Photocoagulation with free-running mode Nd: YAG laser on neovascular maculopathy

Seventeen eyes in 14 cases of early neovascular maculopathy were treated with free-running mode Nd: YAG laser and followed up for 7 to 56 months by examination of visual acuity, fluorescein angiography and static perimetry. Obliteration of subretinal neovascularization could be achieved with both mild and moderate photocoagulation. Retinal sensitivity after moderate photocoagulation decreased moderately. Damaged retinal sensitivity after mild photocoagulation recovered one month later. Two out of 11 eyes in which only the neovascular membrane was treated showed recurrent neovascularization adjacent to the treated lesion 6 months and 9 months after photocoagulation. One out of 6 eyes received mild photocoagulation on the neovascular membrane and the surrounding area showed recurrent neovascularization adjacent to the treated lesion 6 months after photocoagulation. Retinal hemorrhage occurred in one out of 14 eyes that received mild photocoagulation and in one out of three moderately photocoagulated eyes. The recurrent neovascularization occurred in two eyes with retinal hemorrhage and in one mild burned eye without retinal hemorrhage. Recurrent neovascularization may correlate with retinal hemorrhage.     

倍频Nd∶YAG激光治疗视网膜静脉阻塞的临床疗效分析

目的:探讨倍频532nmNd∶YAG激光治疗视网膜静脉阻塞的方法及疗效。方法:回顾性分析我院近年应用倍频Nd∶YAG激光仪治疗视网膜静脉阻塞病例42例,根据其分型及眼底血管荧光造影改变,采用不同的光凝方法进行治疗,并分析其疗效。结果:42例视网膜静脉阻塞病例视力提高者(2行以上)4眼(10%);视力无明显变化者30眼(71%);视力下降者(2行以上)8眼(19%);眼底荧光血管造影(fundusfluoresceinangiography,FFA)检查显示视网膜出血吸收、黄斑水肿消退,治疗有效者38眼(90%)。结论:尽管对非缺血型和缺血型视网膜静脉阻塞的治疗目的和方法有所不同,倍频Nd∶YAG激光能有效地缩短病程,促进视网膜出血吸收和视力恢复,预防和减少并发症的发生。     

倍频固体激光治疗视网膜静脉阻塞疗效分析

目的探讨倍频固体激光治疗视网膜静脉阻塞的方法和疗效。方法应用倍频固体激光治疗视网膜静脉阻塞46例47眼,对其中10眼行全网膜光凝术,37眼行局域性视网膜光凝术,治疗次数1-4次,光凝后3m-6m随访,4眼复查后行补充光凝。对比分析治疗前后视力及眼底荧光血管造影(FFA)情况。结果激光治疗后视力提高(2行以上)者5眼(10.6%);视力无明显变化者29眼(61.7%);视力下降者13眼(27.7%)。荧光血管造影显示治疗有效42眼(89.4%),治疗无效5眼(10.6%)。结论激光治疗虽不能明确提高视力,但能促进水肿、出血、渗出的吸收,阻止病变的进一步发展,防止增殖性玻璃体视网膜病变和新生血管性青光眼的发生。     

Assessment of foveal function in eyes of patients with exudative age-related macular degeneration before and after argon laser treatment

PURPOSE: 1. Can foveal cone electroretinogram (FCERG) be a useful diagnostic test in evaluation of efficacy of argon laser treatment in eyes with exudative (wet) age-related macular degeneration (AMD)? 2. Comparison of FCERG with visual acuity, static perimetry and fluorescein angiography results. MATERIAL AND METHODS: FCERGs were recorded from 30 eyes with mean visual acuity 0.6 (Snellen Table) of 20 patients (mean age: 61 years) with wet AMD. The fovea was stimulated with 5-degree flickering light spot (f = 31.25 Hz), surrounded by a 20-degree annulus of intensive steady retinali illuminance. FCERGs were recorded and analysed in amplitude according to the computer-aided method recently put in practice in our laboratory. FCERGs were obtained twice for each AMD patients: before and 3 months after argon laser treatment. Electrophysiological data were also compared with the results of fluorescein angiography, visual acuity and static perimetry. RESULTS: In the group of patients with wet AMD, significant increase of FCERG amplitude (p < 0.001) after laser treatment was obtained in group I (33% of analysed eyes) and there were mainly patients with extrafoveal choroidal neovascularisation (CNV). Significant decrease of FCERG amplitude (p < 0.01) was obtained in group II (67% of analysed eyes). These were mainly patients with subfoveal CNV and also with extrafoveal CNV. In both groups after laser treatment we did not receive significant changes in visual acuity and macular perimetric mean sensitivity. CONCLUSIONS: These findings suggest that foveal cone ERG can be a useful, independent from fluorescein angiography, test for objective evaluation of efficacy of argon laser treatment in patients with wet AMD, opposite to visual acuity and static perimetry (macula threshold) examinations. FCERG probably indicates patients with better or worse prognosis.     

