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Eva Lenassi, Eric Troeger, Robert Wilke, Adnan Tufail, Marko Hawlina, Glen Jeffery, Andrew Webster; Laser Clearance of Drusen Deposit in Patients with Autosomal Dominant Drusen (p.Arg345Trp in EFEMP1) - an Exploratory Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5014.
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To assess whether laser treatment to the retinal pigment epithelium anterior to drusen in eyes of patients with EFEMP1-related maculopathy affects visual acuity, deposit volume and retinal sensitivity.
Ten patients with Autosomal Dominant Drusen and confirmed mutation in the EFEMP1 gene encoding fibulin-3 were included in the study. The worse-seeing eye was treated with Argon green laser with 10 to 15 laser spots placed anterior to the drusen boundaries (200 µm spot size, 0.1 s duration, 80-120 mW). Patients were examined before treatment as well as 1, 3, 6 and 12 months following the procedure. Clinical assessment included ETDRS visual acuity, microperimetry (MP1; Nidek Technologies), spectral domain optical coherence tomography (SD-OCT; Spectralis; Heidelberg Engineering) and autofluorescence imaging (Heidelberg Engineering HRA). A custom-made software tool (MultiModalMapper) allowed for co-registration of fundus-mapped MP1 and SD-OCT datasets.
Preliminary 6-month data are presented. In all patients, visual acuity in the control eye remained unchanged (p = 0.96, Wilcoxon test) while an average gain of 6.6 (range -4 to 17) letters was observed in the treated eye (p = 0.015, Wilcoxon test). For the MP1 data, 0.01 was set as the level of significance. Locus-by-locus differences were calculated between pre and post treatment results. To eliminate test-retest variability, overall difference in the treated and untreated eye was compared. Two patients showed significant improvement (p < 0.001, Mann-Whitney U test) in retinal sensitivity as a result of laser treatment with the remaining 8 showing no statistically significant change. The thickness of the drusen correlated with retinal sensitivity (rs = -0.68, p < 0.0001). Deposit thickness reduction was observed in SD-OCT over MP1 loci with evident post treatment retinal sensitivity improvement.
Low energy laser treatment is, so far, a safe treatment option for Autosomal Dominant Drusen and might potentially be efficacious for this untreatable disorder. Further evaluation, with long-term assessment is required to confirm the benefits.
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