Micropulse laser treatment of retinal-choroidal anastomoses in age-related macular degeneration.
BACKGROUND
Retinal-choroidal anastomoses (RCA) are a common finding in advanced cases of age-related macular degeneration. These high-flow lesions are associated with extensive subretinal exudation. This study examines the role of high-energy, short-duration (micropulse) laser pulses in effectively closing these shunts and reducing subretinal fluid.


METHODS
Nineteen consecutive eyes with advanced age-related macular degeneration undergoing treatment of RCAs to reduce subretinal exudation in a referral-only retina practice were reviewed retrospectively. RCA were identified using high-speed indocyanine green angiography. RCA were closed using a high-energy, short-duration laser pulse technique. Outcome measures included visual acuity, resolution of subretinal fluid and persistence of RCA.


RESULTS
Nineteen eyes with RCA associated with macular degeneration were successfully treated. Mean baseline visual acuity was 20/140 (HM to 20/50). One hundred percent of eyes had subretinal exudation and 73% had subretinal fibrosis at the time initial treatment. At mean follow-up of 11.7 (2-23) months, patients had undergone an average of 3.52 (1-12) sessions of laser treatment. Average final visual acuity was 20/146 (CF to 20/40). Fifty-three percent of eyes had complete resolution of subretinal fluid. One hundred percent had subretinal fibrosis. Forty-three percent had complete closure of RCA. No significant complications were encountered.


CONCLUSIONS
High-energy, short-duration laser appears to be a reproducible technique to obtain closure of RCA associated with advanced macular degeneration. It appears to be effective in reducing subretinal exudation associated with these lesions. The technique is associated with stabilization of visual acuity without significant risk of complication.
Johnson
T Mark
TM
National Retina Institute, Suite 101, 5530 Wisconsin Ave., Chevy Chase, MD 20815, USA. mjohnson@bmgnri.com
Glaser
Bert M
BM
D000368:Aged; D000369:Aged, 80 and over; D001163:Arteriovenous Anastomosis / Q000473:pathology / Q000601:surgery*; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008268:Macular Degeneration / Q000150:complications* / Q000175:diagnosis; D015861:Retinal Neovascularization / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome