Focal Laser Photocoagulation Research Articles

Laser therapy for retinopathy in sickle cell disease.

Laser therapy for retinopathy in sickle cell disease.

Focal laser photocoagulation treatment in polypoidal choroidal vasculopathy: Long‐term follow‐up

AbstractPurpose: To report the long‐term effect and safety of focal laser photocoagulation treatment (FLPT), in a case of polypoidal choroidal vasculopathy (PCV).Methods: We reviewed a 56‐month follow‐up (April 2017–January 2022) of a 54‐year‐old woman with PCV. The diagnosis was made using indocyanine green angiography (ICG‐A). The measured outcomes of the effect of FLPT were changes in best‐corrected visual acuity (BCVA), complications, regression, and recurrence of polypoidal lesions based on fundoscopy, B‐scan swept source optical coherence tomography (SS‐OCT) and ICG‐A.Results: At the time of diagnosis, the patient had extensive subretinal exudation and haemorrhage in the right eye (RE) related to foveal and juxtapapillary polypoidal lesions. She received 12 bevacizumab intravitreal injections and treatment was interrupted because of extensive macular fibrosis. In the left eye (LE), she had extrafoveal polypoidal lesions with a BCVA of 20/25. At 8 months follow‐up, a decrease in BCVA to 20/50 was noted. Therefore, a first round of FLPT associated with three bevacizumab intravitreal injections, was performed. Four months post‐FLPT, regression of the polypoidal lesions was obtained with a BCVA of 20/25. BCVA and multimodal imaging remained stable for 2 years. The left eye showed recurrence of extrafoveal polypoidal lesions 35 months after FLPT, with a BCVA of 20/50. A second round of FLPT was performed, with a regression of the polypoidal lesions after 1 month, and a stabilization of BCVA at 20/30. After 14 months, BCVA was 20/50, and no signs of recurrence were detected on multimodal imaging. No complications were observed after the two rounds of FLPT.Conclusions: FLPT can be efficient and safe in treating eyes with PCV with extrafoveal polypoidal lesions. In this case, it allowed us to obtain the regression of polypoidal lesions and to maintain visual acuity without serious hemorrhagic complications during the 56‐month follow‐up.

Ischemia and laser photocoagulation in retinal vein occlusion

Retinal vein occlusions (RVO) are associated with retinal ischemia to ahighly variable extent. An ischemic retina may lead to the development of neovascularization and further to secondary complications such as neovascular glaucoma, vitreous hemorrhage or tractional retinal detachment. Numerous factors such as vascular endothelial growth factor (VEGF) and other cytokines are produced in the ischemic area, which cause macular edema. Before the introduction of intravitreal drug injections (IVI), retinal laser photocoagulation was the leading form of treatment. Macular laser photocoagulation was applied in the form of focal laser or grid laser in patients with branch retinal vein occlusion (BRVO) to treat macular edema. In patients with ischemic RVO, panretinal laser photocoagulation (PRP) was recommended for treatment of secondary neovascular complications. The value of laser treatment in the management of patients with RVO changed after the introduction of IVI treatment. This article presents a review of the current study results and the recommendations for performing laser photocoagulation of the central and peripheral retina in patients with RVO. Conventional focal or grid laser photocoagulation has been replaced by IVI treatment in the management of macular edema secondary to BRVO; however, macular laser treatment can still be considered in patients with BRVO if the macular edema persists despite the use of available IVI drugs. The use of central laser photocoagulation in these cases is based on the findings of fluorescein angiography. Disseminated panretinal laser photocoagulation is still indicated in RVO patients who have large areas of nonperfusion, have developed neovascularization and/or late complications. Targeted laser photocoagulation of the peripheral areas of nonperfusion has recently been recommended by several authors and is expected to improve not only the visual outcome of IVI treatment, but more importantly to also reduce the duration of treatment and the number of re-injections needed. Clear evidence for targeted laser treatment is not yet available and is afocus of currently ongoing prospective randomized studies.

