Visual Acuity

Purpose. To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC).Methods. Thirty-three eyes of 30 patients with chronic CSC received either PDT (18 eyes) or SMYL (15 eyes) therapy. Best corrected visual acuity (BCVA), subretinal fluid (SRF) height, and central macular thickness (CMT) were evaluated at the baseline visit and one, three, six, nine, and 12 months after the therapy.Results. After 12 months, mean BCVA improved from67.3±14.2to71.5±21.4ETDRS letters in SMYL group and from60.7±16.3to64.4±24.9ETDRS letters in PDT group (p=0.285andp=0.440, resp.). Mean CMT decreased from242.8±80 μm to156.9±60 μm in the PDT group and from287.3±126 μm to138.0±40 μm in the SMYL group (p=0.098andp=0.003, resp.). SRF resolved completely in 72.2% and 80.0% of the eyes in the PDT and SMYL groups, respectively. Mean SRF height decreased from117.2±58 μm to31.3±56 μm in the PDT group and from130.0±104 μm to12.5±21 μm in the SMYL group (p=0.031andp=0.014, resp.).Conclusions. Subthreshold micropulse yellow wavelength laser seems to be effective in the treatment of chronic CSC without any side effect and results in the resorption of SRF without causing visible retinal scarring.

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Functional and morphological retinal impairment following resolved chronic central serous chorioretinopathy

10.21203/rs.2.29/v1 ◽

2018 ◽

Author(s):

Maciej Gawęcki ◽

Agnieszka Jaszczuk-Maciejewska ◽

Anna Jurska-Jaśko ◽

Małgorzata Kneba ◽

Andrzej Grzybowski

Keyword(s):

Visual Acuity ◽

Central Serous Chorioretinopathy ◽

Retinal Thickness ◽

Subretinal Fluid ◽

Central Retinal Thickness ◽

Morphological Parameters ◽

Chronic Central Serous Chorioretinopathy ◽

Micropulse Laser ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Abstract Purpose Central serous chorioretinopathy is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods Thirty-two eyes with chronic central serous chorioretinopathy in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choroidal perfusion even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. No significant correlation between duration of central serous chorioretinopathy and amount of visual deficit has been found, therefore it is possible that the biggest damage occurs within the first months of active chorioretinopathy. Keywords: chronic central serous chorioretinopathy, micropulse laser, central retinal thickness, subretinal fluid

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The efficacy of intravitreal conbercept for chronic central serous chorioretinopathy: a retrospective clinical study

10.21203/rs.2.232/v1 ◽

2019 ◽

Author(s):

Jianbo Mao ◽

Caiyun Zhang ◽

Chenyi Liu ◽

Lijun Shen ◽

Jimeng Lao ◽

...

Keyword(s):

Visual Acuity ◽

Clinical Study ◽

Central Serous Chorioretinopathy ◽

Central Macular Thickness ◽

Chronic Central Serous Chorioretinopathy ◽

Corrected Visual Acuity ◽

Retrospective Clinical Study ◽

The Difference ◽

Best Corrected Visual Acuity

Abstract Background: To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods: A retrospective clinical study. This study included twenty-seven patients (32 eyes) who were diagnosed with chronic CSC in our hospital from November 2015 to March 2018. All the patients received intravitreal conbercept with one intravitreal injection and pro re nata (PRN). Follow-up observations occurred at 1 week and 1, 2, 3, and 6 months after initial injection. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT) and presence of subretinal fluid (SRF). Results: During the 6-month follow-up, the mean number of injections required and performed was 1.50±0.67. The BCVA at the first visit, 1-week, 1-, 2-, 3- and 6-month follow-ups after the first injection was 0.44±0.26, 0.39±0.29, 0.38±0.29, 0.33±0.29, 0.31±0.30, and 0.31±0.29, respectively. The difference between the BCVA at each follow-up and the first visit was statistically significant (F=9.717, P<0.05). CMT at the first visit, 1-week, 1-, 2-, 3- and 6- month after first injection was 323.25±158.49μm, 263.78±122.52μm, 222.34±92.46μm, 195.63±69.18μm, 189.25±68.71μm, and 200.47±86.30μm, respectively. The difference between the CMT at each follow-up and the first visit was also statistically significant (F=17.072, P<0.05). Full resolution of fluid was achieved in 7 (21.9%) eyes at 1 month, 14 (43.8%) eyes at 2 months, 19 (59.4%) eyes at 3 months and 23 (71.9%) eyes at 6 months after the initial treatment of anti-VEGF injection. No severe adverse event was noted relevant to the therapy. Conclusion: Intravitreal injection of conbercept can effectively reduce the CMT and improve the BCVA in chronic CSC in a short term of 6 months. Keywords: Chronic central serous chorioretinopathy, Conbercept, Best-corrected visual acuity, Central macular thickness.

