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Perifoveal Laser Treatment for Subfoveal Choroidal New Vessels in Age-Related Macular Degeneration: Results of a Randomized Clinical Trial

Perifoveal Laser Treatment for Subfoveal Choroidal New Vessels in Age-Related Macular... Abstract • In a controlled clinical trial, 160 eyes underwent "perifoveal" laser photocoagulation. All patients had age-related macular degeneration and subfoveal neovascularization (0.5 to 2.5 disc diameters), without detectable fibrous tissue, and visual acuity from 20/100 to 20/1000. At least 1 year of follow-up has been completed in 127 eyes. Visual acuity was maintained or improved in 12 (20.3%) of 59 untreated eyes vs 28 (41.1%) of 68 treated eyes (P=.04). Reading visual acuity (J4) with the use of low-vision aids was retained in 28 untreated eyes (47.4%) vs 50 treated eyes (73.5%) (P<.01). Automated static perimetry showed an increased scotomatous area and/or depth with eccentric fixation in all but four patients. A flat atrophic scar was achieved in 53 of 68 treated eyes. Statistical analysis indicated that perifoveal photocoagulation has been effective in the short-term preservation of visual acuity. References 1. Ferris FL, Fine SL, Hyman L. Age-related macular degeneration and blindness due to neovascular maculopathy . Arch Ophthalmol . 1984;102:1640-1642.Crossref 2. Coscas G, Soubrane G. Photocoagulation des néovaisseaux sous-rétiniens dans la dégénérescence maculaire sénile par laser à argon: résultats de l'étude randomisée de 60 cas . Bull Mem Soc Fr Ophtalmol . 1983;94:149-154. 3. Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1982;100:912-918.Crossref 4. Moorfields Macular Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Br J Ophthalmol . 1982;66:745-753.Crossref 5. Macular Photocoagulation Study Group. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1990;108:816-824.Crossref 6. Bressler SB, Bressler NM, Fine SL, et al. Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration . Am J Ophthalmol . 1982;93:157-163. 7. Guyer DR, Fine SL, Maguire MG, Hawkins BS, Owens SL, Murphy RP. Subfoveal choroidal neovascular membranes in age-related macular degeneration: visual prognosis in eyes with relatively good initial visual acuity . Arch Ophthalmol . 1986;104:702-705.Crossref 8. Macular Photocoagulation Study Group. Laser treatment trial for subfoveal neovascular membranes in the Macular Photocoagulation Study . Ophthalmology . 1988;9( (suppl) ):188. 9. Coscas G, Soubrane G, Ramahefasolo C. Perifoveal laser treatment for subretinal new vessels in age-related macular degeneration . Doc Ophthalmol Proc Ser . 1987;50:241-245. 10. Soubrane G, Coscas G, Français C, Koenig F. Occult subretinal new vessels in age-related macular degeneration: natural history and early laser treatment . Ophthalmology . 1990;97:649-657.Crossref 11. Laplanche A, Com-Nougue C, Flamant R. Méthodes Statistiques Appliquées á Recherche Clinique . Paris, France: Flammarion; 1987. 12. Singerman LJ, Wong B, Ai E, Smith S. Spontaneous visual improvement in the first affected eye of patients with bilateral disciform scars . Retina . 1985;5:135-143.Crossref 13. Jalkh AE, Avila MP, Trempe CL, Mc Neil JW, Schepens CL. Choroidal neovascularization in fellow eyes of patients with advanced senile macular degeneration . Arch Ophthalmol . 1983;101:1194-1197.Crossref 14. Melrose MA, Magargal LE, Donoso LA, Goldberg RE, Edmonds SE. Vision parameters in krypton and laser photocoagulation of subfoveal neovascular membranes . Ophthalmic Surg . 1985;16:495-502. 15. Yassur Y, Axer-Siegel R, Cohen S. Treatment of neovascular senile maculopathy at the foveal capillary free zone with red krypton laser . Retina . 1982;2:29-46.Crossref 16. Boldrey EE. Foveal ablation for subfoveal choroidal neovascularization . Ophthalmology . 1989;96:1430-1436.Crossref 17. Decker WL, Grabowski WM, Annesley WH. Krypton red laser photocoagulation of subretinal neovascular membranes located within the foveal avascular zone . Ophthalmology . 1984;91:1582-1586.Crossref 18. Timberlake GT, Mainster MA, Peli E, Reed AA, Essock EA, Arend LE. Reading with a macular scotoma . Invest Ophthalmol Vis Sci . 1986;27:1137-1147. 19. Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma . Invest Ophthalmol Vis Sci . 1988;29:268-278. 20. Ebert EM, Fine AM, Markowitz J, Maguire MG, Starr JS, Fine SL. Functional vision in patients with neovascular maculopathy and poor visual acuity . Arch Ophthalmol . 1986;104:1009-1012.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Perifoveal Laser Treatment for Subfoveal Choroidal New Vessels in Age-Related Macular Degeneration: Results of a Randomized Clinical Trial

