Br J Ophthalmol 2000;84:40-47
( January )
Subthreshold (retinal pigment epithelium) photocoagulation in
macular diseases: a pilot study
Johann Roidera, Ralf Brinkmannc, Christopher Wirbelauerb, Horst Laquab, Reginald Birngruberc
a Department of
Ophthalmology, University of Regensburg, Regensburg, Germany, b Department of Ophthalmology, Medical
University of Lübeck, Lübeck, Germany, c Medical Laser Center, Lübeck, Germany
Correspondence to: Johann Roider, MD, Augenklinik, Klinikum der Universität
Regensburg, Franz-Josef-Strauss Allee 11, D-93053 Regensburg, Germany
Accepted for publication 31 August 1999
BACKGROUND Subthreshold
(retinal pigment epithelium) photocoagulation is a new photocoagulation
method, which treats the retinal pigment epithelium (RPE) and avoids
damage to the neural retina. The initial results in this prospective
pilot study on various macular diseases are presented.
METHODS12 patients
with diabetic maculopathy (group I), 10 with soft drusen (group II),
and four with central serous retinopathy (CSR) (group III) were treated
and followed up for 1 year. Treatment was achieved using a train of
repetitive short laser pulses (1.7 µs) of a green Nd:YLF laser
(parameters: 527 nm, 100 and 500 pulses, repetition rate: 500 Hz, spot
size: 160 µm, energies: 70-100 µJ). Laser energy was based on the
visibility of test lesions on fluorescein angiography (50-130 µJ).
Patients were examined at various times by ophthalmoscopy, fluorescein
and ICG angiography, and infrared imaging.
RESULTSAfter 6 months
hard exudates disappeared in six out of nine patients in group I and
leakage disappeared in six out of 12 diabetic patients. In group II
drusen were less in seven out of 10 patients. In group III serous
detachment disappeared in three out of four cases. Visual acuity was
stable in all cases. None of the laser lesions was clinically visible
immediately. After 1 day most lesions were visible as yellowish RPE
depigmentation. After 3 months some of the lesions were visible as
hyperpigmented areas but most were not. Fluorescein angiography showed
leakage only in the first week. Infrared imaging showed that most
lesions can be visualised in groups I and II after a period longer than
1 week as hyperreflective areas.
CONCLUSIONThis study
showed that subthreshold (RPE) photocoagulation is effective in some
cases of diabetic maculopathy, drusens, and in CSR. Visibility of laser
burns is not always necessary in the treatment of macular diseases
presented here. Infrared imaging is an effective and non-invasive way
of visualising subthreshold (RPE) laser burns.
© 2000 by British Journal of Ophthalmology
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