Laser Treatment Modalities for Diabetic Retinopathy

Diabetes is a chronic progressive metabolic disorder that is caused by the body's inability to regulate blood glucose levels. If uncontrolled, it can lead to various complications. Among its various complications, long-term diabetes leads to diabetic retinopathy (DR). It is a disease involving blood vessels and the destruction of retinal nerves. It is usually classified into two types: proliferativediabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR). It progresses and causes loss of vision. The leading cause of loss of vision is diabetic macular edema (DME). The argon laser is used as a modality in the management of PDR. There are various types of laser photocoagulation, such as peripheral retinal laser photocoagulation,focal macular laser photocoagulation, and grid photocoagulation. DR results in various adverse consequences such as vitreous hemorrhage, fibrosis, traction, detachment of the retina, and glaucoma. To assess DR, a detailedfundus examination with a slit lamp biomicroscopeneeds to be done. Seven-standard field stereoscopic-color fundus photography needs to be done for documentation and follow-up. Patients with diabetesmellitus (DM) type 1 have a greater risk of suffering fromDR. Another major complication of the condition is DME, which is characterized by an increase in the permeability of vessels and the thickening of the central part of the retina along with the accumulation of hard exudates on the macula. This article discussesvarious laser therapy modalities for the treatment of DR, their types, mechanisms, and aims. Clinical features of DR include abnormal dilatation of capillaries, and outpouchings in the form of microaneurysm from the capillary wallareone of the earliest and most dangerous changes; later, non-perfusion of the retina occurs, which is associated with cotton wool spots and blot hemorrhages. In patients suffering from PDR and maculopathy, peripheral retinal laser photocoagulation is used as a mode of intervention.

Penetrating Ocular Injury Management in Intraocular Foreign Body (IOFB) and Traumatic Cataract

Highlight: The management of penetrating ocular injury with IOFB and traumatic cataracts needs a thorough examination of the mechanism of injury, location, size, and composition of IOFB. Endophthalmitis, retinal detachment, and development of PVR are potentially vision-threatment. Abstract: Most IOFB are metallic and found in males of productive age as a consequence of work-related accidents. A 45-year-old man complained of sudden blurred vision in the left eye (3/60 pinhole 5/12) after getting hit by a foreign body when cutting grass with a lawn mower. Anterior segment examination revealed a 10 mm long, one-plane, straight, full thickness, already sutured inferonasal corneal laceration, inferonasal traumatic iridectomy size 3x7 mm, and opaque lens. Head CT-scan revealed opacity with metallic density intraocularly. Ultrasonography revealed an echogenic lesion, particle-shaped with 100% RCS complex density, located at the inferonasal of the vitreous cavity. Focal laser photocoagulation was performed preoperatively because there was a tear at the superonasal of the retina. The patient underwent cataract extraction, intraocular lens implantation, vitrectomy, and IOFB extraction in a one-step procedure. IOFB was found at the inferonasal side of a vitreous cavity with size 3 x 1 mm, metallic, and not attached to the retina. Silicon oil tamponade was used as a precaution because there were retinal tears. Postoperatively, the left eye's visualacuity was 5/20. After 6 months, the silicon oil was evacuated and the visual acuity became 5/8.5.

Funduscopy-guided fluorescein angiography-free focal laser photocoagulation for central serous chorioretinopathy.

Purpose:To identify and correlate hypopigmented spots on fundoscopy with the leakage points on fluorescein angiography (FA) in patients with central serous chorioretinopathy (CSCR) to provide criteria for FA-free focal laser photocoagulation (FLP).Methods:Fifty consecutive patients of acute CSCR were evaluated between March and October 2019 confirming the inclusion and exclusion criteria. Colocalization of leakage points with discrete hypopigmented spots on clinical fundoscopy was evaluated using FA. Positive predictive value (PPV) was calculated to identify the status of association between these to formulate criteria for FA-free FLP of CSCR patients in future.Results:Out of the 50 eyes, 38 (76%) had a discrete hypopigmented spot on fundoscopy which coincided with the leakage point on FA. The PPV of finding a leakage point at the area of discrete hypopigmented spot is 95%. Colocalization with a pigment epithelial detachment was found in 25 (65.7%) of these 38 eyes. Retinal pigment epithelial irregularities were found associated in all of these 38 eyes. Subretinal homogenously hyperreflective material was found in 8 (21.05%) of 38 eyes. optical coherence tomography following FLP of leakage point in all cases showed complete resolution of CSCR in 47 (94%) eyes.Conclusion:This study demonstrates that hypopigmented spots on clinical fundus examination in CSCR patients, when present, coincide with the leakage point of FA. This may aid to undergo FA-free FLP treatment in CSCR patients.

