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Johann Roider, MD; Ralf Brinkmann, MS; Christopher Wirbelauer, MD; Horst Laqua, MD; Reginald Birngruber, PhD

Arch Ophthalmol. 1999;117:1028-1034.

Objective  To investigate whether photocoagulation of the retinal pigment epithelium is possible with sparing of the photoreceptors.

Methods  Mild laser effects of a neodymium:yttrium-lithium-fluoride (Nd:YLF) laser (527 nm) were applied to 17 patients. To establish the necessary energy, test exposures were performed to the lower macula (laser variables: 1.7 microseconds, 100 and 500 pulses applied in a train at 500 Hz, 20-130 µJ, 160 µm). Of 179 test lesions, 73 were followed up at various time intervals up to 1 year by performing microperimetry directly on top of the laser lesions.

Results  All of the test lesions were at the threshold of retinal pigment epithelial disruption, and none of the laser effects were visible by ophthalmoscopy during photocoagulation; they were detectable only by fluorescein angiography. After exposure with 500 pulses, retinal defects were detected in up to 73% of the patients (100 µJ) after the first day. Most of these defects were no longer detectable after 3 months. After exposure with 100 pulses, no defects could be detected with 70 and 100 µJ after 1 day. The absence of microscotomas in the follow-up period suggests that retinal damage was minimal or, if it occurred, was functionally repaired.

Conclusion  By choosing proper energy and number of pulses, it is possible to produce retinal pigment epithelial effects with no subsequent retinal damage detectable by microperimetry.

From the Department of Ophthalmology, University of Regensburg, Regensburg, Germany (Dr Roider); and the Department of Ophthalmology, Medical University of Lübeck (Drs Wirbelauer and Laqua), and Medical Laser Center (Mr Brinkmann and Dr Birngruber), Lübeck, Germany. Dr Birngruber has a patent on the laser technique used in this study.

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