Treatment of macular disease with a binocular indirect ophthalmoscope laser delivery system.
OBJECTIVE
Some patients with macular disease, because of physical infirmity or disability, cannot be treated with laser photocoagulation using a typical slit lamp delivery system. The purpose of this study was to determine whether the binocular indirect ophthalmoscope could be used to deliver treatment to the macula when photocoagulation would otherwise be very difficult, if not impossible, to perform.


METHODS
Ten eyes of 10 patients who could not sit for slit lamp laser delivery were treated with binocular indirect ophthalmoscope laser photocoagulation over a 36 month period. Eight had subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD), and 2 patients had clinically significant macular edema (CSME) from diabetes mellitus. Argon laser photocoagulation was delivered to the choroidal neovascular membrane in patients with exudative AMD, and a grid treatment was given to eyes with diabetic macular edema.


RESULTS
Six of 8 patients with exudative AMD were successfully treated with eradication of the CNV. Two required retreatment within 6 months of original treatment. Both patients with CSME had resolution of their edema at 3 and 6 months after treatment. Best corrected visual acuity did not change by more than 2 Snellen lines in any patient with CNV and 1 Snellen line in patients with CSME. No complications of treatment were encountered.


CONCLUSIONS
In certain circumstances, laser photocoagulation of the macula using the indirect ophthalmoscope laser delivery system should be considered when more conventional treatment strategies cannot be implemented.
University of Pittsburgh School of Medicine, and the Eye and Ear Institute of Pittsburgh, PA, USA.
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Friberg
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D048909:Diabetes Complications; D005122:Exudates and Transudates; D005260:Female; D005336:Fiber Optic Technology; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008266:Macula Lutea / Q000473:pathology; D008268:Macular Degeneration / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008269:Macular Edema / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D009887:Ophthalmoscopy; D011187:Posture; D015203:Reproducibility of Results; D014792:Visual Acuity