First Author: J.Luttrull USA
Co Author(s): S. Elmann B. Glaser
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To determine the incidence of new choroidal neovascularization (CNV) following panmacular subthreshold diode micropulse laser (SDM) as retinal protective therapy (RPT) in dry age-related macular degeneration (AMD).
A private vitreoretinal subspeciality practice (JKL).
In an observational retrospective cohort study, the electronic medical records database (EMR) records of all active patients in a private vitreoretinal practice having undergone SDM RPT for dry AMD were reviewed, classified by AREDS categories, and analyzed for the primary endpoint of new CNV after treatment.
Treatment was offered to 305/326 (94%) treatment candidates during the study period, and elected by 296 (97%). Postoperative follow up (avg. 20 mos) was available for 290 treated patients (432 eyes, 98%). Risk factors for CNV included age (avg. 83 years, 68% over 80); high prevalence of reticular pseudodrusen (RPD) (158 eyes, 37%); high AREDS severity (77% category 3 and 4); and high prevalence fellow eye CNV (118 eyes, 27%). Without adjusting for these risk factors, the incidence of new CNV was 7/432 (1.6%, annualized rate 0.97%). RPD and fellow eye CNV increased the risk of CNV post SDM RPT (p=0.02, each). Systemic hypertension lowered the risk (p=0.048). For eyes completing 12 months follow up, there were 4 progressions in 4963 person-eye months (0.81 progressions per 1,000 person-eye months). For eyes completing 24 months follow up, there were 6 progressions in 7635 total person-eye months (0.79 progressions per 1000 person-eye months). Visually acuity (VA) was stabilized. There were no adverse treatment effects.
In a high-risk population, SDM RPT markedly reduced the risk of new CNV in dry AMD and stabilized VA, without adverse treatment effects. SDM RPT may offer a new, safe, and highly effective method of reducing the risk of vision loss in patients with dry AMD.