Original Articles
Prophylactic laser treatment to fellow eyes of unilateral retinal pigment epithelial tears

https://doi.org/10.1016/S0002-9394(98)00061-0Get rights and content

Abstract

Purpose: To evaluate prophylactic laser treatment of the macula in reducing the risk of visual loss in the fellow eye of patients with a retinal pigment epithelial tear caused by age-related macular degeneration in the first eye.

Methods: In a prospective study, 12 patients with a retinal pigment epithelial tear in one eye caused by age-related macular degeneration and drusen in the fellow eye received prophylactic laser treatment of the retina in their fellow eyes and were followed up for 2 years or more after prophylactic treatment.

Results: In 12 fellow eyes that received prophylactic laser treatment, a reduction in best-corrected visual acuity to 20/80 or worse occurred in one (8%) of 12 eyes in the first year and two (18%) of the remaining 11 eyes in the second year after treatment. The cumulative risk of visual loss in the treated fellow eye was 25% in 2 years.

Conclusions: In historical control subjects in a natural history study of patients with retinal pigment epithelial tear in one eye, central visual loss occurred in 16 (37%) of 43 eyes in the first year and in seven (30%) of 23 eyes in the second year for a cumulative loss of 59% in the first 2 years. Compared with these historical control subjects, our findings suggest that visual loss in the fellow eyes of patients with a retinal pigment epithelial tear in the first eye is reduced by prophylactic low intensity laser photocoagulation of the macula.

Section snippets

Patients and methods

We prospectively studied 12 patients with age-related macular degeneration who presented with a retinal pigment epithelial tear in one eye and drusen in the fellow eye. The mean patient age was 76 years (range, 62 to 86 years), and there were 10 women and two men. The initial mean best-corrected visual acuity of the fellow eye was 20/30 (range, 20/20 to 20/40). On fluorescein angiography of the fellow eye, four patients showed hypofluorescent drusen (Patients 4, 5, and 8), two patients had

Results

After we performed prophylactic laser treatment on 12 fellow eyes of eyes with retinal pigment epithelial tears caused by age-related macular degeneration, we retreated Patient 4 after 14 months and Patient 11 after 4 months because the appearance of their large confluent drusen had not changed. Patient 8 had received relatively intense laser treatment initially. After 4 months, her drusen had completely disappeared, but she had developed choroidal neovascularization at one laser scar with

Discussion

Because of the poor prognosis for the fellow eye of patients with unilateral tears of the retinal pigment epithelium, we attempted to lower this risk by placing low-intensity laser spots in the macular region of the fellow eye. The rational for treatment is based on the concept that detachment of the retinal pigment epithelium is caused by diffuse thickening of the Bruch membrane. Particularly in patients with pigment epithelial tears, we often observe delayed choroidal filling on fluorescein

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    The rationale was that diffuse hydrophobic deposits in Bruch’s membrane cause formation of the PED, and these deposits were similar to drusen. Hence, laser to remove the excess material can prevent PEDs and their associated tears.36 However, newer studies were unable to prove prophylactic laser treatment of drusen can subsequently result in a reduction of vision loss.37

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