title: Evaluation of fixation one year after perifoveal laser treatment of subfoveal choroidal neovascularization.
abstract: The natural prognosis of subfoveal neovascularization is severe visual acuity loss. Perifoveal laser photocoagulation is meant to spare a small portion of the central retina so as to possibly preserve foveal fixation. The aim of this retrospective study was to detect the persistence of central fixation and to evaluate the visual function of patients who had undergone perifoveal laser photocoagulation one year before, due to the presence of age-related macular degeneration with subfoveal neovascularization. The visual function was assessed by means of visual acuity (VA) measurement, central perimetry, scanning laser ophthalmoscope (SLO) scotometry and capability of using low-vision aids with success. Twelve eyes of 12 patients, 5 males and 7 females, with mean age 72.6 +/- 9.62 years, were included in the Study Group. Mean VA was 0.22 +/- 0.089 before laser treatment, 0.17 +/- 0.054 one week after laser treatment (p = 0.0152) and 0.13 +/- 0.063 one year after laser treatment (p = 0.045), with a statistically significant reduction of VA overtime (initial-final p = 0.0015). Mean lesion size was 2.12 +/- 0.528 disc diameters on the last follow-up fluorescein angiogram. One year after laser treatment, perimetry showed the persistence of central fixation in 2 eyes, while 10 eyes seemed to have lost it. SLO scotometry revealed central dot stimulus perception in 6 eyes and no central residual in 6 eyes. The SLO fixation plot showed persistence of central fixation also in 1 eye in which static perimetry had not detected it. The preferential retinal locus was located on the upper or upper-right margin of the lesion in 8 of the 9 eyes with paracentral fixation. All patients achieved a useful reading VA using low-vision aids, with 7.16 +/- 6.1 mean magnification power. The eyes with central visual residual on SLO scotometry had a final VA slightly higher than those without central residuals (VA 0.158 +/- 0.03 and 0.098 +/- 0.07, respectively), though the difference was not statistically significant (p = 0.0977).
authors.affiliation: Department of Ophthalmology and Visual Sciences, S. Raffaele Hospital, University of Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fasce
authors.forename: R
authors.initials: R
authors.lastname: Brancato
authors.forename: P
authors.initials: P
authors.lastname: Bettin
authors.forename: U
authors.initials: U
authors.lastname: Introini
authors.forename: A
authors.initials: A
authors.lastname: Pece
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply*; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000473:pathology / Q000601:surgery*; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology