Update on the management of chronic central serous chorioretinopathy | Archivos de la Sociedad Española de Oftalmología (English Edition)

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A) Tomografía de coherencia óptica previa a la TFD que muestra un desprendimiento neurosensorial (DNS). B) OCT 3 días tras la TFD en la que se muestra un aumento del DNS secundario a la inflamación. C) OCT un mes tras la TFD en la que se aprecia la resolución del DNS. D) OCT a los 3 meses tras la TFD en la que persiste la ausencia de DNS." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Moreno-Morillo, J.I. Fernández-Vigo, N. Güemes-Villahoz, B. Burgos-Blasco, L. López-Guajardo, J. Donate-López" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Moreno-Morillo" ] 1 => array:2 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Güemes-Villahoz" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Burgos-Blasco" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "López-Guajardo" ] 5 => array:2 [ "nombre" => "J." 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B) Red-free photo of the right eye that confirms the area of diffuse retinal ischemia. C) Neurological visual field of 120 points of full field, of the right eye, with V stimulus, indexes of good reliability, sensitivity of 33 db of the right eye where the absolute scotoma is highlighted, covering almost the entirety of the examination (gray area)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ortiz Zapata, I. Ortiz Farfán, G. Zapata Díaz, J. Ortiz Zapata, M. Peralta" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ortiz Zapata" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Ortiz Farfán" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Zapata Díaz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Ortiz Zapata" ] 4 => array:2 [ "nombre" => "M." 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A) Color photograph showing multiple retinal serous detachments with associated RPE changes (white arrows). B) Late-stage fluorescein angiography with multiple hyperfluorescence spots due to contrast medium leakage (blue arrows). C) OCT map of central macular thickness showing macular level thickening at various levels. D) Macular level horizontal B-scan showing subretinal fluid at temporal perifoveal levels in the right eye and nasal parafoveal in the left eye (red arrows)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.M. Rangel, Á. Ortiz, R. Sánchez-Ávila, C. Varón, P.L. Cárdenas, L.C. Escaf, D. Jaramillo, H. Rodriguez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "C.M." "apellidos" => "Rangel" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Ortiz" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Sánchez-Ávila" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Varón" ] 4 => array:2 [ "nombre" => "P.L." 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Moreno-Morillo, J.I. Fernández-Vigo, N. Güemes-Villahoz, B. Burgos-Blasco, L. López-Guajardo, J. Donate-López" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F.J." "apellidos" => "Moreno-Morillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" "email" => array:1 [ 0 => "jfvigo@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "N." "apellidos" => "Güemes-Villahoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "B." "apellidos" => "Burgos-Blasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "L." "apellidos" => "López-Guajardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Donate-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro Internacional de Oftalmología Avanzada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización en el tratamiento de la coriorretinopatía serosa central crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1836 "Ancho" => 2925 "Tamanyo" => 794354 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Image obtained by optical coherence tomography angiography (OCTA) and structural OCT. OCTA shows the segmentation at the level of the choriocapillary (CC) and choroids to analyse the vascularization. In the first column in the OCT image, a neurosensory detachment (NSD) can be seen infero-nasal to the macula. In the second column, OCTA images show the vascular occlusion both at the level of the CC and the choroid (indicated by the circular dotted area) after treatment with photodynamic therapy (PDT) at standard doses, with NSD persisting in the OCT. The 3rd and 4th column show resolution of NSD with revascularization of the occluded area after the PDT." ] ] ] "textoCompleto" => "IntroductionCentral serous chorioretinopathy (CSC) is one of the main causes of decreased visual acuity in patients under 60 years of age in Western countries. The pathophysiology of CSC remains partially unknown. CSC is characterized by a fluid accumulation that produces a serous neurosensorial detachment (NSD) and/or detachment of the retinal pigment epithelium (RPE) at the posterior pole. In the pathogenesis of CSC, different mechanisms have been proposed such as ischemia, inflammation and vascular stasis in the choroidal vessels, with alteration or focal defects at the level of the RPE. Usually choroidal thickening occurs, especially in the acute forms, evidenced in the optical coherence tomography (OCT), so it is included within the spectrum of the pachychoroid diseases. In the contrast tests, leakage points are observed in fluorescein angiography (AFG) and a choroidal staining in indocyanine green angiography (IGA), suggesting the presence of increased choroidal hyperpermeability (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the presence of increased choroidal flow, hydrostatic pressure would be raised, damaging the RPE and leading to a decompensation of the barrier function of the RPE, favoring the accumulation of subretinal fluid (SRF).<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Recently it has been described that scleral thickening occurs in these patients that can facilitate the progressive accumulation of fluid.<a class="elsevierStyleCrossRef" href="#bib0010">2</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>CSC is classified as acute, recurrent, and chronic. Acute CSC in most cases resolves spontaneously with favorable results without the need for treatment. Recurring CSC presents an acute episode that follows a previous episode with complete resolution. In contrast, chronic CSC exhibits a persistence of SRF for at least 3–6 months. The most common symptoms are metamorphosis, central relative scotoma and generally moderate reduction in visual acuity, which are produced by the persistence of SRF and damage to RPE and photoreceptors.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Unlike acute CSC, when it has frequent recurrences or becomes chronic, it usually requires treatment to stabilize the VA and avoid long-term deterioration, mainly due to damage to the RPE. The decision to treat must always be agreed upon with the patient, evaluating the possible limitations that it may produce on his or her work or functional activity, the condition of the other eye, and the number of previous episodes and sequelae. Modifications in patient lifestyle should be recommended to reduce stress, as well as the reduction or suspension of steroid treatment, since an association with these factors has been described. The goal of treatment is the disappearance of the NSD, its stabilization and, if possible, improving VA and preventing new episodes.At present there are different therapeutic proposals for the treatment of CSC such as photodynamic therapy or subthreshold laser. However, in clinical practice other interventions are also performed such as treatment with mineralocorticoid antagonists, laser photocoagulation, treatment with intravitreal antiangiogenic drugs, non-steroid anti-inflammatory drugs or eradication of Helycobacter pylori (H. pylori).Therefore, the purpose of this review is to update the available scientific evidence to evaluate the usefulness of the different treatment possibilities currently available for the treatment of chronic CSC.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Different therapeutic possibilities in useFocal laser photocoagulationOne of the first treatments used for the treatment of CSC was focal photocoagulation (FC) with argon laser. The rationale for the use of this treatment was postulated by Imanaga et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> in which CSC was the result of leakage through defects in the Bruch membrane and adjacent RPE, and that focal CF would occlude those defects. While it is true that direct CF can reduce the duration of NSD, the mechanism by which this occurs remains controversial. Spitznas postulated that there was a reversal in the direction of fluid transport through the abnormal RPE, so that this moved from the choroid to the neuroretin.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Laser CF can achieve accelerated resolution of NSD by treating the focal defect of RPE and inducing a migration of healthy adjacent RPE cells by restoring barrier function at the site of the leak.Regarding the results obtained with this treatment, Leaver and Williams in 1979 carried out a prospective randomized clinical trial that included 67 patients with CSC. It was observed that CF with argon laser demonstrated an acceleration in the resolution of NSD, which occurred in an average time of 6 weeks from treatment in the treated group and 16 weeks in the control group without treatment (P<0.001). However, there were no significant differences in the final best corrected visual acuity (BCVA) between the treated and the control group.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>With respect to the recurrence of NSD in CSC, different studies offered very disparate data. Both Watzke and Burton<a class="elsevierStyleCrossRef" href="#bib0025">5</a> in a prospective study and Nanjiani<a class="elsevierStyleCrossRef" href="#bib0030">6</a> or Gilbert et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> in retrospective studies found no significant difference in recurrences between treated and untreated, so laser CF did not prove useful in preventing recurrences. On the contrary, Dellaporta described a lower incidence of recurrence among treated patients.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Subsequently, a prospective randomized trial with a follow-up of 6–12 years found no evidence that laser CF reduced recurrences in CSC, also confirming an absence of improvement in the AV of the treated group.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>A study comparing conventional CF versus the yellow micropulse sub-threshold laser (577nm) found no difference in the percentage of SRF and BCVA resolution between the two techniques.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> However, all patients in the CF group had RPE damage versus only one in the subthreshold laser group evaluated by autofluorescence.Another study carried out by Piasecka et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> compared conventional CF (continuous laser) versus green micro-pulse sub-threshold laser (532nm) observing significant differences in BCVA in favor of the latter after 12 months of treatment (0.89±0.13 versus 0.77±0.71; P=0.028).With regard to the comparison of laser CF versus PDT at medium dose, in a study conducted in 26 patients no difference in visual recovery was observed between the two groups.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> It should be noted that there were significant differences in SRF resolution after one month of treatment (92.8% in the PDT group vs. 58.3% in the laser CF group; P=0.022), although at 3 and 6 months there was resolution in all cases in both groups. The main limitation of this work is that the study groups were not comparable since those patients with a diffuse leak were included in the PDT group, whiel those with an extrafoveal focal leak were included in the CF group. This could be a clear determinant of the response since previous studies have shown better efficacy among those patients treated with PDT with focal leakage than in those with diffuse leakage.Already in 2014, Chhablani et al. evaluated the effectiveness of CF with fluorescein angiography-guided lasers (AFG) (Navilas® 532nm double-pulsed YAG Laser, OD-OS GMBH, Teltow, Germany) with an eye-tracker system in a prospective study.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> A single impact was performed on the peri- or juxtafoveal leakage points, observing full SRF resolution at 2 months of follow-up in 15/16 eyes (94%). However, there was no improvement in the BCVA with respect to the basal values. On the contrary, using the same CF guided laser, Müller et al. in a retrospective study of 32 patients observed an improvement of the BCVA from a median of 0.58 Snellen (range 0.16–1.25) to 0.66 (0.16–1.0) (P<0.001).<a class="elsevierStyleCrossRef" href="#bib0070">14</a> In this study the full resolution of the SRF was 75% at 3 months.In summary, conventional CF laser could be an indicated treatment for recurrent CSC with persistent fluid-filled extrafoveal focal leaks when no other therapeutic possibility exists. However, it is a treatment rarely used at present for the treatment of chronic CSC due to the risk of causing relative scotomas and secondary neovascularization by inducing ruptures in the Bruch membrane<a class="elsevierStyleCrossRefs" href="#bib0045">9,13</a> (the risk being generally low and dependent on the type of lesion and laser parameters) and has been surpassed in terms of efficacy by other therapeutic alternatives. A promising new proposal is the AFG-guided laser that could be useful for the resolution of this entity.Photodynamic therapy with verteporfinPhotodynamic therapy (PDT) consists of the intravenous administration of a photosensitizing agent, verteporfin (Visudyne, Novartis), which is subsequently stimulated with a specific light dose on the macula. The mechanism of action of this treatment consists in the laser excitation of the verteporfin molecule producing the release of free radicals that cause an inflammation of the vascular wall, induction of apoptosis and microthrombosis of the vessels, which produces a non-selective occlusion of the choroidal vessels. In this way, PDT reduces choroidal permeability by altering the structure and perfusion of the choroidal vasculature,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> modifying the perfusion-reabsorption balance in favor of the latter, decreasing the SRF that is present in the macular NSD that typically appears in CSC (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>PDT for the treatment of CSC was first successfully employed by Chan et al. in 2003 in a series of 6 cases guided by IGA angiography.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Since then, numerous studies have been carried out with PDT for the treatment of this entity. The standard PDT treatment lasts 83s, and is applied with a dose of verteporfin of 6mg/m2 and a fluence of 50J/cm2, with a spot size that, in general, should be 1000μm larger than the area to be treated, guided if possible by IGA. It can be applied in a single area or in several, and it is recommended to repeat the treatment no earlier than 3 months if the SRF persists, since the studies that explored the efficacy of shortening this interval offered no advantages.The use of PDT has been associated with different adverse effects such as decreased choriocapillary perfusion (44%)<a class="elsevierStyleCrossRef" href="#bib0085">17</a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), RPE atrophy (4%) or loss of visual acuity (1.5%).