Photocoagulation for optic disc new vessels in diabetes mellitus

The effects of treatment by argon laser and xenon arc photocoagulation in 165 diabetic patients with optic disc new vessel formation have been studied retrospectively. Visual acuity and degree of new vessel formation have been assessed over a period of between six months and seven years of follow-up (mean 23 months). Visual acuity improved in 36% of treated eyes and remained unchanged in 34%. Improvement was most marked in those with initially poor acuity (less than 6/36). There was no association between improvement in visual acuity and regression of disc vessels, the latter occurring in 79% of treated eyes. Only 6% of eyes became blind during the period of follow-up, principally as a result of vitreous haemorrhage and retinal detachment. There was no difference between the results produced by the use of separate or combined argon laser and xenon arc photocoagulation on the regression of disc new vessels. However, our results suggest that argon laser treatment was more effective than xenon arc photocoagulation in improving visual acuity. These findings suggest that either form of treatment or a combination offers considerable benefit in the management of proliferative diabetic retinopathy, even when very severe at presentation.     

Treatment of circumscribed choroidal hemangiomas

Forty of 59 patients with a circumscribed choroidal hemangioma have been treated by photocoagulation since 1972 because of visual impairment due to secondary nonrhegmatogenous retinal detachment involving the fovea. An attempt was made in every case to bring about resolution of the subretinal fluid, but no attempt was made to destroy the tumor. The treatment techniques used were xenon arc photocoagulation and less intense argon laser photocoagulation. At least a temporary reduction or resolution of subretinal fluid occurred after treatment in most of the eyes, but subsequent reaccumulation of subretinal fluid was noted in many cases. Unfortunately, only 22.5% of the treated eyes retained visual acuity of 6/12 or better after an average follow-up of four years.     

氩激光和氪激光治疗糖尿病性黄斑水肿疗效的比较

目的分析对比氩激光和氪激光治疗糖尿病性黄斑水肿的疗效。方法对背景型和增生型糖尿病性视网膜病变伴有黄斑水肿(包括局部水肿、弥漫水肿和囊样水肿)的患者共100例,分别采用氩绿激光和氪黄激光进行焦点光凝或格栅光凝,观察治疗前后的视力、眼底和荧光血管造影的改变,对比2种激光的疗效。结果糖尿病性黄斑病变患者共73人,100眼。氩激光治疗组37人53眼,氪激光治疗组36人47眼。随诊观察期平均8.2m。治疗后氩激光组黄斑水肿完全消退者占58.5%,部分消退者占26.4%,未消退者占15.1%;氪激光组黄斑水肿完全消退者占63.8%,部分消退者占17.0%,未消退者占19.1%。氩激光组视力进步者占34.0%,保持不变者占43.4%,氪激光组视力进步者占25.5%,保持不变者占53.2%,两组相比差异无显著性的意义(P>0.05)。经氩激光/氪激光治疗后,多数患者视力有提高(30%)或保持稳定(48%)。结论氩绿激光和氪黄激光均可以有效治疗糖尿病性黄斑水肿,两种激光的疗效无显著性差异。     

Comparison of xenon arc and argon laser photocoagulation in ocular histoplasmosis.

Argon laser and xenon arc photocoagulation can be utilized to obliterate choroidal neovascularization in selected cases of macular histoplasmosis. Central vision can be preserved in many instances if criteria for patient selection, treatment techniques, and method of follow-up, as described in this chapter, are adhered to rigidly. Of 40 patients treated with argon laser photocoagulation, 75 percent maintained or improved central vision an average of one year following treatment. Nonetheless, there is a definite need for a prospective controlled study to document the efficacy of this mode of treatment on a long-term basis.     

A prospective study of xenon arc photocoagulation for central retinal vein occlusion.

Twenty patients with central retinal vein occlusion were randomly divided into two groups in a prospective study to evaluate the effects of xenon are photocoagulation in central retinal vein occlusion. The patients in one group were treated with 360 degrees scatter xenon photocoagulation and the others received no treatment. The average follow-up was 18 months. There were no cases of rubeosis or neovascular glaucoma in the treated group. Two patients in the untreated group developed rubeosis with subsequent neovascular glaucoma. There was no significant difference in the visual prognosis or in fundus neovascularization between the groups.     

