title: Laser clearance of drusen deposit in patients with autosomal dominant drusen (p.Arg345Trp in EFEMP1).
abstract: OBJECTIVE
  To assess whether laser treatment to the retinal pigment epithelium anterior to drusen in eyes of patients with EFEMP1-related maculopathy affects visual acuity, deposit volume, and retinal sensitivity.
  
  
  METHODS
  Prospective, interventional case series.
  
  
  METHODS
  In 11 patients with autosomal dominant drusen and confirmed disease-causing EFEMP1 mutation, the worse-seeing eye was treated with Argon green laser (10 to 15 laser spots; 200-μm spot size, 0.1-second duration, 80 to 120 mW). Patients were examined before treatment as well as 1, 3, 6, and 12 months after the procedure. Clinical assessment included visual acuity, fundus-controlled perimetry, spectral-domain optical coherence tomography, and autofluorescence imaging. Custom-made software allowed for coregistration of fundus-controlled perimetry and spectral-domain optical coherence tomography data sets. The main outcome measures were change in visual acuity, retinal sensitivity, and drusen volume.
  
  
  RESULTS
  The untreated eyes lost an average of 0.8 letters, whereas the treated eyes gained an average of 4.9 letters. For fundus-controlled perimetry, locus-by-locus differences in sensitivity were calculated between pretreatment and posttreatment assessments; subsequently, the overall difference in the treated and untreated eye was compared. Five patients showed significant improvement in retinal sensitivity, 5 patients showed no change, and 1 patient showed significant deterioration. An increase in mean drusen thickness was observed in the untreated eyes, but not in the treated eyes (P = .0322). The thickness of the drusen correlated with retinal sensitivity (ρ = -0.49; P < .0001). Safety was demonstrated and no adverse events were observed.
  
  
  CONCLUSIONS
  Low-energy laser treatment is safe and may be effective in the treatment of autosomal dominant drusen. Further evaluation with long-term assessment is required to confirm the benefits.
authors.affiliation: Institute of Ophthalmology, University College London, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; Eye Hospital, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Eva
authors.initials: E
authors.lastname: Lenassi
authors.forename: Eric
authors.initials: E
authors.lastname: Troeger
authors.forename: Robert
authors.initials: R
authors.lastname: Wilke
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
authors.forename: Marko
authors.initials: M
authors.lastname: Hawlina
authors.forename: Glen
authors.initials: G
authors.lastname: Jeffery
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Webster
mesh_terms: D000328:Adult; D000368:Aged; D016570:Bruch Membrane / Q000473:pathology / Q000601:surgery; D003317:Corneal Dystrophies, Hereditary / Q000235:genetics* / Q000503:physiopathology / Q000601:surgery*; D016326:Extracellular Matrix Proteins / Q000235:genetics*; D015785:Eye Diseases, Hereditary / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation; D054020:Lasers, Gas / Q000627:therapeutic use*; D008875:Middle Aged; D020125:Mutation, Missense; D015594:Optic Disk Drusen / Q000151:congenital; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology; D015593:Retinal Drusen / Q000601:surgery*; D055213:Retinal Pigment Epithelium / Q000601:surgery; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests
chemical_list: C119630:EFEMP1 protein, human; D016326:Extracellular Matrix Proteins