<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Some cases of severe choroidal ischemia have also been described.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Due to these complications of PDT, studies with different therapeutic strategies were proposed with the aim of minimizing them, fundamentally halving the dose of verteporfin (from 6 to 3mg/m2) or reducing the fluence applied by half (from 50 to 25J/cm2).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>In a prospective, multicenter clinical trial in 42 subjects with chronic CSC treated with standard versus medium fluency, Reibaldi et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> found no significant difference in BCVA between the two techniques at any time during follow-up, observing in both a significant improvement in vision with respect to the baseline visit (from 0.43logMar to 0.27 and from 0.46 to 0.28 respectively; P<0.001). The main difference between both PDT strategies was that at 12 months, 8 eyes from the standard fluence treatment group showed areas of non-perfusion compared to none in those treated with medium fluence. However, the possible implication of this exploratory finding is unknown, since a repermeabilization of the choriocapillary over time has been described. Lim et al. developed the largest retrospective study evaluating the efficacy of PDT with medium fluence compared to standard fluence including 256 eyes from 237 patients.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> The therapeutic strategies applied were: standard fluence in 130 eyes (49%), medium fluence in 128 eyes (48%), with no fluence or very low fluence in 7 eyes (3%). A complete resolution of the SRF was observed in 81% of all patients at the end of the follow-up, without observing differences between the different treatment groups. Adverse effects were rare, notably RPE atrophy in 10 eyes (4%), and severe visual decrease in 4 eyes (1.5%). Moreover, similarly to other studies, an increase of choriocapillary non-perfusion areas was observed in patients with standard PDT versus those with medium fluency. Therefore, these findings suggest that the use of mean fluency PDT does not decrease the efficacy of the procedure with respect to standard PDT, but does seem to decrease possible adverse effects.With regard to the dose of verteporfin used for the treatment of PDT, Chan et al. used half the dose (3mg/m2) showing good efficacy at 12 months, being similar to that published in other series, without adverse events.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Studies have also been carried out with a third of the dose (2mg/m2), but with disparate results. In 68 eyes out of 60 patients, Hua et al. found a statistically significant improvement in BCVA (from 0.62logMar to 0.21) at 6 months after treatment, with SRF being completely reabsorbed in 63 eyes (92.6%).<a class="elsevierStyleCrossRef" href="#bib0105">21</a> The main limitation of these works with reduced dose of verteporfin is that they lacked a comparative group with PDT at full dose. On the other hand, Uetani et al. evaluated results in patients with half doses (n=10) and with a third of doses (n=6), with SRF being reabsorbed in 100% and 33% of the eyes respectively at 3 months. Therefore, the authors concluded that PDT with a third of dose was less effective than PDT with half of dose in terms of resolution of the SRF.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>In reference to possible variations in PDT treatment, Nicoló et al. conducted an interesting study comparing the efficacy of half dose versus mean fluency.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Both therapeutic strategies demonstrated a significant improvement in vision (from 0.126 and 0.187logMAR to 0.068 and 0.083logMAR respectively in the mean fluence and half-dose groups). However, there were no significant differences between the 2 treatment groups. Complete resolution of the SRF at one month of PDT was observed in 61.3% and 86.2% of eyes after half-dose and half-dose fluence respectively (P=0.04), which means that the strategy with half-dose but with complete fluence is superior. Even so, at 12 months the percentage of patients with complete SRF resolution was 83.9% and 100% respectively, i.e. non-significant differences (P=0.052). The mean number of required PDT was 1.48 and 1.17 in the mean fluence and half-dose group respectively, with a slight need for greater re-treatment in the case of mean fluence (P=0.49). Overall, 15 and 5 recurrences presented in the mean fluence group and the half-dose group, respectively (P=0.07). Therefore, the authors stated that the half-dose therapeutic strategy induced a greater and more prolonged response with respect to SRF resorption. No differences were found in terms of treatment safety since no atrophic changes in RPE were observed in either group.In another retrospective study conducted by Alkin et al. involving 64 eyes,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> low fluence was compared to half dose (verteporfin 3mg/m2). Thirty-three eyes (91.6%) in the low-flow group and 26 eyes (92.8%) in the half-dose group showed complete SRF resolution. Seventeen eyes (52.8%) in the low-fluence group and 14 eyes (50%) in the half-dose group experienced a BCVA gain of 5 or more letters. In addition, a decrease in central macular thickness was observed with both treatment modalities (basal: 351±90μm and 341±96μm, and significantly decreased to 188±61μm and 181±47μm, for the low-fluence and half-dose groups respectively). Therefore, no differences were observed between low fluency and half dose.Park et al. conducted a study in 43 eyes to compare the effects of PDT according to 3 different treatment strategies: full dose (verteporfin 6mg/m2, n=10), half dose (verteporfin 3mg/m2; n=16) and half dose with mean fluence (verteporfin 3mg/m2 and fluence 25J/cm2; n=17). A significant visual gain was observed in the full-dose and half-dose groups (P<0.023) but in the half-dose and and mean fluence group VA did not improve significantly (P=0.254). Subfoveal choroidal thickness decreased significantly in all three groups. The SRF thicknesses in the full-dose and half-dose groups showed significant decreases (P=0.005 and <0.001 respectively), with the half-dose-half-fluence group not reaching significance (P=0.084).<a class="elsevierStyleCrossRef" href="#bib0125">25</a> The authors conclude that strategies with full and half dose were effective and could be performed at half dose to reduce complications. However, the authors state that the combination of half-dose and half-fluence does not seem to be a recommended option since the effect is less clear.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical results of prospective studies or studies with a large sample size (n≥100) for the treatment of chronic CSC using PDT.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Regarding the safety of long-term PDT treatment to assess side effects and also to study recurrences, Park et al. conducted the study with a longer follow-up time, which was a minimum of 3 years, including 94 patients.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> This study was mostly conducted with mean fluence PDT (81%), although cases treated with mid-dose PDT (13%) or standard PDT (6%) were also included. Complete resolution of SRF at 6 months after PDT was evident in 90% of cases, with a recurrence of 24%. The mean interval from initial PDT to recurrence was 28.6 months±20.8 months (range: 1.1–86.3 months). A multivariate analysis suggested bilaterality (OR=3.407; P=0.048), a small decrease in central macular thickness (OR=0.936; P=0.028) and male sex (OR=20.417; P=0.007) as risk factors for recurrence. Coinciding with this, a previous study carried out by Lai et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> observed these same risk factors for recurrence, except for the sex in which they found greater recurrence in women.Regarding the presence of CSC-associated CNV, two patients developed CNV. One of those treated with mean fluence appeared two years after treatment and one patient with standard PDT one month after PDT.In summary, PDT offers high efficacy for SRF resorption and AV improvement in patients with chronic CSC, with mean fluence showing the same efficacy as the standard fluence, and there seems to be a lower rate of adverse effects. Similarly, the use of PDT at half dose instead of full dose may be a useful treatment option since there are no differences in efficacy compared to mean fluence.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>Micropulse sub-threshold laserThe sub-threshold micro-pulse (MP) laser was initially used for treating macular edema secondary to diabetic retinopathy and venous occlusions.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> The exact mechanism of action of the MP laser remains unclear, but it is considered that it raises the temperature of the retina enough to induce the expression of heat shock proteins, which are essential to maintain adequate protein structure without inducing tissue necrosis.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> By minimizing thermal damage, it can be applied near the fovea eliminating possible scotomas caused by the argon laser.There are currently different variants of the MP laser on the market. Different wavelengths have been described from 527nm (green),<a class="elsevierStyleCrossRef" href="#bib0155">31</a> 532nm (green)<a class="elsevierStyleCrossRefs" href="#bib0055">11,32</a>, 577nm (yellow)<a class="elsevierStyleCrossRef" href="#bib0165">33</a> and 810nm (infrared)<a class="elsevierStyleCrossRef" href="#bib0170">34</a> although the last two have been the most used. The 810 nm laser allows greater tissue penetration, respecting the retina and exerting its effect directly on the choroid.In addition to wavelength, other parameters are modifiable such as duty cycles, power, spot size and pulse duration. The duty cycle is defined as the relationship between the “ON” time and the total treatment time (“ON” plus “OFF”). The total exposure time is fragmented so that the impact is spread evenly over a series of microsecond pulses over the total treatment time. In various studies for CSC, this time varies between 5% and 15%.<a class="elsevierStyleCrossRefs" href="#bib0050">10,35</a> This micropulse treatment contributes to the selectivity of its action on RPE without damaging photoreceptors. The power varies from 90mW to 1800mW according to published studies.<a class="elsevierStyleCrossRef" href="#bib0180">36</a> The spot size usually ranges from 100μm to 200μm.<a class="elsevierStyleCrossRefs" href="#bib0185">37,38</a> The treatment usually consists of making a grid over the leakage areas of the AGF or IGA. The pulse duration is the time interval between each new pulse cycle and varies from 100ms to 300ms.<a class="elsevierStyleCrossRefs" href="#bib0165">33,39</a>. All these parameters mean that there is no standard sub-threshold laser therapy and therefore it is difficult to compare different studies.One of the first articles to describe the use of the sub-threshold micro-pulse diode laser (810 nm) was a prospective study in 26 eyes of 25 patients with chronic CSC.<a class="elsevierStyleCrossRef" href="#bib0200">40</a> Patients were divided in 3 groups based on whether they had a localized leakage point (group 1) with associated RPE atrophy (group 2) or a diffuse leakage (group 3). Group 1 exhibited complete resolution of SRF in all patients in a single session. In group 2, 8/9 patients achieved complete resabsorption requiring 1–3 laser sessions. In group 3, complete resabsorption of SRF was observed in only 45% of patients (5/11), so non-responsive patients were rescued with a PDT treatment that was effective in such cases. Therefore, it seems that this technique was more effective when there is a focal leak. These data were confirmed in a subgroup of the PLACE study of 79 patients treated with MP laser, in which 41% of patients with focal leakage had complete SRF resolution versus 21% of the patients with diffuse leakage at 7−8 months.<a class="elsevierStyleCrossRef" href="#bib0205">41</a>Among the different studies carried out for the MP laser treatment in CSC, it is interesting to highlight the prospective studies or those with a larger sample size as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. First, in 2018, van Dijk et al. conducted a multicenter randomized clinical trial that compared the sub-threshold diode laser (810nm) with PDT at mid-dose.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> At the end of the follow-up only 28.8% of patients treated with the MP laser showed complete SRF resolution versus 67.2% in the PDT group (P<0.001). With regard to visual gain, there were no significant differences between both treatments, although a favorable trend to the PDT group was observed (6.8±8.5 versus 4.5±7.3 letters ETDRS; P=0.099). The poor results offered by the PD laser in this study for the resolution of SRF are in contrast with those found in other retrospective or prospective studies with smaller sample sizes with success rates of up to 92%.<a class="elsevierStyleCrossRefs" href="#bib0210">42,43</a> Some authors attribute these great differences in efficacy to the fact that they are retrospective or small sample studies, as well as to the different inclusion or exclusion criteria.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> Battaglia proposed that these differences could be attributed to undertreatment because the area treated in the MP laser group was very small.<a class="elsevierStyleCrossRefs" href="#bib0220">44,45</a> This possible under-treatment had already been proposed by other authors as one of the main causes of therapeutic failure of this laser in inexperienced hands, since in the absence of a visible lesion it is not possible to verify the treatment area.<a class="elsevierStyleCrossRef" href="#bib0230">46</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The Pan American Collaborative Retinal Study Group (PACORES) conducted a study comparing 92 yellow (577nm) MP laser-treated eyes with 67 eyes that received PDT at half-dose.<a class="elsevierStyleCrossRef" href="#bib0190">38</a> In the MP laser group at 12 months of follow-up, BCVA improved from 0.41±0.27 at baseline to 0.21±0.26logMAR (P<0.001). On the other hand, the PDT group did not show BCVA improvement, which was 0.50±0.34 at study baseline and 0.47±0.34 logMAR (P=0.89) at the end. In the MP laser group, 48.9% (45/92) of eyes showed improvement ≥3 lines from baseline, while another 48.9% remained within the 2 basal BCVA lines, and only in 2 eyes there was a loss ≥3 lines from baseline. In the PDM group, 19% (13/67) of eyes showed improvement ≥3 lines over baseline, with 73% (49/67) of the eyes remaining within the 2 baseline AVM lines, while 5 eyes had a loss ≥3 lines. In both groups a significant decrease in central macular thickness and in subfoveal choroidal thickness was evidenced.Therefore, MP laser is an effective and safe treatment option for the resolution of SRF and improvement of VA in patients with chronic CSC, obtaining better results in the presence of a focal leakage point. However, there is still a great disparity of results with this treatment, as well as the superiority/inferiority of its efficacy compared to PDT. In addition, the parameters to be used and the influence of the type of choroids remain unknown. Therefore, new prospective clinical trials with a large sample size are necessary to provide more evidence.Mineralocorticoid antagonistsThe use of exogenous corticosteroids has been consistently shown to be a risk factor for the development of CSC,<a class="elsevierStyleCrossRef" href="#bib0235">47</a> with increased expression of ocular mineralocorticoid receptors in patients with this pathology. Thus, authors such as Zhao et al. postulated that because corticosteroids induce and aggravate CSC by binding to the mineralocorticoid receptor,<a class="elsevierStyleCrossRef" href="#bib0240">48</a> CSC may be correlated with inadequate mineralocorticoid activation. This is because activation of steroid receptors can lead to an alteration in electrolyte balance that affects SRF generation and absorption.Based on the above hypothesis, numerous studies have been developed using eplerenone and spirolonactone for the treatment of CSC, most of them being retrospective.