Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

OBJECTIVE: To describe a case of retinal arterial macroaneurysm associated with macular pucker with good response to subthreshold laser treatment.
METHODS: Two-year follow-up of a patient with decreased vision in one eye for the past 6 months. Baseline best-corrected visual acuity was 20/40 in the affected eye. Multiple retinal arterial macroaneurysms were diagnosed on biomicroscopy fundus examination, with the presence of subretinal fluid and hard exudates on macula. Multimodal imaging including optical coherence tomography and fluorescein angiography confirmed the diagnosis and presence of macular pucker, which complicated the treatment choice. The largest retinal arterial macroaneurysm was treated 2 days after the diagnosis by means of subthreshold micropulse laser using an infrared diode laser with 1400 mW power, 200 ms exposure and 10% duty cycle.
RESULTS: Five months after the treatment, despite absorption of subretinal fluid, there were increased hard exudates at the posterior pole and best-corrected visual acuity was unchanged. Progressively, the exudates were absorbed and vision improved. Eighteen months after the treatment, best-corrected visual acuity was 20/25. Hard exudates were almost completely reabsorbed, with no evidence of fluid. Macular pucker was unchanged, with no retinal traction or complications related to conventional laser treatment.
CONCLUSIONS: Subthreshold laser treatment could be the treatment of choice in complicated cases of retinal arterial macroaneurysm with macular pucker, as it is able to modify the vessel permeability, without any thermal negative effect.

In this article, we present a case of retinal arterial macroaneurysm (RAM) complicating into exudative maculopathy who was successfully treated with subthreshold laser treatment (STLT). A 45-year-old Indian female was referred to our institution with diminution of vision in her left eye for 1 month with best-corrected visual acuity (BCVA) of counting fingers at 2 m in the left eye. A dilated fundus examination of the left eye revealed deposition of lipid exudates in the macular area and a reddish round vascular lesion superior to macula around two disc diameters from the center of fovea. Optical coherence tomography (OCT) showed serous neurosensory detachment in the macular area in the left eye. Fundus fluorescein angiography showed leakage at the site of vascular lesion in the arterial phase of angiogram. Laser treatment using subthreshold laser parameters was done with three mirror contact lens at the site of vascular lesion. Over the next 12-month follow-up, her BCVA as well as OCT picture improved gradually, and at the last follow up, her BCVA was 20/30 in the left eye with complete resolution of subretinal fluid as detected by OCT. STLT offers promising results in the treatment of symptomatic RAM without causing any complications.