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Eplerenone for treatment of chronic central serous chorioretinopathy

European Journal of Ophthalmology ◽

10.1177/1120672120952648 ◽

2020 ◽

pp. 112067212095264 ◽

Cited By ~ 1

Author(s):

Doris Fraenkel ◽

Shady Suffo ◽

Achim Langenbucher ◽

Berthold Seitz ◽

Alaa Din Abdin

Keyword(s):

Visual Acuity ◽

Treatment Response ◽

Central Serous Chorioretinopathy ◽

Life Experience ◽

Real Life ◽

Subretinal Fluid ◽

Macular Thickness ◽

Chronic Central Serous Chorioretinopathy ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Purpose: To assess the morphological and functional outcome of oral eplerenone for treatment of patients with chronic central serous chorioretinopathy (CSC) in a real life experience. Patients and methods: In this retrospective study, we reviewed the clinical files of 30 patients with chronic CSC. All patients were treated with eplerenone for a period of 6 weeks or 3 months depending on the clinical response. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and height of the subretinal fluid (SRF). Comparisons between responders and non-responders were performed to identify factors that were predictive of the treatment response. Results: All patients were treated with eplerenone 18 ± 20 weeks after onset of the first symptoms. BCVA (LogMAR) improved from 0.2 ± 0.2 to 0.13 ± 0.18 at 6 weeks ( p = 0.01) and to 0.09 ± 0.15 at 3 months ( p = 0.01). Mean CMT decreased from 409 ± 136 to 323 ± 87 µm at 6 weeks ( p = 0.001) and to 298 ± 98 µm at 3 months ( p = 0.01). Mean height of SRF decreased from 153 ± 126 to 73 ± 79 µm at 6 weeks ( p = 0.001) and to 49 ± 88 µm at 3 months ( p = 0.005). Complete resolution of SRF was achieved in 20 patients after 3 months (67%). Reported stress in the medical history was the only statistical significant predictive factor associated with a positive treatment response. Conclusion: This study showed a statistically significant improvement of the best corrected visual acuity and a significant reduction of macular thickness and subretinal fluid in patients with chronic CSC treated with oral eplerenone, especially in patients under stress.

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Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

10.21203/rs.2.29/v3 ◽

2019 ◽

Author(s):

Maciej Gawęcki ◽

Agnieszka Jaszczuk-Maciejewska ◽

Anna Jurska-Jaśko ◽

Małgorzata Kneba ◽

Andrzej Grzybowski

Keyword(s):

Visual Acuity ◽

Central Serous Chorioretinopathy ◽

Retinal Thickness ◽

Subretinal Fluid ◽

Morphological Parameters ◽

Healthy Individuals ◽

Chronic Central Serous Chorioretinopathy ◽

Micropulse Laser ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Abstract Purpose Central serous chorioretinopathy(CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/- 10.5) with chronic central serous chorioretinopathy ( mean duration 18.9 months SD +/- 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

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Eplerenone versus placebo for chronic central serous chorioretinopathy: the VICI RCT

Efficacy and Mechanism Evaluation ◽

10.3310/eme08020 ◽

2021 ◽

Vol 8 (2) ◽

pp. 1-82

Author(s):

Andrew Lotery ◽

Sobha Sivaprasad ◽

Abby O’Connell ◽

Rosie A Harris ◽

Lucy Culliford ◽

...

Keyword(s):

