Subthreshold Laser Treatment for Retinal Arterial Macroaneurysm
Résumé
Purpose: To assess the effects of subthreshold laser treatment(STLT) for retinal arterial macroaneurysms(RAM) associated with foveal exudative manifestations and visual acuity deterioration. Methods: Patients with RAM associated with foveal exudative manifestations and best corrected visual acuity (BCVA) worse than 20/80 Snellen equivalent underwent a ophthalmologic examination, including ETDRS visual acuity, optical coherence tomography (OCT), and fluorescein angiography. The patients were prospectively observed for 4 months period, and in absence of spontaneous improvement, they underwent STLT using an infrared diode laser. Primary outcome measures were reduction of mean central point thickness(CPT) and BCVA changes at the 12-month examination. Secondary outcomes included changes in mean total macular volume(TMV) and central subfield thickness(CST). Results: Nine patients were enrolled and prospectively followed up. Mean baseline values of BCVA, CPT, TMV, and CST were 0.8±0.1 (logMAR±SD), 340±49µm, 7.14±0.05mm3, and 366±37ìm, respectively. At the 4-month examination following STLT, mean BCVA improved to 0.6±0.2, whereas mean CPT, TMV, and CST decreased to 274±29µm, 6.87±0.11mm3, and 296±33ìm. At the 12-month examination, mean BCVA was 0.36±0.2, mean CPT was 195±11µm, mean TMV was 6.55±0.19mm3, and mean CST was 239±14ìm, respectively. No side-effects were noted. In particular, no sign of retinal thinning and underlying backscattering typical of conventional laser treatment could be detected at the site of the laser application on OCT. Conclusion: The current pilot investigation of STLT for the treatment of symptomatic RAM shows encouraging data. A randomized clinical trial is required to ascertain the real efficacy this technique and the most appropriate settings to be employed.
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