<a class="elsevierStyleCrossRefs" href="#bib0245">49,50</a> In one of the few existing prospective studies, Schwartz et al.<a class="elsevierStyleCrossRef" href="#bib0245">49</a> analyzed 13 eyes of patients with chronic CSC after eplerenone and 6 eyes after placebo for 3 months, showing a reduction in SRF in both groups. However, a higher rate of SRF resolution was found in the placebo group compared to eplerenone (30.8% vs. 23%), with a significant difference in BCVA between the placebo vs. eplerenone group (P=0.005) at the third month, so the authors concluded that eplerenone was not superior to placebo.In another prospective study, the ECSELSIOR study,<a class="elsevierStyleCrossRef" href="#bib0255">51</a> 15 patients with chronic CSC were randomly assigned to eplerenone or placebo in a 2:1 ratio, obtaining results opposite to those exposed in the above-mentiond study. The eplerenone dose was 25mg/day for one week and then 50mg/day for 2 months. In this study, a significant mean reduction in the central thickness of the retina and the SRF was evidenced in the eplerenone-treated eyes (SRF=121–29μm; P=0.01), compared to no improvement in the placebo group (92μm–134μm; P=0.54). In addition, there was a significant BCVA improvement in the eplerenone treatment group that was not observed in the placebo group. It should be noted that no adverse effects were observed with eplerenone that merited stopping treatment.Therefore, although numerous studies had shown some evidence for the use of eplerenone, other studies had shown conflicting conclusions. It should be noted that most published studies had small sample sizes and short follow-up times, and many had no control group, so new studies with more scientific evidence were needed to overcome this controversy. Thus, the VICI trial was published very recently, in 2020.<a class="elsevierStyleCrossRef" href="#bib0260">52</a> This study included 114 patients, 57 of which received treatment with eplerenone (25mg/day for 1 week, increasing to 50mg/day for a maximum of 12 months) and 57 were given placebo and followed up during 12 months. The mean BCVA at 12 months was 80.4±4.6 letters in the eplerenone group and 79.5±4.5 letters in the placebo group, with no difference between both. There were also no differences in complete SRF resolution, recurrence of activity or in the central thickness of the retina. The only observed significant difference was lower SRF volume in the placebo group. Therefore, due to the finding that eplerenone is not superior to placebo, this group of experts recommended that ophthalmologists who are currently guiding this treatment should stop this practice.Anti-VEGF drugsDespite not being indicated in the data sheet, the possible role of antiangiogenic or anti-vascular endothelial growth factor (anti-VEGF) drugs in chronic CSC is based on the theory that choroidal hyperpermeability is associated with increased VEGF expression. However, no increased levels of VEGF have been found in the aqueous humor of eyes with CSC.<a class="elsevierStyleCrossRef" href="#bib0265">53</a> Jung et al. also did not observe increased levels of VEGF in the aqueous humor of patients with CSC versus controls, but they did observe that those who responded to bevacizumab had higher levels of VEGF compared to those who did not respond to said treatment.<a class="elsevierStyleCrossRef" href="#bib0270">54</a> However, in relation to other pathologies, a relationship has been described between VEGF and cytokine levels in the vitreous and AH.<a class="elsevierStyleCrossRef" href="#bib0275">55</a> In contrast, in CSC there could be an imbalance or absence of cytokine relationship between the aqueous and vitreous humor.Results regarding the treatment of CSC with anti-VEGF are generally contradictory. Some of the main studies are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In a meta-analysis, Chung et al. described the absence of any visual or central retinal thickness benefit in patients treated with bevacizumab over controls.<a class="elsevierStyleCrossRef" href="#bib0280">56</a> Four studies were included, two in patients with chronic CSC<a class="elsevierStyleCrossRefs" href="#bib0285">57,58</a> and two with acute CSC.<a class="elsevierStyleCrossRefs" href="#bib0295">59,60</a> The authors of this meta-analysis suggest that there some cases could benefit and that it would be more appropriate to compare acute and chronic cases of CSC separately. A recent retrospective study conducted by the same group and published in 2019 comprising 77 eyes with chronic CSC treated by intravitreal injections of bevacizumab (injected every 6 weeks until complete resolution of the SRF and then according to OCT-guided activity) exhibited 57% of patients with improved VA, 26% showed no change and 17% had worse vision, however this result was not compared with controls.<a class="elsevierStyleCrossRef" href="#bib0305">61</a> Full resolution of SRF was observed in 68% of eyes during the 12-month follow-up period.In a prospective study, Artunay et al. compared 15 eyes treated with bevacizumab versus 15 eyes that were observed, obtaining an anatomical restoration at 6 months in 80% and 53.3% of the eyes respectively (P<0.01), with a central retinal thickness of 174±68μm and 297±172μm, respectively.<a class="elsevierStyleCrossRef" href="#bib0285">57</a> It was evidenced that all eyes in the bevacizumab group (15/15) improved or maintained stable vision against 10/15 eyes in the control group.Bae et al. conducted a comparative study between low-flow PDT and ranibizumab in 34 eyes of 32 patients. The treatment with ranibizumab consisted of 3 intravitreal load injections, except in the case of full SRF resolution in which the injections were interrupted. At 12 months, 89% of eyes in the PDT group maintained complete resolution of the SRF without requiring rescue treatment versus 12.5% of eyes in the ranibizumab group (P<0.001).Eleven percent of patients in the PDT group and 69% in the ranibizumab group met the criteria for rescue treatment (0.2logMAR decrease in VA with persistence of SRF, or persistence of SRF with no evidence of decrease from previous values). The improvement in BCVA from baseline was significantly higher in the PDT group at the third month of follow-up. Therefore, this study showed that PDT was superior to Ranibizumab both in SRF resolution and in AV improvement.<a class="elsevierStyleCrossRef" href="#bib0310">62</a>The first prospective study evaluating aflibercept in CSC was the CONTAIN study conducted in 12 patients with a 6-month follow-up.<a class="elsevierStyleCrossRef" href="#bib0315">63</a> Fifty percent of patients exhibited complete SRF resolution, with a significant average decrease from 159 to 49μm, decreasing the central macular thickness from 400μm to 306μm. Therefore, no visual improvements were obtained although anatomical improvements were obtained after treatment with aflibercept.The clinical scenario in which the utility of anti-VEGF treatment is most demonstrated is in CSC with the presence of secondary choroidal neovascular membranes (CNV).<a class="elsevierStyleCrossRef" href="#bib0320">64</a> These should be suspected especially when there is a flat and irregular detachment of the RPE and not a purely serous detachment. In addition, type 2 CNV membranes could be present (above the RPE).The MINERVA study carried out with ranibizumab was the study that granted approval in technical data sheet for the use of this drug in CSC complicated with CNV.<a class="elsevierStyleCrossRef" href="#bib0325">65</a> Recently, a retrospective study was published in 21 eyes of 21 patients in which a loading dose of 6 anti-VEGF (ranibizumab or aflibercept) for CSC complicated with CNV<a class="elsevierStyleCrossRef" href="#bib0330">66</a> was prescribed. The mean BCVA improved from 0.65logMar at baseline to 0.29 after the third injection (P=0.012), with no significant visual benefit between the third and sixth injections. Mean central retinal thickness decreased from 346±61 to 257±57μm (P<0.01) after the sixth injection. A significant remodeling of the CNV was also observed as a decrease in the vertical (P=0.021) and horizontal (P=0.024) PED.The best results obtained in patients with CSC with associated CNV could explain part of the disparity in previous results in terms of the benefit of anti-VEGF treatment in this entity (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Different authors have proposed that the percentage of cases of CSC with associated CNV may be much higher than thought a few years ago, and that there may have been an underdiagnosis of these cases due to the limited diagnostic means available in the past. Currently, advances in different imaging techniques such as OCT, OCTA and contrast angiography enable greater precision in diagnosing the presence of an associated CNV.<a class="elsevierStyleCrossRef" href="#bib0335">67</a> In a study of patients with CSC with long-term follow-up, averaging 17 years of disease progression, Mjeren et al. described that approximately 24% developed secondary CNV.<a class="elsevierStyleCrossRef" href="#bib0340">68</a><elsevierMultimedia ident="fig0020"></elsevierMultimedia>Recently, in a retrospective study of 27 eyes with CNV secondary to CSC, Romdhane et al. observed complete resolution of SRF<a class="elsevierStyleCrossRef" href="#bib0345">69</a> in 45% of cases. However, the authors suggest that response is highly variable and often incomplete, suggesting that CNV is not solely responsible for subretinal fluid accumulation.Non-steroidal anti-inflammatory drugsSome authors have proposed the use of non-steroidal anti-inflammatory drugs in the treatment of CSC. Iijima et al. demonstrated that there are elevated levels of PAI-1 in patients with CSC.<a class="elsevierStyleCrossRef" href="#bib0350">70</a> Based on this association, Caccavale et al.<a class="elsevierStyleCrossRef" href="#bib0355">71</a> treated patients with CSC with low-dose acetylsalicylic acid (ASA) at a dose of 100mg, as this antiplatelet drug is effective in lowering PAI-1 levels. All patients were prescribed aspirin 100mg/day for the first month and on alternate days for the next 5 months. The ASA group comprised 113 eyes from 109 patients, compared to historical controls consisting of 95 eyes from 89 patients. At 1 and 3 months, both groups exhibited BCVA improvement vis-a-vis baseline, which was superior in the group treated with ASA that exhibited better and faster recovery than controls. At 6 months no significant differences in VA were found between both treatment groups, but at the end of the follow-up a better BCVA was obtained in the group treated with ASA. In this group, 86% had no recurrences of the disease during the year of follow-up, compared to 57% resolution without recurrences in the control group. However, more studies are needed to demonstrate the efficacy of this treatment.Carbonic anhydrase inhibitorsThis treatment is used in clinic as it has proven to be effective in reducing macular edema associated with various intraocular processes and after surgery. In CSC it has been used with the aim of encouraging SRF reabsorption but its clinical usefulness has not been clearly endorsed and its use in this indication is outside the technical specifications.Pikkel et al. in a nonrandomized study after a 2-year follow-up described oral acetazolamide as shortening the time to resolution of the clinic. However, there were no differences in VA and recurrences in treated patients compared to controls.<a class="elsevierStyleCrossRef" href="#bib0360">72</a>Eradication of H. pyloriIn recent years, highlighting a meta-analysis by Chatziralli et al.,<a class="elsevierStyleCrossRef" href="#bib0365">73</a> it has been proposed that H. pylori infection could be a significant risk factor for the development of recurrent CSC. It has been postulated that this bacterium has thrombogenic effects and that it causes immune reactions by damaging the choroidal endothelium. On this basis, some authors have suggested that the eradication of H. pylori accelerates the SRF resolution in CSC, with most of these studies being conducted in patients with acute CSC. The first study was conducted in 2011 by Rahbani-Nobar et al.,<a class="elsevierStyleCrossRef" href="#bib0370">74</a> finding no significant differences in either visual improvement or SRF resolution compared to observation. However, faster SRF resolution was observed (9.3±3.2 weeks in the H. pylori eradication group versus 11.6±3.2 weeks in the control group; P=0.015). Subsequently, in 2013 a prospective, randomized, placebo-controlled study conducted by Dang et al.<a class="elsevierStyleCrossRef" href="#bib0375">75</a> with 53 participants, 27 in H. pylori eradication treatment and 26 in placebo, found no improvement in BCVA and SRF clearance rate. In a retrospective study in acute CSC, Zavoloka et al.<a class="elsevierStyleCrossRef" href="#bib0380">76</a> also observed no difference in the VA of the H. pylori eradication group at 1 and 2 years after treatment than in H. pylori positive patients who did not receive eradication treatment (P>0.05). They did observe faster resolution of SRF.The only study that treated H. pylori in patients with chronic CSC was in an 18-eye series of 17 patients with a follow-up of 6–27 months.<a class="elsevierStyleCrossRef" href="#bib0385">77</a> In 14/15 cases that were positive for H. pylori, SRF resolution was achieved, with 12 of them being observed in the first month after treatment. However, a recurrence of SRF was observed in 5/17 eyes. The mean baseline visual acuity was 0.57±0.28logMAR improving to 0.16±0.17logMAR (P<0.001). None of the published studies found adverse effects associated with systemic medication for the eradication of H. pylori. However, the current series have reduced sample sizes and many of them without a control group, so new studies with an adequate design are needed to elucidate the possible role of this treatment.ConclusionsThere are currently multiple treatment options for the resolution of SRF and the improvement or stabilization of VA in patients with chronic CSC. PDT and sub-threshold MP laser have proven to be effective and safe alternatives and are currently the treatments of choice. PDT with mean fluence has demonstrated the same efficacy as standard fluence, with an apparently lower rate of adverse effects. Conventional FC laser is in general in disuse due to the risks derived from the procedure. Mineralocorticoid antagonists have not demonstrated a clinical benefit over placebo so, on the basis of current evidence, they should not be prescribed. Intravitreal anti-VEGF drugs have demonstrated their usefulness in cases where the presence of CSC-associated CNV is suspected or confirmed. Controversy remains in published evidence regarding the usefulness of H. pylori eradication. Finally, promising and emerging treatments are arising, including angiographically guided laser or AAS whose role should be supported by properly designed studies with larger sample sizes, longer follow-up, and more scientific evidence.Conflict of interestNo conflict of interests was declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1505479" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1366214" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1505478" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1366213" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Different therapeutic possibilities in use" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Focal laser photocoagulation" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Photodynamic therapy with verteporfin" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Micropulse sub-threshold laser" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Mineralocorticoid antagonists" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Anti-VEGF drugs" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Non-steroidal anti-inflammatory drugs" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Carbonic anhydrase inhibitors" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Eradication of H. pylori" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 12 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-07" "fechaAceptado" => "2020-07-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1366214" "palabras" => array:6 [ 0 => "Central serous chorioretinopathy" 1 => "Photodynamic therapy" 2 => "Micropulse laser" 3 => "Neurosensory retinal detachment" 4 => "Eplerenone" 5 => "Anti-vascular endothelial growth factor" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1366213" "palabras" => array:6 [ 0 => "Coriorretinopatía serosa central" 1 => "Terapia fotodinámica" 2 => "Láser micropulso" 3 => "Desprendimiento neurosensorial" 4 => "Eplerenona" 5 => "Fármacos antiangiogénicos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La coriorretinopatía serosa central (CSC) es una de las principales causas de disminución de la agudeza visual en pacientes menores de 60 años. Su fisiopatología sigue siendo parcialmente desconocida, aunque se ha postulado una hiperpermeabilidad coroidea que produce típicamente un desprendimiento neurosensorial y/o un desprendimiento del epitelio pigmentario de la retina en el polo posterior. La CSC aguda generalmente no requiere tratamiento, mientras que cuando es crónica debe ser tratada para evitar un deterioro visual. Con el desarrollo de las nuevas técnicas de imagen ha existido una mejora en el diagnóstico y se han propuesto diferentes estrategias terapéuticas. Actualmente diversos tratamientos para el manejo de la CSC crónica han demostrado ser útiles para mejorar o estabilizar la agudeza visual, la resolución del fluido subretiniano y para prevenir recurrencias. Los tratamientos más empleados en la actualidad son la terapia fotodinámica con verteporfina, el láser subumbral de micropulso, el tratamiento con antagonistas de los mineralocorticoides o los fármacos intravítreos antiangiogénicos. Pero existen otras propuestas y, además, se están desarrollando nuevos tratamientos con resultados prometedores. Esta revisión pretende ofrecer al lector una visión global de la evidencia científica actual de las diferentes opciones de tratamientos disponibles para la CSC para ayudar en la toma de decisiones en la práctica clínica." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Moreno-Morillo FJ, Fernández-Vigo JI, Güemes-Villahoz N, Burgos-Blasco B, López-Guajardo L, Donate-López J. Actualización en el tratamiento de la coriorretinopatía serosa central crónica. Arch Soc Esp Oftalmol. 2021;96:251–264." ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1251 "Ancho" => 1505 "Tamanyo" => 234654 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Typical image of central serous chorioretinopathy (CSC) by multimodality study. (A) Optical coherence tomography showing neurosensory detachment (B) autofluorescence with epitheliopathy in the trenches. (C) Fluorescein angiography showing the leakage point produced by the neurosensory detachment. (D) Indocyanine green angiography showing dilated choroidal vessels. Note that the images are of different patients." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 333 "Ancho" => 1755 "Tamanyo" => 97812 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient with chronic central serous chorioretinopathy (CSC) treated with standard photodynamic therapy (PDT). (A) Optical coherence tomography prior to PDT showing a neurosensory detachment (NSD). (B) OCT 3 days after PDT showing increased NSD secondary to inflammation. (C) OCT one month after PDT in which NSD resolution is appreciated. (D) OCT 3 months after PDT in which the absence of NSD persists." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1836 "Ancho" => 2925 "Tamanyo" => 794354 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Image obtained by optical coherence tomography angiography (OCTA) and structural OCT. OCTA shows the segmentation at the level of the choriocapillary (CC) and choroids to analyse the vascularization. In the first column in the OCT image, a neurosensory detachment (NSD) can be seen infero-nasal to the macula. In the second column, OCTA images show the vascular occlusion both at the level of the CC and the choroid (indicated by the circular dotted area) after treatment with photodynamic therapy (PDT) at standard doses, with NSD persisting in the OCT. The 3rd and 4th column show resolution of NSD with revascularization of the occluded area after the PDT." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1206 "Ancho" => 905 "Tamanyo" => 255662 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Associated neovascularization (CNV) in a patient with chronic central serous chorioretinopathy detected by optical coherence tomography angiography (OCTA). (A) A neovascular bundle is seen below the retinal pigment epithelium. (B) Image of structural OCT with flow superposition showing fibrovascular RPE detachment corresponding to the CNV." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of TFD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow up \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lim et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medium fluence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">237 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81% SRF resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fujita et al.<a class="elsevierStyleCrossRef" href="#bib0390">78</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Half dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">204 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA from 0.11 to −0.01logMAR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lai et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multi-center retrospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Half dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 months on average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.1% Resolution at 36m. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA 0.36–0.15logMAR at 36m. 2.9% recurrences \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mohabati et al.<a class="elsevierStyleCrossRef" href="#bib0395">79</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Half dose or half fluence or half time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">118 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 weeks on average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88% SRF resolution in severe group and 95% in control. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA 66–72 severe group and 78–72 control \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breukink et al.<a class="elsevierStyleCrossRef" href="#bib0400">80</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Half dose or half fluence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 weeks on average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74% Resolution of SRF in patients with steroids. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% in control group \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">van Dijk et al.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective double-blind randomised controlled trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Half dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7–8 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.2% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA 6.8 letter increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iacono et al.<a class="elsevierStyleCrossRef" href="#bib0405">81</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Standard PDT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Final BCVA increased by 14.4 letters on average \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2586140.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prospective or sample-size studies ≥100 patients with chronic central serous chorioretinopathy (CSC) treated by photodynamic therapy (PDT)." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laser \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow up \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Roisman et al.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Controlled randomized prospecting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">810nm MP diode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 letters of average visual gain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luttrull et al.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">810nm MP diode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–45 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% LSR resolution at 3 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Koss et al.<a class="elsevierStyleCrossRef" href="#bib0290">58</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparative overview \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">810nm MP diode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5% SRF resolution. Change from 45.4 to 51.6 letters at 10m \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kretz et al.<a class="elsevierStyleCrossRef" href="#bib0410">82</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomised controlled trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">810nm MP diode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% SRF improvement, 6.7 letter gain on average \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">van Dijk et al.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Double-blind, multicenter, randomised controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">810nm MP diode \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.8% SRF resolution. 4.48 letter increase at 8m \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arsan et al.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">577nm MP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13–23 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.3% SRF resolution. 89.7% improvement of BCVA over previous \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambiya et al.<a class="elsevierStyleCrossRef" href="#bib0165">33</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">577nm Navilas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% SRF resolution. 73.3±16.1 letter average BCVA at 76.9±13.0 (P=0.59) at 6m \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Roca et al.<a class="elsevierStyleCrossRef" href="#bib0190">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparative retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">577nm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA improved from 0.41±0.27 to 0.21±0.26logMAR (P<0.0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piasecka et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparative retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">532nm MP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA improved from 0.53±0.16 to 0.89±0.13 decimal. SRF height reduced from 166. to 12.4μm (P<.001) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2586141.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of studies treated with micropulse laser (MP)." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow up \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Artunay et al.<a class="elsevierStyleCrossRef" href="#bib0285">57</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparative prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bevacizumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% Maintained or improved AV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Semeraro et al.<a class="elsevierStyleCrossRef" href="#bib0415">83</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comparative prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bevacizumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA improved from 20 to 43 letters \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bae et al.<a class="elsevierStyleCrossRef" href="#bib0310">62</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomised comparative prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ranibizumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA improved 0.19±0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pitcher et al.<a class="elsevierStyleCrossRef" href="#bib0315">63</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-comparative prospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aflibercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA improved from 62 to 64 letters \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kim et al.<a class="elsevierStyleCrossRef" href="#bib0420">84</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective case series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bevacizumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6 months average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% SRF resolution. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCVA improved from 0.35±0.34 to 0.32±0.36logMAR (P=0.359) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peiretti et al.<a class="elsevierStyleCrossRef" href="#bib0425">85</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bevacizumab or ranibizumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Average BCVA 0.30±0.69–0.20±0.49logMAR (P=0.20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schworm et al.<a class="elsevierStyleCrossRef" href="#bib0330">66</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bevacizumab or ranibizumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6–7 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean BCVA improved 0.65±0.35–0.49±0.29logMAR (P=0.011). SRF height reduced from 117 to 25μm (P<0.001) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2586139.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of studies treated with antiangiogenic drug injections (anti-VEGF)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:85 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sociedad Española de Retina y Vítreo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scleral thickness in central 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Update on the management of chronic central serous chorioretinopathy

Actualización en el tratamiento de la coriorretinopatía serosa central crónica

F.J. Moreno-Morilloa, J.I. Fernández-Vigoa,b,

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jfvigo@hotmail.com

Corresponding author.