Visual Acuity ◽

Adverse Events ◽

Usual Care ◽

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Serious Adverse Events ◽

Chronic Central Serous Chorioretinopathy ◽

Corrected Visual Acuity ◽

Acuity Score ◽

Best Corrected Visual Acuity

Background In chronic central serous chorioretinopathy, fluid accumulates in the subretinal space and causes permanent vision loss in ≈ 30% of patients. There is no definitive treatment. Previous research suggests that the mineralocorticoid receptor antagonist eplerenone is effective but it is not licensed for chronic central serous chorioretinopathy. Objectives The objective was to evaluate whether or not eplerenone was safe and superior to placebo for treating chronic central serous chorioretinopathy. We also aimed to set up a biobank of DNA, serum and plasma samples from treatment-naive participants for future research. Design The trial was a parallel, randomised (1 : 1 ratio), multicentre, double-masked, placebo-controlled superiority trial comparing eplerenone plus usual care with placebo plus usual care. Participants were randomly allocated to eplerenone or placebo using a secure online system that returned a unique number corresponding to a bottle of the investigational medicinal product. Participants, clinical care teams, pharmacists, outcome assessors and the trial management group were masked. Setting The trial took place in 22 NHS hospitals in the UK. Participants Eligible participants were patients aged 18–60 years with treatment-naive chronic central serous chorioretinopathy of at least 4 months’ duration, a best corrected visual acuity score of 54–85 letters and no other conditions affecting visual acuity or contraindications to taking eplerenone or placebo. Interventions The intervention was oral eplerenone (25 mg/day for 1 week, increased to 50 mg/day for up to 12 months). Placebo was a lactose-filled capsule that appeared identical to the overencapsulated eplerenone tablets. To maintain blinding, participants in the placebo group followed the same dose escalation schedule as the eplerenone group. Usual care was included in both groups and was administered at the discretion of clinicians. Main outcome measures The primary outcome was best corrected visual acuity score at 12 months. Secondary outcomes were low-luminance visual acuity, central subfield retinal thickness, change in subretinal fluid thickness, systemic and ocular adverse events, macular atrophy of the retinal pigment epithelium, subfoveal choroidal thickness, choroidal permeability, resolution of subretinal fluid, time to recurrence of subretinal fluid, fundus fluorescein angiography phenotype, incidence of chronic central serous chorioretinopathy in the fellow eye, and patient-reported visual function. Results Between 11 January 2017 and 22 February 2018, 57 participants were randomised to eplerenone and 57 to placebo; 57 and 54 participants, respectively, were included in the analysis of the primary outcome. The modelled mean best corrected visual acuity score at 12 months in the eplerenone and placebo groups was 80.4 letters (standard deviation 4.6 letters) and 79.5 letters (standard deviation 4.5 letters), with an estimated difference between groups of 1.73 letters (95% confidence interval –1.12 to 4.57 letters; p = 0.24). Hyperkalaemia occurred in eight participants in each group (14%). No serious adverse events occurred in the eplerenone group; three unrelated serious adverse events occurred in the placebo group. Limitations Limitations included the inability to prevent co-treatments and discontinuation of the investigational medicinal product in the event of resolution or hyperkalaemia. Conclusions Eplerenone was safe but not superior to placebo in improving best corrected visual acuity in people with chronic central serous chorioretinopathy during 12 months of follow-up. In future work, ophthalmologists should investigate alternative treatments for this condition, which remains complicated to treat. Trial registration Current Controlled Trials ISRCTN92746680. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.

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Impairment of visual acuity and retinal morphology following resolved chronic central serous chorioretinopathy

10.21203/rs.2.29/v2 ◽

2019 ◽

Author(s):

Maciej Gawęcki ◽

Agnieszka Jaszczuk-Maciejewska ◽

Anna Jurska-Jaśko ◽

Małgorzata Kneba ◽

Andrzej Grzybowski

Keyword(s):

Visual Acuity ◽

Central Serous Chorioretinopathy ◽

Retinal Thickness ◽

Subretinal Fluid ◽

Morphological Parameters ◽

Healthy Individuals ◽

Chronic Central Serous Chorioretinopathy ◽

Micropulse Laser ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Abstract Purpose Central serous chorioretinopathy(CSCR) is a complex ocular entity that, in its chronic form, can lead to serious visual impairment and morphological damage to the retina. The aim of the current retrospective study was to evaluate the damage present after long-standing but resolved central serous chorioretinopathy and refer it to healthy individuals. Correlations between measurable factors—for example, duration of the disease, baseline retinal morphological parameters, or patient age and/or their degree of impairment—were also assessed. Materials and methods The study group consisted of thirty-two eyes (13 female and 19 male, mean age 49.6 years SD +/- 10.5) with chronic central serous chorioretinopathy ( mean duration 18.9 months SD +/- 15.4) in which complete resolution of subretinal fluid was achieved after subthreshold micropulse laser treatment. Inclusion criterion was a lack of subretinal fluid within the whole area of the central retina scanned by the spectral domain optical coherence tomography. The group was extracted out of 51 cases of chronic CSCR that were treated with that method. They were analyzed according to final best-corrected visual acuity and retinal morphological parameters as measured by spectral optical coherence tomography with angiography option (OCTA). Results were compared with the outcomes of a control group, which consisted of 40 eyes of healthy individuals with full distance visual acuity (0.0 logMAR, 1.0 Snellen) never treated with subthreshold micropulse laser. Statistical analysis included regarding correlation between final visual acuity and final central retinal thickness and retinal and functional parameters prior to treatment. Results Final best-corrected visual acuity after chronic central serous chorioretinopathy was 0.23 logMAR (0.6 Snellen) and central retinal thickness was 39.32 µm smaller than in controls. No correlation was found between final visual acuity and retinal thickness and duration of the disease, patient age, and baseline morphological retinal parameters. OCTA scans revealed impaired choriocapillaries flow signal even following resolution of the disease. Conclusion Chronic central serous chorioretinopathy is a potentially damaging clinical entity that results in serious visual impairment, retinal thinning, and choroidal flow defects. Further research is needed to determine precisely the timepoint of this damage.

