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In eyes with AMD or other choroidal pathologies prone to develop subretinal neovascular membranes we occasionally encounter cases where the CNV is localized around the optic disc, giving rise to an exudative retinal detachment frequently involving the macula and reducing visual function.
When the CNV does not involve the foveal zone directly, anti-VEGF therapy is not indicated, although it might be effective. Many will be hesitant to use laser therapy in these cases for fear of causing damage to the nerve fiber layers in the papillomaculary area and around the optic disk causing visual field defects in the process.
I will demonstrate a laser technique that is safe and effective even in that sensitive area of the retina.
The main principle of this technique is to use a very low laser energy (initially <100mW) with a long exposure (0.5s to 1s) and a large spot size (500┬Ám) and apply this energy in hundreds of repetitive spots directly onto the CNV, very much akin to the transpupillary thermotherapy (TTT) once used for the treatment of choroidal melanoma. These settings will result in a very deep penetration of the laser energy, literally warming the CNV from the bottom up. Initially the spots will be subclinical, and I use many layers of overlapping shots before slowly turning up the laser energy until eventually the surface of the CNV shows a minimal greying effect. Under no circumstances does one want whitening of any retinal tissue and since the retina is transparent and detached, there is no danger of this happening.
In the last years we collected ten patients treated with this method. In six cases the treatment was successful with just one session, leaving a dry peripapillary scar. Failures were attributed to the CNV being actually predominantly occult and as a result too large to be effectively destroyed by laser therapy alone.
The presentation will include the demonstration of some physical aspects of laser energy application and a few clinical examples.