Transpupillary retinopexy of chorioretinal lesions predisposing to retinal detachment with the use of diode (810 nm) microlaser.

摘要

PURPOSE: To evaluate the clinical efficacy and safety of diode microlaser for transpupillary retinopexy in eyes with retinal degenerations and retinal tears in a prospective clinical study. METHODS: Twenty eyes (19 patients) with mid or peripheral degenerations and retinal tears were treated with infrared diode photocoagulation. A continuous-wave diode laser was used to create clinically just visible chororetinal bums. The follow-up period was extended to 3 months. Color photographs of the coagulated retina were taken 24 hours after laser retinopexy and at 1 month and 3 months postoperatively. RESULTS: Acute chorioretinal burns appeared gray-white on the midperiphery, not sharply defined and sometimes somewhat difficult to detect during photocoagulation. Power levels ranged from 110 to 640 mW (mean +/- SD 384+/-133.47 mW). In eyes with dark brown irises, the mean laser power was significantly lower than in eyes with blue-green irises (325.83+/-117.90 mW versus 471.25+/-109.60 mW, P < 0.05). At the 1 -month postoperative follow-up examination, all eyes showed chororetinal scarring with pigmentary mottling. At 3 months, the diode lesions' appearance was that of a marked atrophic chonoretinal scar. There were no adverse side effects in the laser-treated eyes except for a small choroidal-retinal-vitreal bleeding in 1 (5%) of the eyes. CONCLUSIONS: Transpupillary photocoagulation to mid or peripheral retina with diode microlaser has proven to be effective at providing retinopexy of retinal degenerations and retinal tears. The long wave 810 nm can also be used successfully and safely for the prophylaxis of retinal detachment because it can create a strong adhesion between the retina and choroid. However, diode laser should not be employed routinely for treating patients with clear media or fundus hypopigmentation. The use of diode is preferably indicated in eyes with media opacities because infrared light has the advantage of a better transmission through lens opacity or vitreous hemorrhage. As diode laser energy can produce variable tissue effects, there may be some difficulty in obtaining reproducible bums because of unpredictable changes in melanin density of the retinal pigment epithelium and choroid.