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TM Johnson, JK Luu, BM Glaser; Micropulse Laser Modulation of Retinal-Choroidal Anastamoses in Exudative Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2506.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Application of laser with a pulse duration less than the relaxation time of the vessel (termed micropulse laser ) has been shown to be effective in the closure of skin angiomas. This study describes a modification this technique for the management of retinal-choroidal anastamoses in neovascular macular degeneration. Methods: A retrospective case series of 19 eyes in 18 patients with neovascular macular degeneration undergoing micropulse laser treatment to patent retinal-choroidal anastamoses was conducted. Retinal-choroidal anastamoses were identified using conventional fluorescein angiography and high speed ICG imaging. Yellow wavelength (568 nm) laser energy with a power of 600 mW and a duration of 0.01 seconds was applied to the retinal-choroidal anastamoses to obtain closure. Patients were followed for an average of 8.1 months. Outcomes included ETDRS visual acuity, resolution of subretinal fluid on stereoscopic photographs and resolution of leakage on fluorescein angiography. Results: In this series 100 % of eyes had occult choroidal neovascular membranes with and average of 1.2 retinal-choroidal anastamoses per eye. Initial visual acuity ranged from 2 / 200 to 20 / 50. Patients required an average of 3.4 treatment sessions of laser per eye. 82 % of patients lost 1 line of visual acuity. 82 % had a reduction in subretinal fluid with 46 % having a complete resolution of subretinal fluid compared to the initial examination (p=0.005). 73 % had resolution of leakage on fluorescein angiography compared to baseline (p=0.0003). 90 % demonstrated maturation of subretinal vasculature on high speed ICG imaging. The flow in the RCA was attenuated in 100 % of cases with complete closure obtained in 55 % of cases. Conclusion: Previously described laser treatment strategies for retinal-choroidal anastamoses have achieved resolution of subretinal fluid in only 14 % of cases compared to 43% in our current series. This study suggests that micropulse laser techniques may have a significant role in the treatment of retinal-choroidal anastamoses in macular degeneration.
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