Fluorescein angiographic abnormalities after prophylactic macular photocoagulation for high-risk age-related maculopathy.
OBJECTIVE
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.
Owens
S L
SL
Department of Clinical Ophthalmology, Institute of Ophthalmology, University of London, Moorfields Eye Hospital, United Kingdom.
Guymer
R H
RH
Gross-Jendroska
M
M
Bird
A C
AC
D000368:Aged; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects*; D008268:Macular Degeneration / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015593:Retinal Drusen / Q000601:surgery; D012307:Risk Factors; D014792:Visual Acuity