Prospective evaluation of the argon laser treatment of trachomatous trichiasis

PURPOSE: To evaluate the effectiveness of argon laser photocoagulation for the treatment of trachomatous trichiasis. METHODS: This report presents a prospective, non-masked study of 22 patients (36 eyelids) with trachomatous trichiasis treated with the argon laser. Each abnormal lash was treated with a beam of 50- to 200-micron spot size, for 0.2 seconds, and 1 to 1.2 watts power. In 30 lids (83.3%) infiltration anesthesia was used and in 6 lids (16.7%) no anesthesia was used. RESULTS: Successful treatment with no evidence of recurrence was achieved in 55.5% of lids after one laser session. The remaining 44.5% of the lids required two or three sessions. The final success rate of the method was 88.9%. No complications were observed. The mean follow-up time was 10.6 months. CONCLUSION: Argon laser photocoagulation is an effective and safe method for the treatment of trachomatous trichiasis.     

Treatment of choroidal melanoma using photocoagulation]

The author defines the conditions for treatment of chorioid melanomas by photocoagulation which is restricted only to a small number of tumours. The author describes different therapeutic techniques, using photocoagulation. The success rate of treatment of chorioid melanomas by xenon photocoagulation is 50-60%, similar results are obtained with laser coagulation (maily krypton or a combination of argon and krypton). Treatment with an argon laser alone is not suitable as blue light which forms 70% of the light energy does not penetrate into the chorioid. Green light of the argon laser is suited for use in the first stage of treatment, i. e. for obliteration of retinal and chorioid vessels. The authors treated six patients with melanoma of the chorioid using combined xenon-argon therapy. During the average observation period of six years only one patient developed regression of the tumour, in another patient further growth ceased, but regression was not observed. In four patients on account of progression of the tumour the eye had to be enucleated.     

氩激光治疗视网膜血管病致黄斑水肿的临床观察

目的探讨氩绿激光光凝治疗视网膜血管病致黄斑水肿的方法和疗效。方法对46例58眼视网膜血管病致黄斑水肿患者包括糖尿病视网膜病变24例36眼、视网膜静脉阻塞22例22眼,采用波长514.5nm氩绿激光行黄斑区局部或格栅样光凝治疗。术后随访6~12个月,观察患者黄斑水肿消退情况和治疗后视力变化。结果光凝治疗后视力提高者34眼(58.6%),视力不变者21眼(36.2%),视力下降者3眼(5.2%)。黄斑水肿完全吸收17眼(29.3%),部分吸收34眼(58.6%),7眼无变化(12.1%)。结论氩离子激光光凝是治疗视网膜血管病致黄斑水肿有效、安全的方法。     

A randomized clinical trial of feeder vessel photocoagulation of proliferative sickle cell retinopathy. I. Preliminary results

A randomized prospective clinical trial of feeder vessel photocoagulation for proliferative sickle cell retinopathy was performed. In Chicago there were 34 argon laser-treated eyes and 30 control eyes. In Kingston there were 53 xenon arc treated eyes and 50 control eyes. Prolonged loss of visual acuity was rare in both photocoagulated and control eyes. Argon laser and xenon arc feeder vessel photocoagulation reduced the incidence of vitreous hemorrhage and visual loss from vitreous hemorrhage. However, photocoagulation was associated with an increased risk of choroidal neovascularization (xenon arc greater than argon laser) and retinal detachment (argon laser), although visual loss from these complications has not been seen in these patients so far.     

