CSR treatment options

[Diglesia]

I was diagnosed with chronic csr and have been suggested PDT by two different retinal specialists. I have read about yellow laser therapy on the internet and was wondering if anyone has had that done instead? It was never brought up to me as an option by the rs. Any feedback is appreciated.

[Lagrene]

Hi, I had several PDT treatments in the past which I assumed worked but it can only stop leakage not restore vision. I’ve just started Lucentis treatment but enquired about PDT again and was told I would have to fund it myself. Subsequently told that it was no longer offered at QMC. I can’t comment on the other laser therapy you mentioned.

[CSCRkid]

Hi, I have had PDT twice in the last 15 years for Chronic CSR. It has worked for me and is a fairly simple process. It does seal the leakage and lets the retina flatten down again, which can allow your vision to return to its pre CSR state, although there may be chnages if you are unlucky. It takes time though to show improvement, it is n ot instant. Lack of contrast sensitivity is one but it did improve slowly. Not sure what the yellow dye laser is though. Verteporfin is the light sensitive drug that is used with PDT. It is an inactive drug injected into the arm, and travels around the body where it shows up in the leakage areas. A low level laser is then fired at it and the drug is activated and 'seals the leaks'. Hopefully then, the fluid will be reabsorbed and the retina flattens down. After treatment, your body is susceptible to strong light 'burning' the skin where the dye is still in the system, so you need to cover up form sun or halogen lights for a couple of days and drink lots of water to flush it out. Your skin will go a slight yellow and your urine bright yellow for a day or two!! Not sure if your 'yellow dye laser' is referring to this effect. If I can help with any more info please do not hesitate to contact me.

[Diglesia in reply to CSCRkid]

Thank you. How long did it take for your eye to improve after PDT?

[CSCRkid in reply to Diglesia]

Hi again! I think my vision acuity gradually started to improve after a month or so and slowly improved over the following couple of months. The improvement meant that I could start reading a book again without a magnifier and eventually i was able to take my laptop off maximum text size! Thh main thing that took the time and yet was more noticeable in terms of improvement in was contrast sensitivity. One of the things with with my CSR was it was difficult to see things that were against a dark/dim or similar colour background ie a person in shadow or a face that was not lit or text on a non white background or looking out on grey days. To be able to start making these things out was a definite sign of improvement. About 3-4 months of gradual improvement, I was back to 'normal'. I don't have any central vision in my left eye, only peripheral due to macular scarring probably from CSR not being recognised and diagnosed some 50 years ago, consequently my right eye which developed CSR 15 years ago does all the work and that + myleft eye peripheral vision + my brain enables me to often read (in normal times) 20/20 on a sight chart. Hope this helps understand, although everyone has differences of course. . Incidentally, I am suffering again at the moment and will proabably have to go private for treatment because the UK NHS declines to authorise Verteporfin for CSR, but at the moment OCT scans by my friendly Optician indicates the accumulated sub retinal fluid might be receding a little, so I will wait a while longer to see if the improvement continues. Mine doesnt usually recede but always a first time! Feel free to ask me anything, I know how the unknown can affect you!

[Diglesia in reply to CSCRkid]

Thank you for all this detail. I’m having many of the sane issues with contrast and blurriness. I hope PDT works for me. I am nervous because I was reading that in 1-4% of people it makes the vision worse. I feel i have no choice and it is my only chance of recuperating.

[Hrosie]

What is CSR & PDT ?

[CSCRkid in reply to Hrosie]

Its Photodynamic Therapy and Central Serous Retinopathy aka Central Serous Chorioretinopathy.

[Blink182_joel]

PDT (Visudyne) shortage worldwide until 2024, unless you live in US or Japan manufacturing has been halted for over a year due to a production issue at the factory that produces it. UK consultant wants me to have Eylea injections. But have read a lot, and they don’t seem to last, perhaps the same time as when it goes on its own. I enquired about yellow laser, but he was dead against it. However I have read and watched a lot about it and decided to have it done last week. There’s a 1hr+ youtube video with consultants across the globe suggesting its benefits that was released a few days ago. £1000+ in UK, which is extortionate compared to some EU countries, so opted for the latter. There are suggestions that PDT is more damaging than yellow micropulse laser, from what I’ve read.

1 week later it is still there, however I believe it is reducing. I have read that it can take a month to disappear and then constant, slow improvement up to 1 year.

For me it is not the quick resolution I’m looking for, but to prevent it occurring in the future. Fingers crossed!

My consultant was concerned with scarring. However yellow micropulse does minimal damage, as it heats the retina for about 200 microseconds, that’s micro not milli. This increases the temperature by about 10-20c. I believe the only damage is to do with pigment bleaching, and is not generally visible on OCT scans even. The whole procedure took about 2 minutes with not a single sense of pain. Had Chronic CSR since Sept 2020. Each “attack” seemed worse than the last.

So just went private after he stopped seeing me, and sent in a Junior Dr. every time and kept me on Spironolactone, which fid nothing for me.

My advice would be to read up on Yellow micropulse laser, but obviously make the decision that’s right for you.