Fast Progression to Proliferative Diabetic Retinopathy

Purpose. This case report illustrates rapid progression of diabetic retinopathy in a patient with poor compliance to diabetic management. It additionally demonstrates the utility of panoramic/ultra-wide field retinal imaging in assessing diabetic retinopathy progression. Material and Methods. A 42-year-old female patient was examined seven times over a 25 month period at a private ophthalmology/optometry practice with dilated fundus examinations. Fundus images were obtained using a pano- ramic/ultra-widefield laser retinal imager. Fluorescein angio- graphy (FA) was performed to assess for diabetic macular edema (DME), retinal ischemia and neovascularization, and laser photocoagulation was conducted as indicated by the clinical picture. Ophthalmic ultrasonography was performed to confirm tractional retinal detachments (TRD) at the final visit. Results. Initially, visual acuity was adequate (20/30; 6/9; LogMAR 0.18 in each eye) and the patient was diagnosed with moderate non-proliferative diabetic retinopathy. Diffuse leakage resulting in DME, confirmed with FA at the second visit, was treated with focal laser photocoagulation. However, after being lost to follow-up for over a year, her vision had deteriorated severely to finger counting at 1ft (30.5 cm) in the right eye, and 20/400; 6/120; LogMAR 1.30 in the left: the result of high-risk proliferative diabetic retinopathy in each eye. The patient underwent three treatments of pan-retinal photocoagulation (PRP), but she nevertheless developed tractional retinal detachments (TRD) in both eyes. Conclusion. The combination of poorly controlled diabetes and poor compliance with follow-up care in diabetic retino- pathy can lead to rapid progression of retinopathy and blind- ness. Early detection of diabetic retinopathy with panoramic/ ultra-wide field retinal imaging allows for appropriate staging and management of the disease, and ultimately, better visual outcomes. Keywords Diabetic retinopathy, proliferative diabetic retinopathy, panoramic retinal imaging, ultra-wide field retinal imaging, pan-retinal photocoagulation, tractional retinal detachment

Unveiling the Nanotechnology-Based Drug Delivery Systems and Patent Literature for Diabetic Retinopathy

Diabetes mellitus is a principal reason for globally developing chronic microvascular disorders defined as diabetic retinopathy (DR). Proliferative retinopathy and non-proliferative retinopathy are the two types of DR. Long-term diabetes, and poor blood sugar and arterial blood pressure regulation are the key risk factors for the onset and advancement of DR. A variety of biochemical pathways are involved in the pathogenesis of DR, which includes increased polyol pathway fluxes, advanced glycation end product growth, protein kinase C isoform activation, and increased hexosamine pathway flux. The varieties of cells are involved in diabetic retinopathy, including glial cells, retinal ganglion cells, endothelial cells, and pericytes. Surgical treatment of DR includes laser treatment, panretinal photocoagulation, focal laser photocoagulation, and vitrectomy surgery. The systemic treatment of DR includes glycemic management and control of blood pressure and hyperlipidemia. Nanotechnology-based formulations like nanoparticles, polymeric nanomicelles, and nanocarrier composite, and various patented formulations have been investigated for the treatment of DR.