Quantification of macular ischaemia in sickle cell retinopathy.

Macular ischaemia has a central role in the pathophysiology and prognosis of retinal macular disease. We attempted to quantitate two of its major components as follows: vascular nonperfusion, by measuring the foveal avascular zone (FAZ), using fluorescein angiography; and functional damage, using automated perimetry of the central 30 degrees. Sickle cell disease was chosen for study because it was considered a prototype for a purely ischaemic retinopathy without an exudative component. We found that the FAZ measurement was reproducible and that the patients with maculopathy had statistically larger FAZs than the normal controls (p = 0.016, Wilcoxon rank sum test). In addition, scotomas measured by visual field perimetry were significantly larger in the sickle cell patients with maculopathy than in those without maculopathy. Our results showed that angiography and perimetry of the central 30 degrees were more sensitive tests for the detection of ischaemic macular disease than visual acuity and that macular ischaemia could be quantified by their use.     

Association between intensity of posterior capsule opacification and visual acuity

PURPOSE: To investigate the correlation between the change in visual acuity and the difference in objective posterior capsule opacification (PCO) scores before and after neodymium:YAG (Nd:YAG) laser capsulotomy. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Forty pseudophakic eyes of 35 patients with PCO of varying intensity were examined before and after Nd:YAG laser capsulotomy. Visual acuity was determined using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 4 m and the Holladay reading chart at 40 cm. The pupil diameter under reading conditions was measured each time. Digital retroillumination images of the posterior capsule were taken, and the corresponding area inside the pupil was evaluated using the Automated Quantification of After-Cataract (AQUA) automated PCO analysis program. The change in visual acuity and difference between PCO scores before and after Nd:YAG laser capsulotomy were calculated for all eyes. RESULTS: The mean AQUA score (scale 0 to 10) was 3.56 before and 0.13 after Nd:YAG laser capsulotomy. The mean ETDRS visual acuity score (logMAR scale) was 0.28 and -0.07, respectively. The correlation coefficient between the differences in PCO score and distance visual acuity was 0.61 and near visual acuity, 0.62. CONCLUSIONS: The objective PCO score obtained by an automated image-analysis program correlates well with the PCO-induced decrease in visual acuity when the central area (inside the pupillary aperture) of the posterior lens capsule was evaluated. Objective PCO assessment by automated image-analysis systems is, therefore, a valuable and clinically relevant method for clinical studies of the development and prevention of PCO.     

Presumed sertraline maculopathy.

PURPOSE: To report a unique case of a woman who developed simultaneous bilateral maculopathy presumed to result from intake of sertraline hydrochloride, a serotonin reuptake inhibitor. METHODS: Full clinical ocular examination, color vision testing, automated static perimetry, electroretinography, electrooculography and fundus fluorescein angiography were performed. Living members of her family were also examined. RESULTS: The patient had normal electroretinography and electrooculography results. Automated static perimetry showed generalized reduction of sensitivity and central scotomas. Macular lesions resolved 6 months after discontinuation of sertraline, however, during twenty months of follow-up her visual acuity and abnormalities in other psychophysical tests did not improve. CONCLUSION: Patients started on sertraline should be informed of the potential risk of developing maculopathy, and they should be examined regularly to detect possible early alterations.     

