Infrared reflectance image-guided laser photocoagulation of telangiectatic capillaries in persistent diabetic macular edema

This study aimed to assess detection rate of telangiectatic capillaries (TelCaps) with infrared reflectance (IR) and optical coherence tomography (OCT) images and to evaluate the clinical efficacy of IR image-guided focal laser photocoagulation of TelCaps in persistent diabetic macular edema (DME). This retrospective case series included 28 eyes of 28 patients with TelCap and persistent DME refractory to intravitreal anti-vascular endothelial growth factor or corticosteroids. The presence of TelCaps was confirmed using IR and OCT images. All patients were followed up for more than 12 months after direct focal laser photocoagulation of the TelCaps. The TelCap closure rate, changes in best-corrected visual acuity, and central subfield thickness were analyzed. On IR imaging, TelCap appeared as a characteristic hyperreflectivity within a hyporeflective spherical lesion in 85.7% of the eyes. After focal laser photocoagulation, the TelCap closure rate was 57.1% at 3 months and 71.4% at 12 months. A significant improvement in visual acuity and reduction in central subfield thickness were observed at three and 12 months after focal laser photocoagulation (all p < 0.05). The characteristic hyperreflectivity within hyporeflective lesions on the IR image in conjunction with OCT helps identify the TelCap. Our results suggest that IR imaging and OCT-guided focal laser photocoagulation of TelCaps can improve functional and anatomical outcomes in persistent DME.

Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy

AIM: To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2y after focal laser photocoagulation treatment. The patients were diagnosed with PCV using indocyanine green angiography, and eyes with other comorbid ocular diseases were excluded. The measurement outcomes of the study were the post-treatment regression and recurrence of polyps, complications, and changes in visual acuities. Paired t-test was performed to compare visual outcome before and after the treatment. RESULTS: The mean age of the 13 patients was 70.2±5.5y, and the follow-up period was 72.3±31.0 (range, 25-118)mo. Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps. Of the 13 eyes, 9 eyes (69.2%) had regression of polyps 1.7±1.2 (range, 0.9-4)mo after focal laser photocoagulation. Five eyes (55.6%) showed recurrence of polyps during the follow-up periods, and the recurrence period was 12.8±18.9 (range, 1.9-48)mo. Mild subretinal hemorrhage occurred in two eyes (15.4%) 27 and 72d after laser treatment, respectively. There were no statistically significant differences in visual acuities at baseline; 1, 2, 3y post-treatment (all P>0.05); and last follow-up (0.63±0.5, 0.73±0.70, 0.67±0.57, 0.75±0.7, and 0.95±0.8 logMAR, respectively). CONCLUSION: Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up. Furthermore, it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.

Efficacy of Treatment of Diabetic Macular Edema through Frequency-Doubled ND:YAG Laser (532NM) Green Laser

Objective: To determine the efficacy of Frequency-doubled Nd: YAG laser (532 nm) green laser in treatment of diabetic macular edema Study Design: This is a descriptive case series study. Setting: Study carried out at Ophthalmology Department, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from 01-10-2019 to 31-03-2020 (06 months). Materials and Methods: The patients with diabetic macular edema and were advised focal laser photocoagulation with help of frequency doubled Nd: YAG laser (532 nm) green laser. Improvement in visual acuity >2 lines after 3 months on snellen’s chart from the baseline was labeled as efficacy positive. Results: The total of 150 patients were included to assess efficacy of frequency doubled Nd: YAG laser (532 nm) green laser in treating diabetic macular edema as a result improvement in visual acuity of 98 (65.33%) and no improvement or same vision in 52 (34.67%) patients was observed. Conclusion: It is to be concluded that frequency doubled Nd: YAG laser (532 nm) green laser is an effective, useful and non-invasive diagnostic tool in treating diabetic macular edema.

Retinal vasoproliferative tumour secondary to retinitis pigmentosa sine pigmento

Retinitis pigmentosa can be associated with exudative vasculopathy in rare instances, which can manifest as retinal vasoproliferative tumours. We present the case of a 33-year-old woman previously diagnosed with retinitis pigmentosa sine pigmentosa in both eyes. She was asymptomatic and just came in for a routine follow-up eye examination. Thorough examination of the peripheral retina on the right eye revealed a dome-shaped retinal tumour with a feeder vessel and surrounding exudative changes at the superotemporal periphery, consistent with a secondary retinal vasoproliferative tumour from retinitis pigmentosa. She subsequently underwent focal laser photocoagulation of the tumour which resulted in tumour stabilisation. While exudative vasculopathy is very uncommon in retinitis pigmentosa, ophthalmologists need to be aware of its occurrence in such patients. Vision loss may occur from exudation, haemorrhage, retinal detachment and neovascularisation. A thorough examination of the peripheral retina is warranted in these cases.

Coats retinopathy with pachychoroid and central serous chorioretinopathy in the fellow eye

A 37-year-old man presented with blurring of vision and scotoma in the left eye since last 2 weeks and has a history of poor vision in his right eye since childhood. On examination, his best corrected visual acuity in the right eye was counting finger 1 m and 20/20, N/12 in the left eye. Fundus examination revealed features of Coats disease in the right eye and central serous chorioretinopathy (CSCR) in the left eye. He was given intravitreal triamcinolone acetonide injection in the right eye for reducing subretinal exudation. Simultaneously, focal laser photocoagulation was done to the CSCR leaks in the left eye to prevent the possible worsening of CSCR due to steroid injection in the fellow eye. He underwent cryotherapy to the retinal telangiectatic vessels 3 weeks after steroid injection in the right eye. Optical coherence tomography (OCT) of both eyes showed pachy vessels with a compression of overlying choriocapillaries. After 1 month, the condition of the right eye was unchanged and the CSCR in the left eye was completely resolved with the recovery of near visual acuity.

Assessment of the Dynamic Alteration of Choriocapillaris Vessel Density after Focal Laser Photocoagulation with OCT Angiography

Purpose. To evaluate the changes of choriocapillaris blood flow beneath laser lesions in noncenter-involved diabetic macular edema patients using optical coherence tomography angiography (OCTA). Methods. This was a retrospective case-series study. We used OCTA to analyze the characteristics of the choriocapillaris blood flow beneath laser lesions before laser treatment and at several intervals after treatment. The choriocapillaris vessel density (CCVD) beneath the laser lesions was based on the OCTA images and was defined as the proportion of flow pixels in the selected area calculated using FIJI software through automatic binarization processing based on threshold methods. Results. A total of 63 laser lesions in 8 eyes of 5 patients were included in this study. There was a significant decrease in the CCVD at 1 hour and 1 day following laser treatment (24.25% ± 5.04% and 22.00% ± 4.71%, respectively) when compared with the baseline value (39.09% ± 3.71%, all p<0.001). The CCVD was 31.82% ± 4.53% in 1 week after laser treatment, which was significantly higher than that in 1 day after treatment (p<0.001), and then continued to improve at 1 month after treatment (34.44% ± 4.16%). Additionally, in the group with smaller spot size and lower energy, the CCVD recovery at 1 month after laser was significantly better than that in the group with larger spot size and higher energy (p=0.006). Conclusions. OCTA image analysis can reflect changes in the choriocapillaris blood flow beneath laser lesions at different times following laser treatment in vivo. Spot size and laser energy may affect blood flow recovery.