Photocoagulation in Eales' disease

Between 1970 and 1991 the authors examined 466 cases with Eales' disease. 359 eyes of 295 of these 466 cases received photocoagulation treatment. The mean age was 30.4, ranging between 14 and 55 years. Ten eyes with persistent vitreous hemorrhage underwent pars plana vitrectomy before photocoagulation. 210 eyes were treated with xenon arc, 135 with argon laser, 12 with krypton laser and two with yellow dye laser. Hypoxic areas and retinal neovascularizations were closed completely in 298 eyes. In 21 eyes with elevated neovascularizations intruding into the vitreous cavity feeder vessel photocoagulation was used. 24 eyes with disc neovascularization were treated with panretinal photocoagulation. 12 eyes with branch vein occlusion and four eyes with central vein occlusion received photocoagulation treatment to areas of non-perfusion and retinal neovascularization. At a mean follow-up of 43 months, seven new retinal neovascularizations and three new disc neovascularizations developed in eyes which previously had received photocoagulation for retinal neovascularization and hypoxia. Nine out of 21 eyes with elevated neovascularizations developed vitreous hemorrhage. Disc neovascularization resolved completely in 13 out of 24 eyes, it partially regressed in eight eyes and did not respond to treatment in three eyes. The visual acuities were improved in 12.3%, maintained in 77.4% and deteriorated in 10.3% of the eyes after treatment. Periodic follow-up and early photocoagulation treatment is useful in stabilizing the retinal lesions and in maintaining functional levels of vision in Eales' disease.     

Photocoagulation in Eales' disease

Between 1970 and 1991 the authors examined 466 cases with Eales' disease. 359 eyes of 295 of these 466 cases received photocoagulation treatment. The mean age was 30.4, ranging between 14 and 55 years. Ten eyes with persistent vitreous hemorrhage underwent pars plana vitrectomy before photocoagulation. 210 eyes were treated with xenon arc, 135 with argon laser, 12 with krypton laser and two with yellow dye laser. Hypoxic areas and retinal neovascularizations were closed completely in 298 eyes. In 21 eyes with elevated neovascularizations intruding into the vitreous cavity feeder vessel photocoagulation was used. 24 eyes with disc neovascularization were treated with panretinal photocoagulation. 12 eyes with branch vein occlusion and four eyes with central vein occlusion received photocoagulation treatment to areas of non-perfusion and retinal neovascularization. At a mean follow-up of 43 months, seven new retinal neovascularizations and three new disc neovascularizations developed in eyes which previously had received photocoagulation for retinal neovascularization and hypoxia. Nine out of 21 eyes with elevated neovascularizations developed vitreous hemorrhage. Disc neovascularization resolved completely in 13 out of 24 eyes, it partially regressed in eight eyes and did not respond to treatment in three eyes. The visual acuities were improved in 12.3%, maintained in 77.4% and deteriorated in 10.3% of the eyes after treatment. Periodic follow-up and early photocoagulation treatment is useful in stabilizing the retinal lesions and in maintaining functional levels of vision in Eales' disease.     

Comparative electroretinograms in argon laser and xenon arc panretinal photocoagulation.

We performed electroretinograms (ERG) on both eyes of 11 diabetic patients before and one month after panretinal photocoagulation for diabetic retinopathy. Each patient had one eye treated with argon laser and the fellow eye treated with the xenon arc photocoagulator. After photocoagulation the ERG was symmetrically reduced unless the retinal area burned with xenon arc was greater than twice the retinal area burned in the fellow eye by the argon laser photocoagulator.     

黄斑裂孔的激光治疗与玻璃体切割联合自体浓缩血小板手术治疗的比较

目的：对比激光治疗与手术治疗黄斑裂孔的不同视力结果。方法：30例30眼黄斑裂孔患者行氩激光治疗,随诊3－108个月（平均25．9个月）;43例43眼行玻璃体切割术联合自体浓缩血小板手术治疗,随诊3－23个月（平均5．95个月）。结果：激光治疗组术后视力≥0.1者8眼,占26．7％,术后最好视力0．2,视力提高5眼,占16．7％;手术治疗组术后视力≥0.1者27眼,占62．8％,术后最好视力1．0,视力提高26眼,占60．5％。结论：玻璃体切割术联合自体浓缩血小板手术治疗黄斑裂孔的视力明显好于激光治疗黄斑裂孔。     