Static and kinetic perimetry results of krypton red laser treatment for macular edema complicating branch vein occlusion

Twenty patients with clinical and angiographic evidence of recent branch vein occlusion complicated by macular edema were assigned to receive krypton red laser treatment if their macular edema lasted more than three months. Visual acuity, static and kinetic perimetry, fundus photography, and fluorescein angiography were evaluated before treatment and at two-month intervals thereafter. Visual acuity improved by two lines one year after treatment in 65% of patients. Each of these patients had a complete perifoveal capillary arcade. Static perimetry results correlated well with visual acuity, and a significant threshold improvement was detected in these patients. Visual-acuity results and static and kinetic perimetry findings are presented. The rationale for selection of the krypton red wavelength (647 nm) is discussed.     

倍頻Nd:YAG激光治療糖尿病視網膜病變

目的探討倍頻NdYAG激光治療糖尿病視網膜病變(DR)的時機、療效及其影響因素.方法根據DR的不同時期及不同程度的眼底損害,制定不同的治療方案,對91例144眼DR采用倍頻NdYAG激光進行光凝治療.結果視力進步25%、穩定57.64%.總有效率82.64%,其中NPDR總效率爲100%,PPDR爲91.3%,PDR爲66.15%.結論 DR患者應提倡早期發現、早期光凝,只要把握好光凝時機和方法,倍頻NdYAG激光治療DR療效顯著,且保存視力比恢復已喪失視力更有效.     

Nd:YAG激光治疗囊袋收缩综合征的临床效果分析

目的观察Nd:YAG激光治疗囊袋收缩综合征的疗效。方法 15例(15只眼)经专科检查确定为囊袋收缩综合征的患者接受Nd:YAG激光囊袋切开治疗,对比观察治疗前后的视力、人工晶状体位置的变化。结果 86.7%的患者治疗取得了成功,变现为视力的提高、人工晶状体位置的改善,囊袋收缩过程结束。结论 Nd:YAG激光囊袋切开是治疗囊袋收缩综合征的有效方法。     

Refraction,intraocular pressure and anterior chamber depth changes after Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes

Purpose: The aim was to investigate the effect of Nd:YAG capsulotomy on refraction, intraocular pressure and anterior chamber depth changes and complications of Nd:YAG laser treatment for posterior capsular opacification in pseudophakic eyes. Methods: Our study includes 26 eyes (23 patients) with posterior capsular opacification after uncomplicated phacoemulsification surgery and intraocular lens implantation. Complete ocular examinations were performed for all patients. The visual acuity, intraocular pressure and anterior chamber depth measurements were obtained in all examinations. Nd:YAG capsulotomy was measured in all patients. Eyes received one drop of aproclonidine 0.5 % before and immediately after YAG laser capsulotomy. Data were analysed statistically. Results: Mean patient age was 53.73 ± 13.53 years. Before Nd:YAG capsulotomy mean anterior chamber depth was 4.03 ± 0.58 mm and in the first day after capsulotomy the mean value was 4.02 ± 0.46 mm. Mean spherical equivalent refraction before laser treatment was ‐0.52 D and on the first day after laser treatment was ‐0.49 D. An improvement in visual acuity was achieved in all cases. Before Nd:YAG capsulotomy mean visual acuity was 0.38 ± 0.13 and on the first day after capsulotomy, the mean value was 0.93 ± 0.11, the difference of which was statistically significant. There were no statistically significant differences between the anterior chamber depth and intraocular pressure measurements before laser capsulotomy and on the first day, first month and third month after laser. Conclusion: Nd:YAG laser capsulotomy is an effective and safe method of treatment of posterior capsular opacification.     