, N. Güemes-Villahoza, B. Burgos-Blascoa, L. López-Guajardoa, J. Donate-Lópeza

a Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain

b Centro Internacional de Oftalmología Avanzada, Madrid, Spain

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so it is included within the spectrum of the pachychoroid diseases&#46; In the contrast tests&#44; leakage points are observed in fluorescein angiography &#40;AFG&#41; and a choroidal staining in indocyanine green angiography &#40;IGA&#41;&#44; suggesting the presence of increased choroidal hyperpermeability &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the presence of increased choroidal flow&#44; hydrostatic pressure would be raised&#44; damaging the RPE and leading to a decompensation of the barrier function of the RPE&#44; favoring the accumulation of subretinal fluid &#40;SRF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Recently it has been described that scleral thickening occurs in these patients that can facilitate the progressive accumulation of fluid&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">CSC is classified as acute&#44; recurrent&#44; and chronic&#46; Acute CSC in most cases resolves spontaneously with favorable results without the need for treatment&#46; Recurring CSC presents an acute episode that follows a previous episode with complete resolution&#46; In contrast&#44; chronic CSC exhibits a persistence of SRF for at least 3&#8211;6 months&#46; The most common symptoms are metamorphosis&#44; central relative scotoma and generally moderate reduction in visual acuity&#44; which are produced by the persistence of SRF and damage to RPE and photoreceptors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Unlike acute CSC&#44; when it has frequent recurrences or becomes chronic&#44; it usually requires treatment to stabilize the VA and avoid long-term deterioration&#44; mainly due to damage to the RPE&#46; The decision to treat must always be agreed upon with the patient&#44; evaluating the possible limitations that it may produce on his or her work or functional activity&#44; the condition of the other eye&#44; and the number of previous episodes and sequelae&#46; Modifications in patient lifestyle should be recommended to reduce stress&#44; as well as the reduction or suspension of steroid treatment&#44; since an association with these factors has been described&#46; The goal of treatment is the disappearance of the NSD&#44; its stabilization and&#44; if possible&#44; improving VA and preventing new episodes&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">At present there are different therapeutic proposals for the treatment of CSC such as photodynamic therapy or subthreshold laser&#46; However&#44; in clinical practice other interventions are also performed such as treatment with mineralocorticoid antagonists&#44; laser photocoagulation&#44; treatment with intravitreal antiangiogenic drugs&#44; non-steroid anti-inflammatory drugs or eradication of <span class="elsevierStyleItalic">Helycobacter pylori &#40;H&#46; pylori&#41;</span>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore&#44; the purpose of this review is to update the available scientific evidence to evaluate the usefulness of the different treatment possibilities currently available for the treatment of chronic CSC&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Different therapeutic possibilities in use</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Focal laser photocoagulation</span><p id="par0030" class="elsevierStylePara elsevierViewall">One of the first treatments used for the treatment of CSC was focal photocoagulation &#40;FC&#41; with argon laser&#46; The rationale for the use of this treatment was postulated by Imanaga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in which CSC was the result of leakage through defects in the Bruch membrane and adjacent RPE&#44; and that focal CF would occlude those defects&#46; While it is true that direct CF can reduce the duration of NSD&#44; the mechanism by which this occurs remains controversial&#46; Spitznas postulated that there was a reversal in the direction of fluid transport through the abnormal RPE&#44; so that this moved from the choroid to the neuroretin&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Laser CF can achieve accelerated resolution of NSD by treating the focal defect of RPE and inducing a migration of healthy adjacent RPE cells by restoring barrier function at the site of the leak&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the results obtained with this treatment&#44; Leaver and Williams in 1979 carried out a prospective randomized clinical trial that included 67 patients with CSC&#46; It was observed that CF with argon laser demonstrated an acceleration in the resolution of NSD&#44; which occurred in an average time of 6 weeks from treatment in the treated group and 16 weeks in the control group without treatment &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; However&#44; there were no significant differences in the final best corrected visual acuity &#40;BCVA&#41; between the treated and the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With respect to the recurrence of NSD in CSC&#44; different studies offered very disparate data&#46; Both Watzke and Burton<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in a prospective study and Nanjiani<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> or Gilbert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> in retrospective studies found no significant difference in recurrences between treated and untreated&#44; so laser CF did not prove useful in preventing recurrences&#46; On the contrary&#44; Dellaporta described a lower incidence of recurrence among treated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Subsequently&#44; a prospective randomized trial with a follow-up of 6&#8211;12 years found no evidence that laser CF reduced recurrences in CSC&#44; also confirming an absence of improvement in the AV of the treated group&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A study comparing conventional CF versus the yellow micropulse sub-threshold laser &#40;577<span class="elsevierStyleHsp" style=""></span>nm&#41; found no difference in the percentage of SRF and BCVA resolution between the two techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; all patients in the CF group had RPE damage versus only one in the subthreshold laser group evaluated by autofluorescence&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another study carried out by Piasecka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> compared conventional CF &#40;continuous laser&#41; versus green micro-pulse sub-threshold laser &#40;532<span class="elsevierStyleHsp" style=""></span>nm&#41; observing significant differences in BCVA in favor of the latter after 12 months of treatment &#40;0&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;13 versus 0&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;71&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">With regard to the comparison of laser CF versus PDT at medium dose&#44; in a study conducted in 26 patients no difference in visual recovery was observed between the two groups&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> It should be noted that there were significant differences in SRF resolution after one month of treatment &#40;92&#46;8&#37; in the PDT group vs&#46; 58&#46;3&#37; in the laser CF group&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;022&#41;&#44; although at 3 and 6 months there was resolution in all cases in both groups&#46; The main limitation of this work is that the study groups were not comparable since those patients with a diffuse leak were included in the PDT group&#44; whiel those with an extrafoveal focal leak were included in the CF group&#46; This could be a clear determinant of the response since previous studies have shown better efficacy among those patients treated with PDT with focal leakage than in those with diffuse leakage&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Already in 2014&#44; Chhablani et al&#46; evaluated the effectiveness of CF with fluorescein angiography-guided lasers &#40;AFG&#41; &#40;Navilas&#174; 532<span class="elsevierStyleHsp" style=""></span>nm double-pulsed YAG Laser&#44; OD-OS GMBH&#44; Teltow&#44; Germany&#41; with an eye-tracker system in a prospective study&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> A single impact was performed on the peri- or juxtafoveal leakage points&#44; observing full SRF resolution at 2 months of follow-up in 15&#47;16 eyes &#40;94&#37;&#41;&#46; However&#44; there was no improvement in the BCVA with respect to the basal values&#46; On the contrary&#44; using the same CF guided laser&#44; M&#252;ller et al&#46; in a retrospective study of 32 patients observed an improvement of the BCVA from a median of 0&#46;58 Snellen &#40;range 0&#46;16&#8211;1&#46;25&#41; to 0&#46;66 &#40;0&#46;16&#8211;1&#46;0&#41; &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In this study the full resolution of the SRF was 75&#37; at 3 months&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary&#44; conventional CF laser could be an indicated treatment for recurrent CSC with persistent fluid-filled extrafoveal focal leaks when no other therapeutic possibility exists&#46; However&#44; it is a treatment rarely used at present for the treatment of chronic CSC due to the risk of causing relative scotomas and secondary neovascularization by inducing ruptures in the Bruch membrane<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a> &#40;the risk being generally low and dependent on the type of lesion and laser parameters&#41; and has been surpassed in terms of efficacy by other therapeutic alternatives&#46; A promising new proposal is the AFG-guided laser that could be useful for the resolution of this entity&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Photodynamic therapy with verteporfin</span><p id="par0070" class="elsevierStylePara elsevierViewall">Photodynamic therapy &#40;PDT&#41; consists of the intravenous administration of a photosensitizing agent&#44; verteporfin &#40;Visudyne&#44; Novartis&#41;&#44; which is subsequently stimulated with a specific light dose on the macula&#46; The mechanism of action of this treatment consists in the laser excitation of the verteporfin molecule producing the release of free radicals that cause an inflammation of the vascular wall&#44; induction of apoptosis and microthrombosis of the vessels&#44; which produces a non-selective occlusion of the choroidal vessels&#46; In this way&#44; PDT reduces choroidal permeability by altering the structure and perfusion of the choroidal vasculature&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> modifying the perfusion-reabsorption balance in favor of the latter&#44; decreasing the SRF that is present in the macular NSD that typically appears in CSC &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">PDT for the treatment of CSC was first successfully employed by Chan et al&#46; in 2003 in a series of 6 cases guided by IGA angiography&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Since then&#44; numerous studies have been carried out with PDT for the treatment of this entity&#46; The standard PDT treatment lasts 83<span class="elsevierStyleHsp" style=""></span>s&#44; and is applied with a dose of verteporfin of 6<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> and a fluence of 50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; with a spot size that&#44; in general&#44; should be 1000<span class="elsevierStyleHsp" style=""></span>&#956;m larger than the area to be treated&#44; guided if possible by IGA&#46; It can be applied in a single area or in several&#44; and it is recommended to repeat the treatment no earlier than 3 months if the SRF persists&#44; since the studies that explored the efficacy of shortening this interval offered no advantages&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The use of PDT has been associated with different adverse effects such as decreased choriocapillary perfusion &#40;44&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; RPE atrophy &#40;4&#37;&#41; or loss of visual acuity &#40;1&#46;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Some cases of severe choroidal ischemia have also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Due to these complications of PDT&#44; studies with different therapeutic strategies were proposed with the aim of minimizing them&#44; fundamentally halving the dose of verteporfin &#40;from 6 to 3<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#41; or reducing the fluence applied by half &#40;from 50 to 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In a prospective&#44; multicenter clinical trial in 42 subjects with chronic CSC treated with standard versus medium fluency&#44; Reibaldi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> found no significant difference in BCVA between the two techniques at any time during follow-up&#44; observing in both a significant improvement in vision with respect to the baseline visit &#40;from 0&#46;43<span class="elsevierStyleHsp" style=""></span>logMar to 0&#46;27 and from 0&#46;46 to 0&#46;28 respectively&#59; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The main difference between both PDT strategies was that at 12 months&#44; 8 eyes from the standard fluence treatment group showed areas of non-perfusion compared to none in those treated with medium fluence&#46; However&#44; the possible implication of this exploratory finding is unknown&#44; since a repermeabilization of the choriocapillary over time has been described&#46; Lim et al&#46; developed the largest retrospective study evaluating the efficacy of PDT with medium fluence compared to standard fluence including 256 eyes from 237 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The therapeutic strategies applied were&#58; standard fluence in 130 eyes &#40;49&#37;&#41;&#44; medium fluence in 128 eyes &#40;48&#37;&#41;&#44; with no fluence or very low fluence in 7 eyes &#40;3&#37;&#41;&#46; A complete resolution of the SRF was observed in 81&#37; of all patients at the end of the follow-up&#44; without observing differences between the different treatment groups&#46; Adverse effects were rare&#44; notably RPE atrophy in 10 eyes &#40;4&#37;&#41;&#44; and severe visual decrease in 4 eyes &#40;1&#46;5&#37;&#41;&#46; Moreover&#44; similarly to other studies&#44; an increase of choriocapillary non-perfusion areas was observed in patients with standard PDT versus those with medium fluency&#46; Therefore&#44; these findings suggest that the use of mean fluency PDT does not decrease the efficacy of the procedure with respect to standard PDT&#44; but does seem to decrease possible adverse effects&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to the dose of verteporfin used for the treatment of PDT&#44; Chan et al&#46; used half the dose &#40;3<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#41; showing good efficacy at 12 months&#44; being similar to that published in other series&#44; without adverse events&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Studies have also been carried out with a third of the dose &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; but with disparate results&#46; In 68 eyes out of 60 patients&#44; Hua et al&#46; found a statistically significant improvement in BCVA &#40;from 0&#46;62<span class="elsevierStyleHsp" style=""></span>logMar to 0&#46;21&#41; at 6 months after treatment&#44; with SRF being completely reabsorbed in 63 eyes &#40;92&#46;6&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The main limitation of these works with reduced dose of verteporfin is that they lacked a comparative group with PDT at full dose&#46; On the other hand&#44; Uetani et al&#46; evaluated results in patients with half doses &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; and with a third of doses &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; with SRF being reabsorbed in 100&#37; and 33&#37; of the eyes respectively at 3 months&#46; Therefore&#44; the authors concluded that PDT with a third of dose was less effective than PDT with half of dose in terms of resolution of the SRF&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In reference to possible variations in PDT treatment&#44; Nicol&#243; et al&#46; conducted an interesting study comparing the efficacy of half dose versus mean fluency&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Both therapeutic strategies demonstrated a significant improvement in vision &#40;from 0&#46;126 and 0&#46;187<span class="elsevierStyleHsp" style=""></span>logMAR to 0&#46;068 and 0&#46;083<span class="elsevierStyleHsp" style=""></span>logMAR respectively in the mean fluence and half-dose groups&#41;&#46; However&#44; there were no significant differences between the 2 treatment groups&#46; Complete resolution of the SRF at one month of PDT was observed in 61&#46;3&#37; and 86&#46;2&#37; of eyes after half-dose and half-dose fluence respectively &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; which means that the strategy with half-dose but with complete fluence is superior&#46; Even so&#44; at 12 months the percentage of patients with complete SRF resolution was 83&#46;9&#37; and 100&#37; respectively&#44; i&#46;e&#46; non-significant differences &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;052&#41;&#46; The mean number of required PDT was 1&#46;48 and 1&#46;17 in the mean fluence and half-dose group respectively&#44; with a slight need for greater re-treatment in the case of mean fluence &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;49&#41;&#46; Overall&#44; 15 and 5 recurrences presented in the mean fluence group and the half-dose group&#44; respectively &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;07&#41;&#46; Therefore&#44; the authors stated that the half-dose therapeutic strategy induced a greater and more prolonged response with respect to SRF resorption&#46; No differences were found in terms of treatment safety since no atrophic changes in RPE were observed in either group&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In another retrospective study conducted by Alkin et al&#46; involving 64 eyes&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> low fluence was compared to half dose &#40;verteporfin 3<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; Thirty-three eyes &#40;91&#46;6&#37;&#41; in the low-flow group and 26 eyes &#40;92&#46;8&#37;&#41; in the half-dose group showed complete SRF resolution&#46; Seventeen eyes &#40;52&#46;8&#37;&#41; in the low-fluence group and 14 eyes &#40;50&#37;&#41; in the half-dose group experienced a BCVA gain of 5 or more letters&#46; In addition&#44; a decrease in central macular thickness was observed with both treatment modalities &#40;basal&#58; 351<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>&#956;m and 341<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>96<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; and significantly decreased to 188<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>61<span class="elsevierStyleHsp" style=""></span>&#956;m and 181<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; for the low-fluence and half-dose groups respectively&#41;&#46; Therefore&#44; no differences were observed between low fluency and half dose&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Park et al&#46; conducted a study in 43 eyes to compare the effects of PDT according to 3 different treatment strategies&#58; full dose &#40;verteporfin 6<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&#44; half dose &#40;verteporfin 3<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; and half dose with mean fluence &#40;verteporfin 3<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> and fluence 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#46; A significant visual gain was observed in the full-dose and half-dose groups &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41; but in the half-dose and and mean fluence group VA did not improve significantly &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;254&#41;&#46; Subfoveal choroidal thickness decreased significantly in all three groups&#46; The SRF thicknesses in the full-dose and half-dose groups showed significant decreases &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005 and &#60;0&#46;001 respectively&#41;&#44; with the half-dose-half-fluence group not reaching significance &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;084&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> The authors conclude that strategies with full and half dose were effective and could be performed at half dose to reduce complications&#46; However&#44; the authors state that the combination of half-dose and half-fluence does not seem to be a recommended option since the effect is less clear&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical results of prospective studies or studies with a large sample size &#40;n<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100&#41; for the treatment of chronic CSC using PDT&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the safety of long-term PDT treatment to assess side effects and also to study recurrences&#44; Park et al&#46; conducted the study with a longer follow-up time&#44; which was a minimum of 3 years&#44; including 94 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> This study was mostly conducted with mean fluence PDT &#40;81&#37;&#41;&#44; although cases treated with mid-dose PDT &#40;13&#37;&#41; or standard PDT &#40;6&#37;&#41; were also included&#46; Complete resolution of SRF at 6 months after PDT was evident in 90&#37; of cases&#44; with a recurrence of 24&#37;&#46; The mean interval from initial PDT to recurrence was 28&#46;6 months<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;8 months &#40;range&#58; 1&#46;1&#8211;86&#46;3 months&#41;&#46; A multivariate analysis suggested bilaterality &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;407&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#44; a small decrease in central macular thickness &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;936&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#41; and male sex &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46;417&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41; as risk factors for recurrence&#46; Coinciding with this&#44; a previous study carried out by Lai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> observed these same risk factors for recurrence&#44; except for the sex in which they found greater recurrence in women&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding the presence of CSC-associated CNV&#44; two patients developed CNV&#46; One of those treated with mean fluence appeared two years after treatment and one patient with standard PDT one month after PDT&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In summary&#44; PDT offers high efficacy for SRF resorption and AV improvement in patients with chronic CSC&#44; with mean fluence showing the same efficacy as the standard fluence&#44; and there seems to be a lower rate of adverse effects&#46; Similarly&#44; the use of PDT at half dose instead of full dose may be a useful treatment option since there are no differences in efficacy compared to mean fluence&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Micropulse sub-threshold laser</span><p id="par0130" class="elsevierStylePara elsevierViewall">The sub-threshold micro-pulse &#40;MP&#41; laser was initially used for treating macular edema secondary to diabetic retinopathy and venous occlusions&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> The exact mechanism of action of the MP laser remains unclear&#44; but it is considered that it raises the temperature of the retina enough to induce the expression of heat shock proteins&#44; which are essential to maintain adequate protein structure without inducing tissue necrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> By minimizing thermal damage&#44; it can be applied near the fovea eliminating possible scotomas caused by the argon laser&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There are currently different variants of the MP laser on the market&#46; Different wavelengths have been described from 527<span class="elsevierStyleHsp" style=""></span>nm &#40;green&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> 532<span class="elsevierStyleHsp" style=""></span>nm &#40;green&#41;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;32</span></a>&#44; 577<span class="elsevierStyleHsp" style=""></span>nm &#40;yellow&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> and 810<span class="elsevierStyleHsp" style=""></span>nm &#40;infrared&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> although the last two have been the most used&#46; The 810 nm laser allows greater tissue penetration&#44; respecting the retina and exerting its effect directly on the choroid&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In addition to wavelength&#44; other parameters are modifiable such as duty cycles&#44; power&#44; spot size and pulse duration&#46; The duty cycle is defined as the relationship between the &#8220;ON&#8221; time and the total treatment time &#40;&#8220;ON&#8221; plus &#8220;OFF&#8221;&#41;&#46; The total exposure time is fragmented so that the impact is spread evenly over a series of microsecond pulses over the total treatment time&#46; In various studies for CSC&#44; this time varies between 5&#37; and 15&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;35</span></a> This micropulse treatment contributes to the selectivity of its action on RPE without damaging photoreceptors&#46; The power varies from 90<span class="elsevierStyleHsp" style=""></span>mW to 1800<span class="elsevierStyleHsp" style=""></span>mW according to published studies&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> The spot size usually ranges from 100<span class="elsevierStyleHsp" style=""></span>&#956;m to 200<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> The treatment usually consists of making a grid over the leakage areas of the AGF or IGA&#46; The pulse duration is the time interval between each new pulse cycle and varies from 100<span class="elsevierStyleHsp" style=""></span>ms to 300<span class="elsevierStyleHsp" style=""></span>ms&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;39</span></a>&#46; All these parameters mean that there is no standard sub-threshold laser therapy and therefore it is difficult to compare different studies&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">One of the first articles to describe the use of the sub-threshold micro-pulse diode laser &#40;810 nm&#41; was a prospective study in 26 eyes of 25 patients with chronic CSC&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Patients were divided in 3 groups based on whether they had a localized leakage point &#40;group 1&#41; with associated RPE atrophy &#40;group 2&#41; or a diffuse leakage &#40;group 3&#41;&#46; Group 1 exhibited complete resolution of SRF in all patients in a single session&#46; In group 2&#44; 8&#47;9 patients achieved complete resabsorption requiring 1&#8211;3 laser sessions&#46; In group 3&#44; complete resabsorption of SRF was observed in only 45&#37; of patients &#40;5&#47;11&#41;&#44; so non-responsive patients were rescued with a PDT treatment that was effective in such cases&#46; Therefore&#44; it seems that this technique was more effective when there is a focal leak&#46; These data were confirmed in a subgroup of the PLACE study of 79 patients treated with MP laser&#44; in which 41&#37; of patients with focal leakage had complete SRF resolution versus 21&#37; of the patients with diffuse leakage at 7&#8722;8 months&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Among the different studies carried out for the MP laser treatment in CSC&#44; it is interesting to highlight the prospective studies or those with a larger sample size as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; First&#44; in 2018&#44; van Dijk et al&#46; conducted a multicenter randomized clinical trial that compared the sub-threshold diode laser &#40;810<span class="elsevierStyleHsp" style=""></span>nm&#41; with PDT at mid-dose&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> At the end of the follow-up only 28&#46;8&#37; of patients treated with the MP laser showed complete SRF resolution versus 67&#46;2&#37; in the PDT group &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; With regard to visual gain&#44; there were no significant differences between both treatments&#44; although a favorable trend to the PDT group was observed &#40;6&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5 versus 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3 letters ETDRS&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;099&#41;&#46; The poor results offered by the PD laser in this study for the resolution of SRF are in contrast with those found in other retrospective or prospective studies with smaller sample sizes with success rates of up to 92&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a> Some authors attribute these great differences in efficacy to the fact that they are retrospective or small sample studies&#44; as well as to the different inclusion or exclusion criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Battaglia proposed that these differences could be attributed to undertreatment because the area treated in the MP laser group was very small&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">44&#44;45</span></a> This possible under-treatment had already been proposed by other authors as one of the main causes of therapeutic failure of this laser in inexperienced hands&#44; since in the absence of a visible lesion it is not possible to verify the treatment area&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">The Pan American Collaborative Retinal Study Group &#40;PACORES&#41; conducted a study comparing 92 yellow &#40;577<span class="elsevierStyleHsp" style=""></span>nm&#41; MP laser-treated eyes with 67 eyes that received PDT at half-dose&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> In the MP laser group at 12 months of follow-up&#44; BCVA improved from 0&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27 at baseline to 0&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;26<span class="elsevierStyleHsp" style=""></span>logMAR &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; On the other hand&#44; the PDT group did not show BCVA improvement&#44; which was 0&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;34 at study baseline and 0&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;34 logMAR &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;89&#41; at the end&#46; In the MP laser group&#44; 48&#46;9&#37; &#40;45&#47;92&#41; of eyes showed improvement &#8805;3 lines from baseline&#44; while another 48&#46;9&#37; remained within the 2 basal BCVA lines&#44; and only in 2 eyes there was a loss &#8805;3 lines from baseline&#46; In the PDM group&#44; 19&#37; &#40;13&#47;67&#41; of eyes showed improvement &#8805;3 lines over baseline&#44; with 73&#37; &#40;49&#47;67&#41; of the eyes remaining within the 2 baseline AVM lines&#44; while 5 eyes had a loss &#8805;3 lines&#46; In both groups a significant decrease in central macular thickness and in subfoveal choroidal thickness was evidenced&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Therefore&#44; MP laser is an effective and safe treatment option for the resolution of SRF and improvement of VA in patients with chronic CSC&#44; obtaining better results in the presence of a focal leakage point&#46; However&#44; there is still a great disparity of results with this treatment&#44; as well as the superiority&#47;inferiority of its efficacy compared to PDT&#46; In addition&#44; the parameters to be used and the influence of the type of choroids remain unknown&#46; Therefore&#44; new prospective clinical trials with a large sample size are necessary to provide more evidence&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Mineralocorticoid antagonists</span><p id="par0165" class="elsevierStylePara elsevierViewall">The use of exogenous corticosteroids has been consistently shown to be a risk factor for the development of CSC&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> with increased expression of ocular mineralocorticoid receptors in patients with this pathology&#46; Thus&#44; authors such as Zhao et al&#46; postulated that because corticosteroids induce and aggravate CSC by binding to the mineralocorticoid receptor&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> CSC may be correlated with inadequate mineralocorticoid activation&#46; This is because activation of steroid receptors can lead to an alteration in electrolyte balance that affects SRF generation and absorption&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Based on the above hypothesis&#44; numerous studies have been developed using eplerenone and spirolonactone for the treatment of CSC&#44; most of them being retrospective&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">49&#44;50</span></a> In one of the few existing prospective studies&#44; Schwartz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> analyzed 13 eyes of patients with chronic CSC after eplerenone and 6 eyes after placebo for 3 months&#44; showing a reduction in SRF in both groups&#46; However&#44; a higher rate of SRF resolution was found in the placebo group compared to eplerenone &#40;30&#46;8&#37; vs&#46; 23&#37;&#41;&#44; with a significant difference in BCVA between the placebo vs&#46; eplerenone group &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; at the third month&#44; so the authors concluded that eplerenone was not superior to placebo&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In another prospective study&#44; the ECSELSIOR study&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> 15 patients with chronic CSC were randomly assigned to eplerenone or placebo in a 2&#58;1 