Infrared reflectance image-guided laser photocoagulation of telangiectatic capillaries in persistent diabetic macular edema

This study aimed to assess detection rate of telangiectatic capillaries (TelCaps) with infrared reflectance (IR) and optical coherence tomography (OCT) images and to evaluate the clinical efficacy of IR image-guided focal laser photocoagulation of TelCaps in persistent diabetic macular edema (DME). This retrospective case series included 28 eyes of 28 patients with TelCap and persistent DME refractory to intravitreal anti-vascular endothelial growth factor or corticosteroids. The presence of TelCaps was confirmed using IR and OCT images. All patients were followed up for more than 12 months after direct focal laser photocoagulation of the TelCaps. The TelCap closure rate, changes in best-corrected visual acuity, and central subfield thickness were analyzed. On IR imaging, TelCap appeared as a characteristic hyperreflectivity within a hyporeflective spherical lesion in 85.7% of the eyes. After focal laser photocoagulation, the TelCap closure rate was 57.1% at 3 months and 71.4% at 12 months. A significant improvement in visual acuity and reduction in central subfield thickness were observed at three and 12 months after focal laser photocoagulation (all p < 0.05). The characteristic hyperreflectivity within hyporeflective lesions on the IR image in conjunction with OCT helps identify the TelCap. Our results suggest that IR imaging and OCT-guided focal laser photocoagulation of TelCaps can improve functional and anatomical outcomes in persistent DME.

Current Approach to Treatment for Central Serous Chorioretinopathy. Review

Central serous chorioretinopathy (CSC) is a disease of complex origin and unknown etiology. Traditionally, two clinical forms of CSC are verified in accordance with the activity and duration of the pathological process: classic acute form and chronic CSC. Nowadays, there is no unified concept accepted for the management of patients with this disease, particular difficulties exist in cases of chronic CSC. This literature review highlights current trends and approaches to the treatment of CSC patients — from focal laser photocoagulation to physical methods oh therapy. The therapeutic approach as a whole depends on the form of the CHS. In most cases of the acute form of CSF, spontaneous regression, spontaneous adhesion of RPE detachment and retinal neuroepithelium are noted within several months from the onset of the disease. Therapy for the chronic form of this disease is still a difficult task and a controversial issue. Direct laser coagulation of the retina at the oozing point is recognized as the most effective method of therapy for acute typical form of CSF. In the chronic form of CSC, photodynamic therapy, transpupillary thermotherapy and subthreshold micropulse laser exposure are used. The goal of drug therapy for CSF is to activate the processes of resorption of serous fluid from the subretinal or subpigmented space, reduce the activity of pathological processes in the choroid, and improve trophism and metabolism. The currently used methods of treating chronic CSH have a number of disadvantages and variable efficacy. The existence of treatment-resistant cases is the subject of further research and clinical research. The development of new physical and physiopharmacological methods of treatment for CSF is perspective.

Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy.

To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy (PCV). Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2y after focal laser photocoagulation treatment. The patients were diagnosed with PCV using indocyanine green angiography, and eyes with other comorbid ocular diseases were excluded. The measurement outcomes of the study were the post-treatment regression and recurrence of polyps, complications, and changes in visual acuities. Paired t-test was performed to compare visual outcome before and after the treatment. The mean age of the 13 patients was 70.2±5.5y, and the follow-up period was 72.3±31.0 (range, 25-118)mo. Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps. Of the 13 eyes, 9 eyes (69.2%) had regression of polyps 1.7±1.2 (range, 0.9-4)mo after focal laser photocoagulation. Five eyes (55.6%) showed recurrence of polyps during the follow-up periods, and the recurrence period was 12.8±18.9 (range, 1.9-48)mo. Mild subretinal hemorrhage occurred in two eyes (15.4%) 27 and 72d after laser treatment, respectively. There were no statistically significant differences in visual acuities at baseline; 1, 2, 3y post-treatment (all P>0.05); and last follow-up (0.63±0.5, 0.73±0.70, 0.67±0.57, 0.75±0.7, and 0.95±0.8 logMAR, respectively). Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up. Furthermore, it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.