Fluorescein angiographic abnormalities after prophylactic macular photocoagulation for high-risk age-related maculopathy

PURPOSE: Initial studies suggest that drusen associated with age-related maculopathy resolve in response to laser photocoagulation; there are conflicting reports regarding whether this treatment might prevent neovascular complications and blindness. The goal of the Drusen Laser Study is to maintain good visual acuity in eyes at the highest risk for neovascular complications of age-related maculopathy. In this report, we alert the ophthalmic community to possible laser-induced complications in patients treated within the context of this clinical trial. METHODS: A double-masked, randomized, controlled clinical trial of prophylactic macular photocoagulation for high-risk age-related maculopathy is in progress. Patients randomly assigned to treatment received a ring-type distribution of 12 light spots of argon laser photocoagulation. Drusen were treated directly only if they were present at the protocol treatment locations. Fluorescein angiography was performed in all patients at yearly review, and at nonprotocol visits if symptoms or clinical examination were suggestive of choroidal neovascularization. RESULTS: Fluorescein angiographic abnormalities suggestive of choroidal neovascularization have been seen in treated eyes only: one patient in the pilot study and six patients in the Drusen Laser Study. No fluorescein angiographic abnormalities were seen in eyes of control subjects. CONCLUSIONS: Laser photocoagulation in high-risk age-related maculopathy may induce choroidal neovascularization and, therefore, is not recommended outside the context of a randomized, controlled clinical trial.     

后囊膜混浊的Nd:YAG激光治疗

目的：探讨Nd:YAG激光后囊膜切开的方法，疗效及并发症。方法：回顾性分析了108例112只眼用Nd:YAG激光切开混浊后囊膜的病例，并记录了视力，眼压的变化和并发症的发生情况，结果；所有病例都成功切开后囊膜，视力提高，裸眼平均视力由术前0.2增加到术后0.5，平均矫正视力达到0.7,30.3%的眼内人工晶状体出现激光损伤斑，无人工晶状体移位；眼压出现一过性升高；随访中发现2例视网膜脱离，结论：Nd:YAG激光后囊膜切开操作容易，安全，疗效好，并发症少。     

Application of automated perimetry in diagnosis of macular diseases

PURPOSE: Evaluation of automated perimetry application in diagnosis of macular diseases. MATERIAL AND METHODS: Examinations were performed in 27 patients with central chorioretinopathy (CSCR), 29 patients with diabetic maculopathy, 12 patients with drusen, 13 patients with macular hole, 55 patients with age-related macular degeneration (AMD) and 23 healthy volunteers. Central visual fields were tested with automated threshold-measuring perimetry using the LED-PERS perimeter. Localisation, depth and spread of defect in central visual field were estimated. All threshold values, mean sensitivity, fixation, fluctuation and visual acuity were calculated. Statistical comparison of examined parameters and multidimensional analysis of variance (MANOVA) was performed using software. RESULTS: Significant differences were found when comparing all threshold values, mean sensitivity, fixation and fluctuation between the control and the other groups, and between patients with CSCR, with drusen and with AMD. Good results of MANOVA were obtained in 3 distinguishable classes between patients with CSCR, diabetic maculopathy and AMD. Positive correlation between threshold values of fields and visual acuity was noticed. CONCLUSIONS: Automated perimetry has been confirmed to be very useful in differential diagnosis of patients with macular diseases.     

掺钕钇铝石榴石激光击栓术治疗视网膜分支动脉阻塞的初步报告

目的探讨掺钕钇铝石榴石（Nd：YAG）激光击栓术治疗视网膜分支动脉阻塞的临床效果。方法选择视网膜分支动脉阻塞的患者进行Nd：YAG激光治疗。治疗前检查视力和眼底,确定动脉栓子的部位并行眼底照相。治疗后立即进行眼底照相,并与治疗前图像对比分析,之后定期复查。随访时间为2周至4个月,平均1．6个月。结果共治疗7例患者,其中男性5例,女性2例;年龄为49～73岁,平均61岁;病程为1d至2个月,平均13d。治疗前视力为0．06至0．8;眼底可见典型的分支动脉阻塞表现。所有患者治疗后动脉管径均立即增粗,荧光素眼底血管造影检查显示血流完全恢复,患者自觉视力改善,检查视力为0．2～1．0。多数患者视野检查显示在相应的动脉分布范围内仍有视野缺损区。在治疗过程中,偶见局部小出血,仅2例患者术中因击破邻近静脉引起玻璃体积血,观察2周后,逐渐吸收。未见其他并发症。结论Nd：YAG激光击栓术是治疗视网膜分支动脉阻塞的有效方法,见效快且相对安全。     

