title: Neodymium:YLF picosecond laser segmentation for retinal traction associated with proliferative diabetic retinopathy.
abstract: OBJECTIVE
  To determine the applicability of laser segmentation for severing fibrovascular tissue and hyaloid interfaces in the treatment of tractional complications of proliferative diabetic retinopathy.
  
  
  METHODS
  A prototype neodymium:yttrium-lithium-fluoride (Nd:YLF) picosecond pulse photodisruptive laser was used in eight eyes (seven patients) with proliferative diabetic retinopathy as part of a Food and Drug Administration-approved phase 1 protocol. There were three indications for treatment: type I: distortion and shallow elevation of the macular caused by taut, adherent, posterior hyaloid interface (two eyes); type II: traction retinal detachment involving the fovea (two eyes); and type III: fovea-threatened, traction retinal detachment (four eyes). Traction release was accomplished by laser segmentation of the detached hyaloid interfaces and fibrotic, contracted proliferative tissue. The Nd:YLF uses low pulse energy (0.10 mJ, 1,000 pulses per second for 10 consecutive seconds) that allows tissue cutting near the retinal surface.
  
  
  RESULTS
  Both type I eyes had relief of traction forces; visual acuity improved from 20/400 to 20/50 in one eye; the other remained stable. Of the two type II eyes, one had anatomic reattachment of the fovea with improvement in visual acuity (hand movements to 20/50); the second required vitrectomy. Of the four type III eyes, all had anatomic improvement; three maintained pretreatment acuity; the fourth eye developed vitreous hemorrhage at 6 months and underwent vitrectomy. Three treatments (two eyes) caused vitreous hemorrhage that resulted in a transient drop in acuity (1 to 2 lines). No patient developed a retinal break or choroidal hemorrhage.
  
  
  CONCLUSIONS
  In a small pilot study, the Nd:YLF laser segmented proliferative tissue near the retinal surface and elevated hyaloid interfaces. In selected cases, this may enable flattening of traction retinal detachment or release of retinal distortion.
authors.affiliation: Retina Associates of New York, NY 10021, USA. raony@interport.net
authors.forename: B Z
authors.initials: BZ
authors.lastname: Cohen
authors.forename: K J
authors.initials: KJ
authors.lastname: Wald
authors.forename: K
authors.initials: K
authors.lastname: Toyama
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000601:surgery; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D012160:Retina / Q000473:pathology / Q000601:surgery; D012163:Retinal Detachment / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015861:Retinal Neovascularization / Q000209:etiology / Q000601:surgery; D014792:Visual Acuity