Demarcation laser photocoagulation of macular sparing retinal detachments in teenagers

Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan.
Retina (Philadelphia, Pa.) (Impact Factor: 3.24). 09/2008; 28(10):1487-92. DOI: 10.1097/IAE.0b013e318183570d
Source: PubMed


To report a series of macular sparing rhegmatogenous retinal detachment (MSRRD) in teenagers treated with demarcation laser photocoagulation.
Retrospective, interventional, and noncomparative case series of 36 eyes in 33 patients with primary MSRRD. Eyes with ocular congenital anomalies or perforation ocular injury were excluded from this study. All eyes received three or more rows of confluent demarcation laser photocoagulation at the margin of retinal detachment. Best corrected preoperative and postoperative visual acuity and progression of retinal detachment during the follow-up were recorded.
Thirty two eyes needed only one session of laser to wall off the retinal detachment. The other four eyes required one additional laser because of progressive retinal detachment. All but one eye had shallow retinal detachment and retinal detachment was successfully demarcated after 1 or 2 episodes of laser treatment at the final visit. Patients were observed up at our clinic from 1 to 6 years. Myopia greater than -3 D was noted in all but one eye. Atrophic holes with or without lattice were the causative breaks in all eyes. All patients maintained best corrected visual acuity equal or better than 20/30.
Demarcation laser could successfully wall off macular sparing retinal detachment in teenagers.

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    ABSTRACT: Demarcation laser photocoagulation (DLP) is a low-morbidity procedure that may stabilize selected macula-sparing rhegmatogenous retinal detachments (MSRRDs) by producing a barrier to prevent extension of subretinal fluid (SRF). This procedure may be an alternative to other surgical approaches in patients who are asymptomatic without visual field loss from MSRRD, in simple localized retinal detachments or in patients who are poor candidates for surgery. One factor that appears to be critical for long-term success of DLP for MSRRD is the correct placement of multiple rows of confluent barricading laser photocoagulation spots. Posterior segment features that are favorable for successful DLP include shallow retinal detachment with localized SRF and well-formed vitreous with lack of vitreous traction or proliferative vitreoretinopathy. Less favorable factors for DLP stabilization of MSRRDs include incomplete or insufficient laser spots, corrugated morphology or dome-shaped appearance, extension of SRF preventing adequate laser barrier posteriorly, vigorous exercise, and blunt ocular trauma. Neither the extent nor the location of the retinal detachment appears to be critical when selecting candidates for DLP.
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    ABSTRACT: to evaluate demarcation laser photocoagulation (DLP) for macula-sparing rhegmatogenous retinal detachments (RRD) with and without symptoms of posterior vitreous separation or progressive visual field defect. retrospective, interventional, single surgeon case series of consecutive patients with RRD treated with demarcation laser photocoagulation between March 1999 and February 2008 at an academic center. The null hypothesis was that there exists no difference in the rate of progression for retinal detachment irrespective of the presence ('symptomatic') or absence ('asymptomatic') of symptoms of posterior vitreous separation or visual field defect at presentation. a total of 27 eyes of 26 patients were included in the study. In all, 22 of the 27 eyes (81.4%) did not require additional treatment and remained attached during mean follow-up of 38.4 months. None of the 14 asymptomatic patients required surgery (0%) whereas 5 out of the 13 patients (38.5%) who were symptomatic at presentation required further intervention (p=0.016): one patient required additional laser only and four patients required scleral buckling or vitrectomy. Pre- and post- DLP logMAR visual acuity was 0.15 and 0.14, respectively. demarcation laser photocoagulation is an effective alternative to scleral buckling or vitrectomy for treating asymptomatic RRDs. It has a high failure rate among eyes with symptomatic RRD.
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