Navigated 577-nm subthreshold micropulse retinal laser treatment for peripapillary pachychoroid syndrome

To report a case of peripapillary pachychoroid syndrome (PPS) successfully treated with navigated subthreshold micropulse laser (SML).

A 65-year-old male was referred to our retina service complaining a worsening vision in the left eye (LE) over the past 6 months. A complete ophthalmological evaluation including best corrected visual acuity (BCVA) measurement, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) was performed. SD-OCT showed a thicker nasal choroid and peripapillary intraretinal cysts in both eyes, and macular subretinal fluid (SRF) in the LE. FA illustrated a bilateral peripapillary hyperfluorescent areas, with some macular focal leaking points in the left eye. A diagnosis of PPS was made, and considering the worldwide shortage of verteporfin, Navigated 577-nm SML was performed in the LE on the leaking areas shown on the FA. At the 3- and 6- months follow-up the SRF reabsorbed and BCVA improved from 20/32 to 20/20.

SML can be considered an efficacious treatment option in patients with PPS. Prospective studies with longer follow-up in a bigger cohort are needed to confirm the optimal treatment strategy in PPS.