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1991.01080090082028
Publisher site
See Article on Publisher Site

Abstract

Abstract • In a controlled clinical trial, 160 eyes underwent "perifoveal" laser photocoagulation. All patients had age-related macular degeneration and subfoveal neovascularization (0.5 to 2.5 disc diameters), without detectable fibrous tissue, and visual acuity from 20/100 to 20/1000. At least 1 year of follow-up has been completed in 127 eyes. Visual acuity was maintained or improved in 12 (20.3%) of 59 untreated eyes vs 28 (41.1%) of 68 treated eyes (P=.04). Reading visual acuity (J4) with the use of low-vision aids was retained in 28 untreated eyes (47.4%) vs 50 treated eyes (73.5%) (P<.01). Automated static perimetry showed an increased scotomatous area and/or depth with eccentric fixation in all but four patients. A flat atrophic scar was achieved in 53 of 68 treated eyes. Statistical analysis indicated that perifoveal photocoagulation has been effective in the short-term preservation of visual acuity. References 1. Ferris FL, Fine SL, Hyman L. Age-related macular degeneration and blindness due to neovascular maculopathy . Arch Ophthalmol . 1984;102:1640-1642.Crossref 2. Coscas G, Soubrane G. Photocoagulation des néovaisseaux sous-rétiniens dans la dégénérescence maculaire sénile par laser à argon: résultats de l'étude randomisée de 60 cas . Bull Mem Soc Fr Ophtalmol . 1983;94:149-154. 3. Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1982;100:912-918.Crossref 4. Moorfields Macular Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Br J Ophthalmol . 1982;66:745-753.Crossref 5. Macular Photocoagulation Study Group. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1990;108:816-824.Crossref 6. Bressler SB, Bressler NM, Fine SL, et al. Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration . Am J Ophthalmol . 1982;93:157-163. 7. Guyer DR, Fine SL, Maguire MG, Hawkins BS, Owens SL, Murphy RP. Subfoveal choroidal neovascular membranes in age-related macular degeneration: visual prognosis in eyes with relatively good initial visual acuity . Arch Ophthalmol . 1986;104:702-705.Crossref 8. Macular Photocoagulation Study Group. Laser treatment trial for subfoveal neovascular membranes in the Macular Photocoagulation Study . Ophthalmology . 1988;9( (suppl) ):188. 9. Coscas G, Soubrane G, Ramahefasolo C. Perifoveal laser treatment for subretinal new vessels in age-related macular degeneration . Doc Ophthalmol Proc Ser . 1987;50:241-245. 10. Soubrane G, Coscas G, Français C, Koenig F. Occult subretinal new vessels in age-related macular degeneration: natural history and early laser treatment . Ophthalmology . 1990;97:649-657.Crossref 11. Laplanche A, Com-Nougue C, Flamant R. Méthodes Statistiques Appliquées á Recherche Clinique . Paris, France: Flammarion; 1987. 12. Singerman LJ, Wong B, Ai E, Smith S. Spontaneous visual improvement in the first affected eye of patients with bilateral disciform scars . Retina . 1985;5:135-143.Crossref 13. Jalkh AE, Avila MP, Trempe CL, Mc Neil JW, Schepens CL. Choroidal neovascularization in fellow eyes of patients with advanced senile macular degeneration . Arch Ophthalmol . 1983;101:1194-1197.Crossref 14. Melrose MA, Magargal LE, Donoso LA, Goldberg RE, Edmonds SE. Vision parameters in krypton and laser photocoagulation of subfoveal neovascular membranes . Ophthalmic Surg . 1985;16:495-502. 15. Yassur Y, Axer-Siegel R, Cohen S. Treatment of neovascular senile maculopathy at the foveal capillary free zone with red krypton laser . Retina . 1982;2:29-46.Crossref 16. Boldrey EE. Foveal ablation for subfoveal choroidal neovascularization . Ophthalmology . 1989;96:1430-1436.Crossref 17. Decker WL, Grabowski WM, Annesley WH. Krypton red laser photocoagulation of subretinal neovascular membranes located within the foveal avascular zone . Ophthalmology . 1984;91:1582-1586.Crossref 18. Timberlake GT, Mainster MA, Peli E, Reed AA, Essock EA, Arend LE. Reading with a macular scotoma . Invest Ophthalmol Vis Sci . 1986;27:1137-1147. 19. Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma . Invest Ophthalmol Vis Sci . 1988;29:268-278. 20. Ebert EM, Fine AM, Markowitz J, Maguire MG, Starr JS, Fine SL. Functional vision in patients with neovascular maculopathy and poor visual acuity . Arch Ophthalmol . 1986;104:1009-1012.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Sep 1, 1991

References

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