Diabetic Macular Edema

Diabetic macular edema (DME) is a chronic retinal disease, which requires intensive clinical monitoring. Within the last ten years the intravitreal anti-VEGF (vascular endothelial growth factor) therapy has become the standard of care to improve and stabilize vision in patients with centre involving DME. Long-acting intravitreal corticosteroids can achieve similar visual results with fewer injection rates. Because of steroid-induced side effects (progression of cataract, glaucoma) these drugs are regarded as second-line medication. Since the introduction of anti-VEGF-medication the focal laser photocoagulation is no longer considered as first-line therapy for DME. However, a focal laser treatment can sometimes be a possible alternative in specific situations. In patients with proliferative diabetic retinopathy and DME, the intravitreal anti-VEGF therapy is approved for both conditions. In ischemic maculopathy the functional outcome is restricted. For the indication of anti-VEGF-treatment for DME with accompanying central ischemia not only visual acuity and optical coherence tomography parameters should be considered, the amount of ischemia seen on fluorescein angiography should also be taken into account. In tractional macular edema due to epiretinal membranes and vitreomacular adhesions a pars-plana vitrectomy with membrane peeling is indicated.

Efficacy of Treatment of Diabetic Macular Edema through Frequency-Doubled ND:YAG Laser (532NM) Green Laser

Objective: To determine the efficacy of Frequency-doubled Nd: YAG laser (532 nm) green laser in treatment of diabetic macular edema&#x0D; Study Design: This is a descriptive case series study.&#x0D; Setting: Study carried out at Ophthalmology Department, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from 01-10-2019 to 31-03-2020 (06 months).&#x0D; Materials and Methods: The patients with diabetic macular edema and were advised focal laser photocoagulation with help of frequency doubled Nd: YAG laser (532 nm) green laser. Improvement in visual acuity &gt;2 lines after 3 months on snellen’s chart from the baseline was labeled as efficacy positive.&#x0D; Results: The total of 150 patients were included to assess efficacy of frequency doubled Nd: YAG laser (532 nm) green laser in treating diabetic macular edema as a result improvement in visual acuity of 98 (65.33%) and no improvement or same vision in 52 (34.67%) patients was observed.&#x0D; Conclusion: It is to be concluded that frequency doubled Nd: YAG laser (532 nm) green laser is an effective, useful and non-invasive diagnostic tool in treating diabetic macular edema.

Focal laser photocoagulation in the management of perifoveal exudative vascular anomalous complex

Perifoveal exudative vascular anomalous complex is an unilateral, isolated, perifoveal aneurysm with adjacent exudative maculopathy. It has been hypothesized to develop due to progressive endothelial injury leading to aneurysmal changes. Usually, it is unresponsive to routinely used anti-VEGF agents. We present a case of a 33-year-old woman presented with PEVAC who was treated with a thermal focal laser. Complete resolution of PEVAC and improvement in BCVA was noted.

Role of focal laser retinal photocoagulation in treatment of diabetic macular edema

Vascular endothelial growth factor (anti-VEGF) inhibitors in action have demonstrated efficacy and safety in the treatment of diabetic macular edema (DME), and have changed both the goal and prospects for treatment of this disease. Consequently, the role of focal laser retinal photocoagulation in the treatment of DME has been actively debated. However, technical advances in new laser systems, treatment protocols for anti-VEGF drug research, and the functional impact of modern focal photocoagulation are necessary to assess the role of laser coagulation in the treatment of DME. A wide range of clinical studies of laser therapy was necessary as an additional treatment for 20 to 50 % of patients receiving monotherapy with anti-VEGF drugs in patients with diabetic macular edema. In addition, a lower frequency of repeated treatment and a more stable reduction in retinal thickness have been demonstrated in other studies. However, the lack of information about the laser systems used, their technical characteristics, and application protocols often make it difficult to compare directly the results of anti-VEGF tests. Therefore, the aim of our work was to analyze the currently available data related to the potential role of focal laser photocoagulation in the treatment of DME, including a detailed review of the most commonly used laser systems. The results obtained with sub-threshold diode micro-pulse laser photocoagulation may be a valuable option as an adjunct therapy to treatment with angiogenesis inhibitors. Current evidence suggests that focal laser therapy should still exist as an adjunct therapy for many patients.

