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Daniel Lavinsky, Daniel V Palanker; Non-damaging Retinal Laser Therapy for Treatment of Macular Telangiectasia. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5858.
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© ARVO (1962-2015); The Authors (2016-present)
To assess safety and clinical efficacy of the non-damaging retinal laser therapy (NRT) for treatment of macular telangiectasia type 2 (MacTel 2).
Ten eyes of 5 patients with MacTel 2 were treated with the PASCAL (TMLS, USA) at 577nm wavelength, using 200μm retinal spot sizes. Using EndPoint Management (EpM) software the laser power was first titrated for a barely visible burn with 15ms pulses, which was defined as a 100% energy. Treatment was then applied over the area of leakage based on fluorescein angiography (FA), using 30% pulse energy and spot spacing of 0.25 beam diameter. Changes in ETDRS best corrected visual acuity and in OCT appearance of the retina were measured over 12 months follow-up. Pre- and post-treatment FA and fundus autofluorescence (FAF) were also assessed.
Unlike the natural course of MacTel, the central macular thickness in the treated eyes did not decrease during the follow-up period: it went from 246+/-13 μm at baseline to 241+/-14 μm (p=0.48) at 1 year. The inner and outer retinal lacunae significantly decreased in 80% of the eyes, while the central outer nuclear layer thickness remained the same as at baseline: 68+/-6 μm vs. 69+/-8 μm, suggesting that the decreased cavitation was not due to collapse of the tissue. In one patient with completely missing outer nuclear layer and IS/OS junction line near the fovea at baseline, the outer nuclear layer was partially restored and the ELM and IS/OS line reappeared 5 months after the treatment, and remained through the follow-up period. Visual acuity improved, on average, from 20/40 at baseline to 20/25 at one year. Four out of five patients were retreated once during the follow-up period due to persistent lacunae. No tissue damage due to NRT could be detected ophthalmoscopically, nor with FA, OCT or FAF.
NRT at 30% energy on EpM scale was safe, and resulted in improved visual acuity, partial restoration of the retina and stabilization of the disease in patients with MacTel 2. Lack of tissue damage allows high density treatment even in the fovea to boost therapeutic response, and periodic retreatment without cumulative scaring characteristic of conventional photocoagulation. Recent findings of HSP and GFAP expression after NRT suggests that this technique could activate endogenous mechanisms of neuroprotection and restoration. Larger controlled randomized clinical trials are warranted to confirm these results.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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