A case of macular damage following micropulse laser treatment for central serous chorioretinopathy

Subthreshold micropulse laser treatment has proven to be an effective treatment for central serous chorioretinopathy. We report a rare case of localized macular damage following 577-nm subthreshold micropulse laser therapy in a patient with central serous chorioretinopathy in his early 40s, with 3-year longitudinal follow-up data. Pretreatment optical coherence tomography demonstrated the presence of subretinal hyperreflective material in the macular area. Despite adherence to validated fixed safety parameters during subthreshold micropulse laser application, post-treatment optical coherence tomography revealed partial macular damage characterized by disruption and atrophy of the ellipsoid and interdigitation zones. Fundus examination revealed localized lesions precisely corresponding to the subthreshold micropulse laser spot distribution patterns, confirming treatment-induced damage. These findings suggest that 577-nm subthreshold micropulse laser therapy for central serous chorioretinopathy induces macular damage, especially in patients with optical coherence tomography-detectable subretinal hyperreflective material. When subretinal hyperreflective material is present, careful energy adjustment is crucial. We recommend using reduced power settings (250-300 mW, 5% duty cycle) for subretinal hyperreflective material-associated central serous chorioretinopathy to enhance safety.