Outcomes of combined treatments in patients with retinal arterial macroaneurysm.

Purpose:To evaluate the outcome of the combined approach between intravitreal ranibizumab (IVR) and focal laser photocoagulation (FLP) in the treatment of symptomatic retinal arterial macroaneurysm (RAM).Methods:A total of 10 patients were included in this clinical case series report. They were diagnosed with symptomatic RAM (one eye in each) and assessed by a comprehensive ophthalmologic examination, including fluorescein angiography (FA), optical coherence tomography angiography (OCT-A), and indocyanine green angiography (ICGA). All patients were treated with an IVR followed by an FLP 2 weeks later. If necessary, a second IVR was given 1 month after the first one (or 2 weeks after the first FLP), which was followed by a second FLP treatment 2 weeks later in the needed cases. All cases were followed up for 6 months after the last treatment.Results:Both the retina hemorrhage and edema were resolved by the treatment. No ocular and/or systemic side effects were evident, and no recrudescence of RAM was seen within the 6 months of follow-up.Conclusion:The combined treatment of IVRs and FLPs was successful in the management of symptomatic RAM.

Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion.

Branch retinal vein occlusion (BRVO) occurs when a retinal vein that drains part of the retina becomes blocked. BRVO can affect approximately four to five people per 1,000 of the population. Known risk factors for BRVO include hypertension, atherosclerosis, high cholesterol, diabetes mellitus, and other inflammatory or autoimmune conditions. In a BRVO the severity of vision loss is related to the extent of macular involvement by haemorrhage, swelling (oedema), and poor blood supply (ischaemia). The most common cause of visual loss in patients with BRVO is macular oedema (MO). Patients with BRVO in one eye are at risk of a venous occlusion in the fellow eye. Untreated, approximately one third of affected eyes will achieve a high level of vision (20/40 or better). Current "gold" standard treatment is laser photocoagulation which has been shown to reduce the risk of visual loss and improve the vision in up to two thirds of individuals with macular oedema secondary to BRVO, however, limitations to this treatment exist and newer modalities have suggested equal or improved efficacy. Recent studies have suggested that an injection of anti-vascular endothelial growth factor (anti-VEGF) in the eye may be of benefit to patients with BRVO. In this review, we appraise and present the level of current evidence for the use of anti-VEGF injections in the treatment of macular oedema after BRVO. In total, we found one randomised controlled trial and one quasi-randomised controlled trial. One study from the USA. had 397 participants and compared anti-VEGF injections with sham injections. It demonstrated a potential benefit of repeated anti-VEGF injections to improve vision (at least 15 letters) at one year. A second study with 30 participants, conducted in Italy, compared anti-VEGF injections with laser photocoagulation and did not demonstrate an improvement in vision (of at least 15 letters) of anti-VEGF injections over laser photocoagulation at one year. Antiangiogenic treatment was well tolerated in these studies, but since the studies were only of one year duration, we were unable to discuss long-term effects. There are several ongoing studies which undoubtedly will add to the evidence available.

Efficacy of navigated focal laser photocoagulation in diabetic macular edema planned with en face optical coherence tomography versus fluorescein angiography.

To analyze the efficacy of navigated focal laser photocoagulation (FLP) of microaneurysms in diabetic macular edema (DME) planned using en face optical coherence tomography (OCT) as against fluorescein angiography (FA). Twenty-six eyes of 21 DME patients (12 males, 9 females, 69.5 ± 12.3years) with mean BCVA of 0.52 ± 0.44 LogMAR were included. En face OCT images of deep capillary plexus slab and FA images were used to plan FLP targeting of leaky microaneurysms. The primary outcome measures were central retinal thickness (CRT) and macular volume. The secondary outcome measure was best-corrected visual acuity (BCVA). The difference in the change of CRT and macular volume between en face OCT and FA-planned FLP after 1month and at the end of follow-up was not statistically significant (p > 0.05), except for a higher CRT reduction in the en face OCT-planning group (p = 0.007) at the end of mean follow-up of 2.6 ± 0.9months. There was no difference in BCVA change between the two planning options (p = 0.42). En face OCT is a non-inferior alternative for FA in the planning of navigated FLP of microaneurysms in DME.