ratio&#44; obtaining results opposite to those exposed in the above-mentiond study&#46; The eplerenone dose was 25<span class="elsevierStyleHsp" style=""></span>mg&#47;day for one week and then 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 2 months&#46; In this study&#44; a significant mean reduction in the central thickness of the retina and the SRF was evidenced in the eplerenone-treated eyes &#40;SRF<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>121&#8211;29<span class="elsevierStyleHsp" style=""></span>&#956;m&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; compared to no improvement in the placebo group &#40;92<span class="elsevierStyleHsp" style=""></span>&#956;m&#8211;134<span class="elsevierStyleHsp" style=""></span>&#956;m&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#41;&#46; In addition&#44; there was a significant BCVA improvement in the eplerenone treatment group that was not observed in the placebo group&#46; It should be noted that no adverse effects were observed with eplerenone that merited stopping treatment&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Therefore&#44; although numerous studies had shown some evidence for the use of eplerenone&#44; other studies had shown conflicting conclusions&#46; It should be noted that most published studies had small sample sizes and short follow-up times&#44; and many had no control group&#44; so new studies with more scientific evidence were needed to overcome this controversy&#46; Thus&#44; the VICI trial was published very recently&#44; in 2020&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> This study included 114 patients&#44; 57 of which received treatment with eplerenone &#40;25<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 1 week&#44; increasing to 50<span class="elsevierStyleHsp" style=""></span>mg&#47;day for a maximum of 12 months&#41; and 57 were given placebo and followed up during 12 months&#46; The mean BCVA at 12 months was 80&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6 letters in the eplerenone group and 79&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5 letters in the placebo group&#44; with no difference between both&#46; There were also no differences in complete SRF resolution&#44; recurrence of activity or in the central thickness of the retina&#46; The only observed significant difference was lower SRF volume in the placebo group&#46; Therefore&#44; due to the finding that eplerenone is not superior to placebo&#44; this group of experts recommended that ophthalmologists who are currently guiding this treatment should stop this practice&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Anti-VEGF drugs</span><p id="par0185" class="elsevierStylePara elsevierViewall">Despite not being indicated in the data sheet&#44; the possible role of antiangiogenic or anti-vascular endothelial growth factor &#40;anti-VEGF&#41; drugs in chronic CSC is based on the theory that choroidal hyperpermeability is associated with increased VEGF expression&#46; However&#44; no increased levels of VEGF have been found in the aqueous humor of eyes with CSC&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> Jung et al&#46; also did not observe increased levels of VEGF in the aqueous humor of patients with CSC versus controls&#44; but they did observe that those who responded to bevacizumab had higher levels of VEGF compared to those who did not respond to said treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> However&#44; in relation to other pathologies&#44; a relationship has been described between VEGF and cytokine levels in the vitreous and AH&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> In contrast&#44; in CSC there could be an imbalance or absence of cytokine relationship between the aqueous and vitreous humor&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Results regarding the treatment of CSC with anti-VEGF are generally contradictory&#46; Some of the main studies are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">In a meta-analysis&#44; Chung et al&#46; described the absence of any visual or central retinal thickness benefit in patients treated with bevacizumab over controls&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> Four studies were included&#44; two in patients with chronic CSC<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#44;58</span></a> and two with acute CSC&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">59&#44;60</span></a> The authors of this meta-analysis suggest that there some cases could benefit and that it would be more appropriate to compare acute and chronic cases of CSC separately&#46; A recent retrospective study conducted by the same group and published in 2019 comprising 77 eyes with chronic CSC treated by intravitreal injections of bevacizumab &#40;injected every 6 weeks until complete resolution of the SRF and then according to OCT-guided activity&#41; exhibited 57&#37; of patients with improved VA&#44; 26&#37; showed no change and 17&#37; had worse vision&#44; however this result was not compared with controls&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a> Full resolution of SRF was observed in 68&#37; of eyes during the 12-month follow-up period&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In a prospective study&#44; Artunay et al&#46; compared 15 eyes treated with bevacizumab versus 15 eyes that were observed&#44; obtaining an anatomical restoration at 6 months in 80&#37; and 53&#46;3&#37; of the eyes respectively &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; with a central retinal thickness of 174<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68<span class="elsevierStyleHsp" style=""></span>&#956;m and 297<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>172<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> It was evidenced that all eyes in the bevacizumab group &#40;15&#47;15&#41; improved or maintained stable vision against 10&#47;15 eyes in the control group&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Bae et al&#46; conducted a comparative study between low-flow PDT and ranibizumab in 34 eyes of 32 patients&#46; The treatment with ranibizumab consisted of 3 intravitreal load injections&#44; except in the case of full SRF resolution in which the injections were interrupted&#46; At 12 months&#44; 89&#37; of eyes in the PDT group maintained complete resolution of the SRF without requiring rescue treatment versus 12&#46;5&#37; of eyes in the ranibizumab group &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Eleven percent of patients in the PDT group and 69&#37; in the ranibizumab group met the criteria for rescue treatment &#40;0&#46;2<span class="elsevierStyleHsp" style=""></span>logMAR decrease in VA with persistence of SRF&#44; or persistence of SRF with no evidence of decrease from previous values&#41;&#46; The improvement in BCVA from baseline was significantly higher in the PDT group at the third month of follow-up&#46; Therefore&#44; this study showed that PDT was superior to Ranibizumab both in SRF resolution and in AV improvement&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">The first prospective study evaluating aflibercept in CSC was the CONTAIN study conducted in 12 patients with a 6-month follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a> Fifty percent of patients exhibited complete SRF resolution&#44; with a significant average decrease from 159 to 49<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; decreasing the central macular thickness from 400<span class="elsevierStyleHsp" style=""></span>&#956;m to 306<span class="elsevierStyleHsp" style=""></span>&#956;m&#46; Therefore&#44; no visual improvements were obtained although anatomical improvements were obtained after treatment with aflibercept&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The clinical scenario in which the utility of anti-VEGF treatment is most demonstrated is in CSC with the presence of secondary choroidal neovascular membranes &#40;CNV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> These should be suspected especially when there is a flat and irregular detachment of the RPE and not a purely serous detachment&#46; In addition&#44; type 2 CNV membranes could be present &#40;above the RPE&#41;&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The MINERVA study carried out with ranibizumab was the study that granted approval in technical data sheet for the use of this drug in CSC complicated with CNV&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> Recently&#44; a retrospective study was published in 21 eyes of 21 patients in which a loading dose of 6 anti-VEGF &#40;ranibizumab or aflibercept&#41; for CSC complicated with CNV<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> was prescribed&#46; The mean BCVA improved from 0&#46;65<span class="elsevierStyleHsp" style=""></span>logMar at baseline to 0&#46;29 after the third injection &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;&#44; with no significant visual benefit between the third and sixth injections&#46; Mean central retinal thickness decreased from 346<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>61 to 257<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>57<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; after the sixth injection&#46; A significant remodeling of the CNV was also observed as a decrease in the vertical &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; and horizontal &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41; PED&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The best results obtained in patients with CSC with associated CNV could explain part of the disparity in previous results in terms of the benefit of anti-VEGF treatment in this entity &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Different authors have proposed that the percentage of cases of CSC with associated CNV may be much higher than thought a few years ago&#44; and that there may have been an underdiagnosis of these cases due to the limited diagnostic means available in the past&#46; Currently&#44; advances in different imaging techniques such as OCT&#44; OCTA and contrast angiography enable greater precision in diagnosing the presence of an associated CNV&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a> In a study of patients with CSC with long-term follow-up&#44; averaging 17 years of disease progression&#44; Mjeren et al&#46; described that approximately 24&#37; developed secondary CNV&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">Recently&#44; in a retrospective study of 27 eyes with CNV secondary to CSC&#44; Romdhane et al&#46; observed complete resolution of SRF<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> in 45&#37; of cases&#46; However&#44; the authors suggest that response is highly variable and often incomplete&#44; suggesting that CNV is not solely responsible for subretinal fluid accumulation&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Non-steroidal anti-inflammatory drugs</span><p id="par0240" class="elsevierStylePara elsevierViewall">Some authors have proposed the use of non-steroidal anti-inflammatory drugs in the treatment of CSC&#46; Iijima et al&#46; demonstrated that there are elevated levels of PAI-1 in patients with CSC&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a> Based on this association&#44; Caccavale et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">71</span></a> treated patients with CSC with low-dose acetylsalicylic acid &#40;ASA&#41; at a dose of 100<span class="elsevierStyleHsp" style=""></span>mg&#44; as this antiplatelet drug is effective in lowering PAI-1 levels&#46; All patients were prescribed aspirin 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day for the first month and on alternate days for the next 5 months&#46; The ASA group comprised 113 eyes from 109 patients&#44; compared to historical controls consisting of 95 eyes from 89 patients&#46; At 1 and 3 months&#44; both groups exhibited BCVA improvement vis-a-vis baseline&#44; which was superior in the group treated with ASA that exhibited better and faster recovery than controls&#46; At 6 months no significant differences in VA were found between both treatment groups&#44; but at the end of the follow-up a better BCVA was obtained in the group treated with ASA&#46; In this group&#44; 86&#37; had no recurrences of the disease during the year of follow-up&#44; compared to 57&#37; resolution without recurrences in the control group&#46; However&#44; more studies are needed to demonstrate the efficacy of this treatment&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Carbonic anhydrase inhibitors</span><p id="par0245" class="elsevierStylePara elsevierViewall">This treatment is used in clinic as it has proven to be effective in reducing macular edema associated with various intraocular processes and after surgery&#46; In CSC it has been used with the aim of encouraging SRF reabsorption but its clinical usefulness has not been clearly endorsed and its use in this indication is outside the technical specifications&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Pikkel et al&#46; in a nonrandomized study after a 2-year follow-up described oral acetazolamide as shortening the time to resolution of the clinic&#46; However&#44; there were no differences in VA and recurrences in treated patients compared to controls&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Eradication of <span class="elsevierStyleItalic">H&#46; pylori</span></span><p id="par0255" class="elsevierStylePara elsevierViewall">In recent years&#44; highlighting a meta-analysis by Chatziralli et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a> it has been proposed that <span class="elsevierStyleItalic">H&#46; pylori</span> infection could be a significant risk factor for the development of recurrent CSC&#46; It has been postulated that this bacterium has thrombogenic effects and that it causes immune reactions by damaging the choroidal endothelium&#46; On this basis&#44; some authors have suggested that the eradication of <span class="elsevierStyleItalic">H&#46; pylori</span> accelerates the SRF resolution in CSC&#44; with most of these studies being conducted in patients with acute CSC&#46; The first study was conducted in 2011 by Rahbani-Nobar et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a> finding no significant differences in either visual improvement or SRF resolution compared to observation&#46; However&#44; faster SRF resolution was observed &#40;9&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2 weeks in the <span class="elsevierStyleItalic">H&#46; pylori</span> eradication group versus 11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2 weeks in the control group&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46; Subsequently&#44; in 2013 a prospective&#44; randomized&#44; placebo-controlled study conducted by Dang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> with 53 participants&#44; 27 in <span class="elsevierStyleItalic">H</span>&#46; pylori eradication treatment and 26 in placebo&#44; found no improvement in BCVA and SRF clearance rate&#46; In a retrospective study in acute CSC&#44; Zavoloka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a> also observed no difference in the VA of the <span class="elsevierStyleItalic">H</span>&#46; pylori eradication group at 1 and 2 years after treatment than in H&#46; <span class="elsevierStyleItalic">pylori</span> positive patients who did not receive eradication treatment &#40;P<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; They did observe faster resolution of SRF&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">The only study that treated <span class="elsevierStyleItalic">H&#46; pylori</span> in patients with chronic CSC was in an 18-eye series of 17 patients with a follow-up of 6&#8211;27 months&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">77</span></a> In 14&#47;15 cases that were positive for <span class="elsevierStyleItalic">H&#46; pylori&#44;</span> SRF resolution was achieved&#44; with 12 of them being observed in the first month after treatment&#46; However&#44; a recurrence of SRF was observed in 5&#47;17 eyes&#46; The mean baseline visual acuity was 0&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;28<span class="elsevierStyleHsp" style=""></span>logMAR improving to 0&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;17<span class="elsevierStyleHsp" style=""></span>logMAR &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; None of the published studies found adverse effects associated with systemic medication for the eradication of <span class="elsevierStyleItalic">H&#46; pylori</span>&#46; However&#44; the current series have reduced sample sizes and many of them without a control group&#44; so new studies with an adequate design are needed to elucidate the possible role of this treatment&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusions</span><p id="par0265" class="elsevierStylePara elsevierViewall">There are currently multiple treatment options for the resolution of SRF and the improvement or stabilization of VA in patients with chronic CSC&#46; PDT and sub-threshold MP laser have proven to be effective and safe alternatives and are currently the treatments of choice&#46; PDT with mean fluence has demonstrated the same efficacy as standard fluence&#44; with an apparently lower rate of adverse effects&#46; Conventional FC laser is in general in disuse due to the risks derived from the procedure&#46; Mineralocorticoid antagonists have not demonstrated a clinical benefit over placebo so&#44; on the basis of current evidence&#44; they should not be prescribed&#46; Intravitreal anti-VEGF drugs have demonstrated their usefulness in cases where the presence of CSC-associated CNV is suspected or confirmed&#46; Controversy remains in published evidence regarding the usefulness of <span class="elsevierStyleItalic">H&#46; pylori</span> eradication&#46; Finally&#44; promising and emerging treatments are arising&#44; including angiographically guided laser or AAS whose role should be supported by properly designed studies with larger sample sizes&#44; longer follow-up&#44; and more scientific evidence&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflict of interest</span><p id="par0270" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Different therapeutic possibilities in use"