糖尿病视网膜病变激光治疗疗效及影响因素分析

目的:探讨激光光凝治疗对糖尿病视网膜病变(diabetic retinopathy,DR)的疗效及相关影响因素。方法:对2005-01/2008-12我院就诊的DR患者285例494眼进行视网膜激光光凝治疗。随访3~40(平均18)mo。结果:494眼中58眼(11.7%)视力提高,329眼(66.6%)视力不变,107眼(21.7%)视力下降。392眼视网膜病变得到有效控制,眼底检查及荧光血管造影显示视网膜水肿减退,渗出吸收,新生血管减少或消退,治疗有效率为79.4%。高危PDR患者激光光凝术后治疗有效率(32.2%)明显低于非增殖期DR患者(90.4%)及早期PDR患者(88.3%)(P<0.05)。1型糖尿病患者激光光凝术后治疗有效率(55.6%)明显低于1型糖尿病患者(80.2%)(P<0.05)。糖化血红蛋白水平高(≥8.0%)的患者激光光凝术后治疗有效率(65.5%)明显低于糖化血红蛋白水平低(<8.0%)的患者(91.0%)(P<0.05)。结论:激光光凝治疗是一个可以有效控制DR,阻止病情恶化,保护视功能的方法,其疗效受DR的分期、糖尿病分型及血糖控制水平等影响,关键是把握光凝时机,早期发现并及时治疗,同时积极控制血糖,重视定期随访。     

Diode versus argon-green laser panretinal photocoagulation in proliferative diabetic retinopathy: A randomized study in 44 eyes with a long follow-up time

A clinical randomized study using argon-green (532 nm) and diode (810 nm) lasers was carried out on 44 eyes (34 patients) affected by proliferative diabetic retinopathy (PDR), with the aim of evaluating the long-term effects of diode panretinal photocoagulation. Of the total 44 eyes, 22 were randomized to argon laser treatment (ALT) and 22 to diode laser treatment (DLT). The mean follow-up time was 25 ± 5 months in the ALT group versus 24 ± 4 montsh in the DLT group. In the ALT group 20 eyes (91 %) showed regression of PDR whereas 2 eyes (9%) deteriorated. In the DLT group regression of neovascularization was observed in 22 eyes (100%). These results show that the long-term efficacy of diode laser PRP in the treatment of PDR is similar to that of argon-green laser PRP.     

Utility of indocyanine green angiography guided laser photocoagulation of choroidal neovascularization in age-related macular degeneration

PURPOSE: The efficacy of photocoagulating choroidal neovascularization (CNV) of age-related macular degeneration with indocyanine green angiography(ICG) was evaluated. 1. The utility of ICG-guided laser photocoagulation for juxtafoveal and extrafoveal CNV, 2. The utility of photocoagulating feeder vessels of subfoveal CNV. METHODS: 1. We compared 139 eyes undergoing ICG-guided laser photocoagulation (IA group), with 85 eyes treated with fluorescein angiography (FAG)-guided laser photocoagulation(FA group), of juxtafoveal and extrafoveal CNV. 2. We treated 35 eyes of 35 patients in which feeder vessels detected by ICG served as targets of photocoagulation. RESULTS: 1. The success rate of laser photocoagulation was 81% in the IA group and 82% in the FA group. There was no statically significant difference between the IA and FA groups in terms of distance from the fovea, CNV size, or lesion type. The rates of maintained or improved visual acuity in groups of IA and FA at the final follow-up as compared with those before treatment, were 71% (61/86 eyes) and 65% (36/55 eyes), respectively. 2. The feeder vessels were obliterated in 66%. The percentage of eyes with maintained or improved visual acuity at six months and at final follow-up as compared to visual acuity before treatment was 64% and 58%, respectively. Thirteen(81%) of 16 eyes which had shown extrafoveal feeder vessel ingrowth sites and small CNV of 1-disc area or less showed feeder vessel closure. CONCLUSION: 1. ICG-guided laser photocoagulation of juxtafoveal and extrafoveal CNV should be performed actively in the same way as FAG-guided laser photocoagulation. 2. It is best to attempt to coagulate feeder vessels when they are extrafoveal and when the CNV is small.     