Coats-like Exudative Vitreoretinopathy in Retinitis Pigmentosa: Ocular Manifestations and Treatment Outcomes

To provide a comprehensive review of the ocular manifestations, outcomes, and genetic findings in patients with Coats-like retinitis pigmentosa (RP). Multicenter, retrospective, nonconsecutive case series. Patients with a diagnosis of RP demonstrating Coats-like exudative vitreoretinopathy between January 1, 2008, and October 1,2019. Evaluation of ocular findings at RP diagnosis and at time of presentation of Coats-like exudative vitreoretinopathy, pedigree analysis, genetic testing, retinal imaging, and anatomic outcomes after treatment. Visual acuity, ophthalmoscopy results, OCT results, fluorescein angiography results, and identification of genetic mutations. Nine patients diagnosed with RP and demonstrating Coats-like exudative vitreoretinopathy were included. Median age at time of RP diagnosis was 8 years (range, 1-22 years), and median age at presentation of Coats-like exudative vitreoretinopathy was 18 years (range, 1-41 years). Seven patients were female, and 2 were male. The genetic cause of disease was identified in 6 patients. Three patients demonstrated Coats-like fundus findings at the time of RP diagnosis. Exudative retinal detachment (ERD) localized to the infratemporal periphery was present in all patients, with bilateral disease observed in 7 patients. In all treated patients, focal laser photocoagulation was used to treat leaking telangiectasias and to limit further ERD expansion. Cystoid macular edema refractory to carbonic anhydrase inhibitor therapy and ultimately amenable to treatment with intravitreal anti-vascular endothelial growth factor injection was observed in 4 patients. Coats-like vitreoretinopathy is present in up to 5% of all RP patients. The term Coats-like RP is used colloquially to describe this disease state, which can present at the time of RP diagnosis or, more commonly, develops late during the clinical course of patients with longstanding RP. Coats-like RP is distinct from Coats disease in that exudative pathologic features occur exclusively in the setting of a coexisting RP diagnosis, is restricted to the infratemporal retina, can affect both eyes, and does not demonstrate a male gender bias. Given the risk of added vision loss posed by exudative vitreoretinopathy in patients with RP, a heightened awareness of this condition is critical in facilitating timely intervention.

Assessment of the Dynamic Alteration of Choriocapillaris Vessel Density after Focal Laser Photocoagulation with OCT Angiography.

Purpose To evaluate the changes of choriocapillaris blood flow beneath laser lesions in noncenter-involved diabetic macular edema patients using optical coherence tomography angiography (OCTA). Methods This was a retrospective case-series study. We used OCTA to analyze the characteristics of the choriocapillaris blood flow beneath laser lesions before laser treatment and at several intervals after treatment. The choriocapillaris vessel density (CCVD) beneath the laser lesions was based on the OCTA images and was defined as the proportion of flow pixels in the selected area calculated using FIJI software through automatic binarization processing based on threshold methods. Results A total of 63 laser lesions in 8 eyes of 5 patients were included in this study. There was a significant decrease in the CCVD at 1 hour and 1 day following laser treatment (24.25% ± 5.04% and 22.00% ± 4.71%, respectively) when compared with the baseline value (39.09% ± 3.71%, all p < 0.001). The CCVD was 31.82% ± 4.53% in 1 week after laser treatment, which was significantly higher than that in 1 day after treatment (p < 0.001). The CCVD was 31.82% ± 4.53% in 1 week after laser treatment, which was significantly higher than that in 1 day after treatment (p < 0.001). The CCVD was 31.82% ± 4.53% in 1 week after laser treatment, which was significantly higher than that in 1 day after treatment (Conclusions OCTA image analysis can reflect changes in the choriocapillaris blood flow beneath laser lesions at different times following laser treatment in vivo. Spot size and laser energy may affect blood flow recovery.