Indirect scatter laser photocoagulation to subfoveal choroidal neovascularization in age-related macular degeneration.
BACKGROUND
Occult choroidal neovascularization (CNV), poorly defined on fluorescein angiography, is present in the majority of patients with exudative complications of age-related macular degeneration. For patients who present with this type of subfoveal CNV but who have useful visual acuity, no form of treatment is of proven benefit. Accordingly, a pilot randomized trial of indirect laser treatment was performed. The rationale of this treatment was to inhibit the CNV through laser-induced effects on the retinal pigment epithelium.


METHODS
Patients with occult subfoveal CNV without retinal pigment epithelial detachment and with visual acuity of 20/200 or better were randomized to treatment or control groups. A grid of laser burns was applied to the macula beyond the area of serous retinal detachment and of angiographically defined occult CNV.


RESULTS
After an average follow-up of 38 months, there was no difference in mean final visual acuity (0.12 treated, 0.14 control) or clinical outcome between treated and untreated groups. Fluorescein angiography showed gradual enlargement in the occult CNV in 58% of eyes in both groups. A decrease in visual acuity to worse than 20/200 (54% of treated, 50% of control eyes) was associated with ingrowth of well-delineated CNV (6 treated, 7 control eyes) or progression to a fibroglial or atrophic scar (11 treated, 8 control eyes).


CONCLUSIONS
No benefit was demonstrated for scatter photocoagulation of the macula in patients with age-related macular degeneration and occult subfoveal CNV with initially good visual acuity. There were, however, no complications related to treatment.
Arnold
J
J
Clinique Ophthalmologique Universitaire de Créteil, France.
Algan
M
M
Soubrane
G
G
Coscas
G
G
Barreau
E
E
D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply* / Q000473:pathology; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000601:surgery*; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008268:Macular Degeneration / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010857:Pigment Epithelium of Eye / Q000473:pathology; D010865:Pilot Projects; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity