First Author: Y.Minowa JAPAN
Co Author(s): T. Komoto J. Kang K. Ohkoshi
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Tilted disc syndrome (TDS) is a congenital anomaly characterized by a nasal-to-temporal “tilting” of the optic disc. Focal serous retinal detachment (SRD) is the most popular complication as macular complications of TDS. Intravitreal bevacizumab (Avastin®) and photodynamic therapy (PDT) were reported as treatment for SRD. However, the proper treatment for SRD is still unknown. Subthreshold laser photocoagulation is selective photocoagulation for treatment of mainly the retinal pigment epithelium (RPE). The purpose of this study is to assess the efficacy of subthreshold laser for SRD in TDS patients.
This single-centre retrospective study included 5 eyes of 5 consecutive TDS patients with SRD, underwent subthreshold laser treatment between January 2011 and September 2016. The mean age of the patients was 65.5 years.
Visual acuity, central macular thickness (CMT), and subretinal fluid (SRF),and fundus autofluorescein at enrollment, as well as 1 and 3-months after treatment were evaluated.
Three patients 3 eyes underwent subthreshold micropulse laser (577nm 5% duty cycle, 100μm, 0.2 sec, the delivery of 60～80% of threshold energy) and 2 patients 2 eyes underwent Pascal endpoint laser (577nm 100μm, 0.015 sec, the delivery of 50～90% of threshold energy). Subthreshold laser treatment was applied to the entire area with SRD using 2x2 or 3x3 pattern except for the foveal area. Focal leaking points, if those are clearly visualized, were also treated with single shots. SRF was completely absorbed in 5 eyes (100%) within 6-months after initial treatment. 2 eyes showed recurrence, one eye requiring additional laser treatment. All eyes showed complete resorption of SRF at the end of visit. The number of laser treatment was 1~3 (average 2.0). Mean visual acuity (LogMAR) were 0.28, 0.31, 0.29 at enrollment and at 1.6 months after initial treatment. Mean CMT (µｍ) were 355.2, 331.0, and 277.6 at enrollment and at 1.6 months after initial treatment and no statistical difference was seen. No laser induced retinal scar was observed at the end of visit. Two eyes showed change in fundus autofluorescein at laser ablation site .There were no instances of laser scotoma.
Subthreshold laser may be an effective treatment to absorb SRD in TDS patients.