Laser photocoagulation for radiation retinopathy after ophthalmic plaque radiation therapy

AIM: To evaluate the use of scatter laser photocoagulation to prevent radiation related retinopathy, maculopathy, and loss of vision. METHODS: This was an interventional case series. 66 eyes with posterior choroidal melanomas treated by ophthalmic plaque radiation therapy were reported. Of these patients, 50 were selected because they developed radiation retinopathy; 45 of these were treated with sector scatter laser photocoagulation to regress clinically evident radiation retinopathy. 16 additional patients (considered to be "high risk" to develop radiation retinopathy) were also treated. RESULTS: Radiation retinopathy was noted to appear at a mean interval of 26 months following plaque treatment. Laser photocoagulation regressed radiation retinopathy in 29 (64.4%) of the 45 patients treated after the onset of radiation retinopathy (17 with only retinopathy, 10 with a combination of retinopathy and maculopathy, and two with only maculopathy). Of the 16 patients who received laser treatment before clinical evidence of retinopathy, one developed radiation maculopathy and two retinopathy without maculopathy (all three responded to additional laser photocoagulation). In the 45 patient group, vision loss of more than three lines was attributable to radiation maculopathy in seven (15.5%). None of the patients in the prophylactic laser group lost more than three lines of vision as a result of maculopathy. CONCLUSION: Sector scatter argon laser photocoagulation induced regression of radiation retinopathy. Though early treatment of radiation retinopathy appears to be more effective, a more long term and prospective randomised study will be needed to prove efficacy.     

Treatment of juxtafoveal and parafoveal neovascular membranes with monochromatic green argon photocoagulation: green laser

Sixty eyes in 58 patients with either juxtafoveal or parafoveal neovascular membranes were treated with monochromatic green argon photocoagulation. The visual acuity was stabilized or improved in 73.2% (22 eyes) in both the juxtafoveal and parafoveal groups. Total eradication of the neovascular membranes was possible in 86.6% (26 eyes) in the juxtafoveal group and 93.4% (28 eyes) of the parafoveal group. This study suggests that successful treatment of both juxtafoveal and parafoveal neovascular membranes can be accomplished with monochromatic green argon photocoagulation.     

Argon laser photocoagulation of symptomatic flap tears and retinal breaks of fellow eyes.

A series of 95 eyes (93 patients) with retinal breaks, high-risk candidates for rhegmatogenous retinal detachment, were treated prophylactically with argon laser photocoagulation (ALP). Group A comprised 74 eyes with flap symptomatic tears. In 28 of these (subgroup A (1)) the size of the tear was smaller than 1 disc diameter and greater than 1/3 disc diameter. In 46 eyes (subgroup A (2)) the size of the tear was at least 1 disc diameter but not greater than 3 disc diameters. Group B comprised 21 fellow eyes with 34 retinal breaks in patients who had retinal detachment in the other eye. One patient of subgroup A (1) developed a rhegmatogenous retinal detachment 6 days after ALP treatment. One patient of group B developed a retinal detachment after cataract extraction. This detachment was unrelated to the previously treated retinal break. In the series of group A the mean follow-up period was 27.8 months. From previously reported follow-up data it is probable that at least in the case of flap symptomatic tears our results can be considered conclusive. There were no complications related to the prophylactic treatment of dangerous retinal breaks with ALP. This form of treatment is accurate, easy to use, and comfortable for the patient. ALP would appear to be superior to xenon arc photocoagulation and cryopexy.     

Diode laser scatter photocoagulation in diabetic retinopathy

The efficacy of scatter photocoagulation therapy for diabetic retinopathy using the diode laser was compared with that of the argon green laser in a prospective randomized trial involving 50 eyes. Six months after treatment, neovascularization regressed in 16 eyes (64%) in the diode group and 18 eyes (72%) in the argon group. Diode laser appears to be a suitable alternative to argon green laser for scatter photocoagulation in diabetic retinopathy.