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              "titulo" => "Focal laser photocoagulation"
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              "titulo" => "Photodynamic therapy with verteporfin"
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          "titulo" => "Micropulse sub-threshold laser"
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              "titulo" => "Mineralocorticoid antagonists"
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          "identificador" => "sec0035"
          "titulo" => "Anti-VEGF drugs"
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          "identificador" => "sec0040"
          "titulo" => "Non-steroidal anti-inflammatory drugs"
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          "titulo" => "Carbonic anhydrase inhibitors"
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          "identificador" => "sec0050"
          "titulo" => "Eradication of H&#46; pylori"
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          "titulo" => "Conclusions"
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    "fechaRecibido" => "2020-05-07"
    "fechaAceptado" => "2020-07-09"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Central serous chorioretinopathy"
            1 => "Photodynamic therapy"
            2 => "Micropulse laser"
            3 => "Neurosensory retinal detachment"
            4 => "Eplerenone"
            5 => "Anti-vascular endothelial growth factor"
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          "palabras" => array:6 [
            0 => "Coriorretinopat&#237;a serosa central"
            1 => "Terapia fotodin&#225;mica"
            2 => "L&#225;ser micropulso"
            3 => "Desprendimiento neurosensorial"
            4 => "Eplerenona"
            5 => "F&#225;rmacos antiangiog&#233;nicos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Central serous chorioretinopathy &#40;CSC&#41; is one of the main causes of impaired visual acuity in patients younger than 60 years&#46; Its pathophysiology remains partially unknown&#44; although it has been postulated that choroidal hyper-permeability may be involved&#46; This typically produces a neurosensory retinal detachment and&#47;or a detachment of the retinal pigment epithelium in the posterior pole&#46; Although acute CSC generally does not require treatment&#44; when chronic it must be treated to avoid visual impairment&#46; With the development of new imaging techniques&#44; there has been an improvement in diagnosis&#44; and different therapeutic strategies have been proposed&#46; Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity&#44; the resolution of subretinal fluid&#44; and to prevent recurrences&#46; The most commonly used treatments today are photodynamic therapy&#44; micropulse subthreshold laser&#44; mineralocorticoid antagonists&#44; or anti-vascular endothelial growth factor drugs&#46; There are also other proposals and new treatments being developed&#44; with promising results&#46; This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La coriorretinopat&#237;a serosa central &#40;CSC&#41; es una de las principales causas de disminuci&#243;n de la agudeza visual en pacientes menores de 60 a&#241;os&#46; Su fisiopatolog&#237;a sigue siendo parcialmente desconocida&#44; aunque se ha postulado una hiperpermeabilidad coroidea que produce t&#237;picamente un desprendimiento neurosensorial y&#47;o un desprendimiento del epitelio pigmentario de la retina en el polo posterior&#46; La CSC aguda generalmente no requiere tratamiento&#44; mientras que cuando es cr&#243;nica debe ser tratada para evitar un deterioro visual&#46; Con el desarrollo de las nuevas t&#233;cnicas de imagen ha existido una mejora en el diagn&#243;stico y se han propuesto diferentes estrategias terap&#233;uticas&#46; Actualmente diversos tratamientos para el manejo de la CSC cr&#243;nica han demostrado ser &#250;tiles para mejorar o estabilizar la agudeza visual&#44; la resoluci&#243;n del fluido subretiniano y para prevenir recurrencias&#46; Los tratamientos m&#225;s empleados en la actualidad son la terapia fotodin&#225;mica con verteporfina&#44; el l&#225;ser subumbral de micropulso&#44; el tratamiento con antagonistas de los mineralocorticoides o los f&#225;rmacos intrav&#237;treos antiangiog&#233;nicos&#46; Pero existen otras propuestas y&#44; adem&#225;s&#44; se est&#225;n desarrollando nuevos tratamientos con resultados prometedores&#46; Esta revisi&#243;n pretende ofrecer al lector una visi&#243;n global de la evidencia cient&#237;fica actual de las diferentes opciones de tratamientos disponibles para la CSC para ayudar en la toma de decisiones en la pr&#225;ctica cl&#237;nica&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno-Morillo FJ&#44; Fern&#225;ndez-Vigo JI&#44; G&#252;emes-Villahoz N&#44; Burgos-Blasco B&#44; L&#243;pez-Guajardo L&#44; Donate-L&#243;pez J&#46; Actualizaci&#243;n en el tratamiento de la coriorretinopat&#237;a serosa central cr&#243;nica&#46; Arch Soc Esp Oftalmol&#46; 2021&#59;96&#58;251&#8211;264&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Typical image of central serous chorioretinopathy &#40;CSC&#41; by multimodality study&#46; &#40;A&#41; Optical coherence tomography showing neurosensory detachment &#40;B&#41; autofluorescence with epitheliopathy in the trenches&#46; &#40;C&#41; Fluorescein angiography showing the leakage point produced by the neurosensory detachment&#46; &#40;D&#41; Indocyanine green angiography showing dilated choroidal vessels&#46; Note that the images are of different patients&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient with chronic central serous chorioretinopathy &#40;CSC&#41; treated with standard photodynamic therapy &#40;PDT&#41;&#46; &#40;A&#41; Optical coherence tomography prior to PDT showing a neurosensory detachment &#40;NSD&#41;&#46; &#40;B&#41; OCT 3 days after PDT showing increased NSD secondary to inflammation&#46; &#40;C&#41; OCT one month after PDT in which NSD resolution is appreciated&#46; &#40;D&#41; OCT 3 months after PDT in which the absence of NSD persists&#46;</p>"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Image obtained by optical coherence tomography angiography &#40;OCTA&#41; and structural OCT&#46; OCTA shows the segmentation at the level of the choriocapillary &#40;CC&#41; and choroids to analyse the vascularization&#46; In the first column in the OCT image&#44; a neurosensory detachment &#40;NSD&#41; can be seen infero-nasal to the macula&#46; In the second column&#44; OCTA images show the vascular occlusion both at the level of the CC and the choroid &#40;indicated by the circular dotted area&#41; after treatment with photodynamic therapy &#40;PDT&#41; at standard doses&#44; with NSD persisting in the OCT&#46; The 3rd and 4th column show resolution of NSD with revascularization of the occluded area after the PDT&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Associated neovascularization &#40;CNV&#41; in a patient with chronic central serous chorioretinopathy detected by optical coherence tomography angiography &#40;OCTA&#41;&#46; &#40;A&#41; A neovascular bundle is seen below the retinal pigment epithelium&#46; &#40;B&#41; Image of structural OCT with flow superposition showing fibrovascular RPE detachment corresponding to the CNV&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of TFD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medium fluence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8211;12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#37; SRF resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fujita et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Half dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA from 0&#46;11 to &#8722;0&#46;01<span class="elsevierStyleHsp" style=""></span>logMAR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multi-center retrospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Half dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 months on average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;1&#37; Resolution at 36<span class="elsevierStyleHsp" style=""></span>m&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA 0&#46;36&#8211;0&#46;15<span class="elsevierStyleHsp" style=""></span>logMAR at 36<span class="elsevierStyleHsp" style=""></span>m&#46; 2&#46;9&#37; recurrences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mohabati et al&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Half dose or half fluence or half time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 weeks on average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#37; SRF resolution in severe group and 95&#37; in control&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA 66&#8211;72 severe group and 78&#8211;72 control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Breukink et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Half dose or half fluence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 weeks on average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#37; Resolution of SRF in patients with steroids&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; in control group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">van Dijk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective double-blind randomised controlled trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Half dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8211;8 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;2&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA 6&#46;8 letter increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iacono et al&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Standard PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Final BCVA increased by 14&#46;4 letters on average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2586140.png"
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Prospective or sample-size studies &#8805;100 patients with chronic central serous chorioretinopathy &#40;CSC&#41; treated by photodynamic therapy &#40;PDT&#41;&#46;</p>"
        ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Roisman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Controlled randomized prospecting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">810<span class="elsevierStyleHsp" style=""></span>nm MP diode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 letters of average visual gain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Luttrull et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">810<span class="elsevierStyleHsp" style=""></span>nm MP diode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8211;45 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; LSR resolution at 3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Koss et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparative overview&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">810<span class="elsevierStyleHsp" style=""></span>nm MP diode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5&#37; SRF resolution&#46; Change from 45&#46;4 to 51&#46;6 letters at 10<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kretz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomised controlled trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">810<span class="elsevierStyleHsp" style=""></span>nm MP diode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; SRF improvement&#44; 6&#46;7 letter gain on average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">van Dijk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Double-blind&#44; multicenter&#44; randomised controlled clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">810<span class="elsevierStyleHsp" style=""></span>nm MP diode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;8&#37; SRF resolution&#46; 4&#46;48 letter increase at 8<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arsan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">577<span class="elsevierStyleHsp" style=""></span>nm MP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#8211;23 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;3&#37; SRF resolution&#46; 89&#46;7&#37; improvement of BCVA over previous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambiya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">577<span class="elsevierStyleHsp" style=""></span>nm Navilas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; SRF resolution&#46; 73&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;1 letter average BCVA at 76&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;0 &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;59&#41; at 6<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Roca et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparative retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">577<span class="elsevierStyleHsp" style=""></span>nm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA improved from 0&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27 to 0&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;26<span class="elsevierStyleHsp" style=""></span>logMAR &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Piasecka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparative retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">532<span class="elsevierStyleHsp" style=""></span>nm MP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA improved from 0&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;16 to 0&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;13 decimal&#46; SRF height reduced from 166&#46; to 12&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Artunay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparative prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bevacizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37; Maintained or improved AV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semeraro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">83</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comparative prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bevacizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA improved from 20 to 43 letters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bae et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randomised comparative prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ranibizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA improved 0&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pitcher et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-comparative prospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aflibercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA improved from 62 to 64 letters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective case series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bevacizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6 months average&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; SRF resolution&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCVA improved from 0&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;34 to 0&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;36<span class="elsevierStyleHsp" style=""></span>logMAR &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;359&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peiretti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bevacizumab or ranibizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Average BCVA 0&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;69&#8211;0&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;49<span class="elsevierStyleHsp" style=""></span>logMAR &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schworm et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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