钕-钇铝石榴石激光治疗囊袋阻滞综合征疗效观察

目的 探讨钕-钇铝石榴石激光治疗囊袋阻滞综合征(CBS)的方法,并评价其疗效和安全性.方法 对2006年2月至2008年7月在眼科就诊的囊袋阻滞综合征患者18例(20只眼),术后早期9只眼,术后晚期11只眼,应用LIGHTMED公司生产的Nd-YAG激光机进行治疗.观察囊袋去除情况、治疗后的视力、眼压和眼部情况.结果 20只眼(100%)一次治疗成功,无IOL损伤.19只眼(95%)治疗后视力显著提高,2只眼(10%)治疗后出现一过性眼压升高(＞21mmHg).结论 对于CBS患者应用Nd-YAG激光治疗,效果显著、操作简单、术后视力恢复快,并发症少.     

青光眼小梁切除术后激光断线控制眼压的观察

目的 观察Nd∶YAG激光切断巩膜瓣缝线控制青光眼小梁切除术后眼压的效果.方法 利用Nd∶YAG激光电离爆破效应切断巩膜瓣缝线,控制青光眼小梁切除术后眼压.结果 Nd∶YAG激光切断巩膜瓣缝线后,滤过增强,眼压明显下降,视力提高,无手术并发症出现.结论 采用Nd∶YAG激光切断巩膜瓣缝线以增加滤过,控制青光眼小梁切除术后的眼压,可以取得良好的效果.     

Neodymium:YAG laser zonulysis for treatment of lens subluxation

Nine eyes with lens subluxation in seven patients (6 patients with Marfan's syndrome, 1 with idiopathic lens subluxation) were treated by neodymium:YAG (Nd:YAG) laser zonulysis. The procedure uses an Nd:YAG laser to lyse the zonules to obtain a clear aphakic visual axis. Pretreatment best-corrected visual acuity was 20/60 or worse in eight eyes (6 eyes less than or equal to 20/200). Movement of the crystalline lens was achieved after zonulysis in all cases (100%), and a clear aphakic visual axis, sufficient to maintain aphakic correction without diplopia or glare, was obtained in eight eyes (88.9%). The procedure was combined with optical iridotomy in three cases (33.3%). Five cases (55.6%) required more than one zonulysis treatment. Visual acuity improved two or more Snellen lines in all but one eye (7 eyes greater than or equal to 20/60). Four cases had complications which included: increased intraocular pressure (IOP), mild iritis, recurrent migration of the lens into the visual axis, and crystalline lens damage. The final two complications necessitated eventual surgical removal of the lens. These results suggest that Nd:YAG laser zonulysis may be of benefit as an alternative treatment modality for selected patients with lens subluxation.     

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AIMS: Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy. METHODS: Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months. RESULTS: All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage. CONCLUSION: Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.     

Transudative myopic maculopathy: pathogenetic validity and comparative effectiveness of laser interventions

The paper presents a retrospective (5-10 years) analysis of results of treatment in a group of patients (104 eyes) with "moist" myopic maculopathy and initial visual acuity from 0.04 to 0.3. Subretinal neovascular membranes were found in 59% of eyes. Localization of the membranes was subfoveolar in 48% of cases, parafoveolar--in 39%, extrafoveolar--in 13%, the size of them being to 300 micrometers in 28%, from 300 to 800--in 58%, more than 800--in 14% of cases. Comparative assessment of effectiveness of various kinds of laser coagulation, laser stimulation and conservative treatment has shown laser coagulation to be the most effective and pathogenetically substantiated method of treatment of neovascular membranes. The most resultant is laser coagulation by the type of "panmacular" in combination with radical laser coagulation of neovascular membranes (if they are present). The most radical is laser coagulation with preservation of a new point of gaze fixation, ensuring preservation of a rather high visual acuity, 0.3. Laser coagulation has a transient effect only in cases of myopic maculopathy without neovascular membranes. Conservative treatment is ineffective. Mechanisms of therapeutic action of laser coagulation and laser stimulation are discussed.