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LONG-TERM SD-OCT/SLO IMAGING OF NEURORETINA AND RETINAL PIGMENT EPITHELIUM AFTER SUBTHRESHOLD INFRARED LASER TREATMENT OF DRUSEN

Mojana, Francesca MD; Brar, Manpreet MD; Cheng, Lingyun MD; Bartsch, Dirk-Uwe G PhD; Freeman, William R MD

doi: 10.1097/IAE.0b013e3181ec80ad
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Purpose: The purpose of this study was to determine the long-term effect of subthreshold diode laser treatment for drusen in patients with nonexudative age-related macular degeneration with spectral domain optical coherence tomography combined with simultaneous scanning laser ophthalmoscope.

Methods: Eight eyes of four consecutive age-related macular degeneration patients with bilateral drusen previously treated with subthreshold diode laser were imaged with spectral domain optical coherence tomography/scanning laser ophthalmoscope. Abnormalities in the outer retinal layers' reflectivity as seen with spectral domain optical coherence tomography/scanning laser ophthalmoscope were retrospectively analyzed and compared with color fundus pictures, and autofluorescence images were acquired immediately before and after the laser treatment.

Results: A focal discrete disruption in the reflectivity of the outer retinal layers was noted in 29% of the laser lesions. The junction in between the inner and outer segment of the photoreceptor was more frequently affected, with associated focal damage of the outer nuclear layer. Defects of the retinal pigment epithelium were occasionally detected. These changes did not correspond to threshold burns on color fundus photography but corresponded to focal areas of increased autofluorescence in the majority of the cases.

Conclusion: Subthreshold diode laser treatment causes long-term disruption of the retinal photoreceptor layer as analyzed by spectral domain optical coherence tomography/scanning laser ophthalmoscope. The concept that subthreshold laser treatment can achieve a selected retinal pigment epithelium effect without damage to rods and cones may be flawed.

Subthreshold diode laser treatment causes long-term disruption of the retinal photoreceptor layer as analyzed by spectral domain optical coherence tomography/scanning laser ophthalmoscope. The concept that subthreshold laser treatment can achieve a selected retinal pigment epithelium effect without damage to rods and cones may be flawed.

From the Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, California.

Research to Prevent Blindness (RPB, Inc), New York, NY; Dr. W.R.F. is the recipient of an RPB Physician Scientist award and support to Department. National Eye Institute NIH-NEI grant EY16323 (D.-U.G.B.) NIH grant EY07366 (W.R.F.); Dr D.-U.G.B. has received discounted products and specialized software from OPKO Instrumentation/OTI, Inc; Dr. W.R.F. has been consultant for OPKO. The other authors declare that they have no financial interest.

Reprint requests: William R. Freeman, MD, UCSD Department of Ophthalmology, Shiley Eye Center, 0946, Joan and Irwin Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037; e-mail: freeman@eyecenter.ucsd.edu

© The Ophthalmic Communications Society, Inc.