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Microperimetric changes and fixation stability status after half-dose photodynamic therapy for chronic central serous chorioretinopathy

European Journal of Ophthalmology ◽

10.1177/1120672119858877 ◽

2019 ◽

Vol 30 (5) ◽

pp. 1053-1060 ◽

Cited By ~ 1

Author(s):

Samet Gulkas ◽

Ozlem Sahin

Keyword(s):

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Choroidal Thickness ◽

Retinal Sensitivity ◽

Central Macular Thickness ◽

Chronic Central Serous Chorioretinopathy ◽

Corrected Visual Acuity ◽

Half Dose ◽

Fixation Stability ◽

Best Corrected Visual Acuity

Purpose: The aim of this study was to evaluate the effect of half-dose verteporfin photodynamic therapy on central retinal sensitivity, status of fixation stability, and choroidal thickness in patients with chronic central serous chorioretinopathy. Methods: In total, 22 eyes of 22 patients with chronic central serous chorioretinopathy were enrolled, and all the eyes received indocyanine green angiography-guided half-dose verteporfin photodynamic therapy. Best-corrected visual acuity, contrast sensitivity, and retinal sensitivity in the central 10° and status of the fixation stability are assessed by MAIA microperimetry, and optical coherence tomography findings (central macular thickness and subfoveal choroidal thickness) were evaluated at baseline and 1, 3, and 6 months after the half-dose verteporfin photodynamic therapy. Results: Subretinal fluid was completely resolved in 9 eyes at 1 month and in 17 eyes at 3 months. There was recurrence in two eyes at 6 months and five of the eyes had a persistent subretinal fluid through all the time points. Best-corrected visual acuity, contrast sensitivity, and retinal sensitivity improved significantly 6 months after half-dose verteporfin photodynamic therapy. Fixation stability did not change in either follow-up visit. Central macular thickness and subfoveal choroidal thickness decreased significantly at 6 months of the visits compared to baseline. There was not any systemic and ocular side effect after the treatment. Conclusion: This study shows that there is significant improvement in best-corrected visual acuity, contrast sensitivity, and retinal sensitivity after half-dose verteporfin photodynamic therapy. The status of fixation stability remained unchanged in the eyes with chronic central serous chorioretinopathy after half-dose verteporfin photodynamic therapy. Furthermore, half-dose verteporfin photodynamic therapy is also effective in decreasing central macular thickness and subfoveal choroidal thickness.

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The Effect of Selective Retina Therapy with Automatic Real-Time Feedback-Controlled Dosimetry for Chronic Central Serous Chorioretinopathy: A Randomized, Open-Label, Controlled Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10194295 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4295

Author(s):

Ji-young Lee ◽

Min-hee Kim ◽

Seung-hee Jeon ◽

Seung-hoon Lee ◽

Young-jung Roh

Keyword(s):

Real Time ◽

Central Serous Chorioretinopathy ◽

Controlled Trial ◽

Subretinal Fluid ◽

Post Treatment ◽

Control Group ◽

Controlled Clinical Trial ◽

Chronic Central Serous Chorioretinopathy ◽

Selective Retina Therapy

This prospective randomized controlled trial evaluated the safety and efficacy of real-time feedback-controlled dosimetry (RFD)-guided selective retina therapy (SRT) in chronic central serous chorioretinopathy (CSC). Forty-four participants with chronic CSC were included and randomly assigned to the control group or SRT group. The SRT laser system with RFD-guidance was applied to cover the entire leakage area. If SRF remained at the 6-week follow-up visit, re-treatment and rescue SRT was performed for the SRT group and crossover group, respectively. The rate of complete resolution of subretinal fluid (SRF), mean SRF height, and mean retinal sensitivity were compared between the two groups at 6-weeks post-treatment. The complete SRF resolution rate in all SRT-treated eyes was evaluated at 12-weeks post-treatment. The rate of complete SRF resolution was significantly higher in the SRT group (63.6%) than in the control group (23.8%) at 6-weeks post-treatment (p = 0.020). The mean SRF height at 6 weeks after SRT was significantly lower in the SRT group (p = 0.041). Overall, SRT-treated eyes showed complete SRF resolution in 70.3% of eyes at 12-weeks post-treatment. RFD-guided SRT was safe and effective to remove SRF in chronic CSC patients during the 3-month follow-up period.

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