Laser treatment in subjects with high-risk clinical features of age-related macular degeneration. Posterior pole appearance and retinal function
R. H. Guymer, M. Gross-Jendroska, S. L. Owens, A. C. Bird and F. W. Fitzke
Department of Clinical Ophthalmology, Eye Hospital, London, England.
OBJECTIVES: To verify that a few laser lesions in the posterior pole can
cause drusen to resolve in patients with age-related macular degeneration,
and to document central retinal sensitivity as drusen resolve. DESIGN: In a
pilot study, 12 patients considered to be at high risk for
sight-threatening complications from age-related macular degeneration were
treated with 12 argon laser lesions in the posterior pole, with review for
12 to 24 months. RESULTS: Choroidal neovascularization developed in 1
patient 8 months after treatment, with consequent loss of central vision.
In 9 of the remaining 11 patients, high-risk characteristics of drusen were
reduced. Four patients had retinal pigment epithelial depigmentation, and
all maintained 20/40 visual acuity at 12 months. One patient lost 3 lines
of vision due to geographic atrophy after 12 months. Scotopic retinal
threshold was elevated before treatment in 8 patients, compared with an
age-matched comparison group. Of these, 4 patients underwent retesting 3 to
6 months after treatment, and all had improved thresholds, but only 1
patient sustained the improvement at 12 months. At 12 months, 3 of the 8
patients showed an improvement in their mean retinal threshold. Of those in
whom the mean retinal threshold worsened, the mean elevation in threshold
was not more than 0.6 log units. CONCLUSIONS: A few laser lesions in the
posterior pole leads to resolution of drusen. There does not appear to be
an increased risk for choroidal neovascularization. Retinal threshold
measurements show no indication of geographic atrophy at 1 year, but cannot
be excluded as a late outcome. Laser treatment may reduce the risk for
profound sight-threatening lesions in age-related macular degeneration.
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Arden et al.
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Robson et al.
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CHONG and BIRD
Br. J. Ophthalmol. 1998;82:1441-1443.
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Frennesson and Nilsson
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