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  • Title: Retinal sparing by selective retinal pigment epithelial photocoagulation.
    Author: Roider J, Brinkmann R, Wirbelauer C, Laqua H, Birngruber R.
    Journal: Arch Ophthalmol; 1999 Aug; 117(8):1028-34. PubMed ID: 10448745.
    Abstract:
    OBJECTIVE: To investigate whether photocoagulation of the retinal pigment epithelium is possible with sparing of the photoreceptors. METHODS: Mild laser effects of a neodymium:yttrium-lithium-fluoride (Nd:YLF) laser (527 nm) were applied to 17 patients. To establish the necessary energy, test exposures were performed to the lower macula (laser variables: 1.7 microseconds, 100 and 500 pulses applied in a train at 500 Hz, 20-130 microJ, 160 microm). Of 179 test lesions, 73 were followed up at various time intervals up to 1 year by performing microperimetry directly on top of the laser lesions. RESULTS: All of the test lesions were at the threshold of retinal pigment epithelial disruption, and none of the laser effects were visible by ophthalmoscopy during photocoagulation; they were detectable only by fluorescein angiography. After exposure with 500 pulses, retinal defects were detected in up to 73% of the patients (100 microJ) after the first day. Most of these defects were no longer detectable after 3 months. After exposure with 100 pulses, no defects could be detected with 70 and 100 microJ after 1 day. The absence of microscotomas in the follow-up period suggests that retinal damage was minimal or, if it occurred, was functionally repaired. CONCLUSION: By choosing proper energy and number of pulses, it is possible to produce retinal pigment epithelial effects with no subsequent retinal damage detectable by microperimetry.
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