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Eye (2007) 21, 742745 & 2007 Nature Publishing Group All rights reserved 0950-222X/07 $30.00
www.nature.com/eye
D Shukla, R Maheshwari and R Kim
CLINICAL
STUDY
Barrage laser photocoagulation for macula-sparing asymptomatic clinical rhegmatogenous retinal detachments
Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
Correspondence: D Shukla, Retina-Vitreous Service, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, 1 Anna Nagar, Madurai 625 020, Tamil Nadu, IndiaTel: 91 452 4356100; Fax: 91 452 2530984. E-mail: [email protected], daksh66@ rediffmail.com
Abstract
Purpose To evaluate the efcacy of barrage laser photocoagulation in containing macula-sparing asymptomatic clinical retinal detachments (RD).Methods Consecutive patients presenting with asymptomatic clinical RD were prospectively treated with barrage photocoagulation in 23 conuent rows, using frequency-doubled Nd:YAG (532 nm) laser on an indirect-ophthalmoscopic delivery system. The patients were reviewed at 0.5, 1.5, 3, and 6 months, and yearly thereafter. Best-corrected visual acuity (BCVA), and stability/ progression of rhegmatous retinal detachment beyond the barrage were noted at eachvisit.Results Nineteen phakic eyes of 17 patients (nine female patients), aged 1258 years (average: 26 years), underwent barrage laser treatment. Two women had bilateral RD. Most detachments were caused by atrophic holes, and involved at least a quadrant of retina. Seven (37%) extended superiorly with breaks above the horizontal raphe. Three eyes had partial demarcation lines, and ve had posterior vitreous detachment at presentation. The minimum follow-up was 6 months (mean: 21 months; range: 6108 months). Pretreatment anatomical and functional status was maintained in 18 (95%) eyes till the nal visit. One superotemporal RD progressed across the laser barrier into macula 5 months after photocoagulation, and BCVA dropped to 6/18. Scleral buckling was performed successfully, with visual recovery to 6/6. Conclusions Barrage photocoagulation may have a place in management of asymptomatic
clinical detachments, as an effective and less morbid alternative to scleral buckling. Eye (2007) 21, 742745; doi:10.1038/sj.eye.6702318; published online 17 March 2006
Keywords: barrage; photocoagulation; retinal detachment; demarcation; prophylaxis
Introduction
The decision to treat a disease is often based on the presence or absence of symptoms, one prototype case being rhegmatogenous retinal detachment (RRD). Literature is clear about the urgency of surgery for symptomatic RRD, but equivocal on the management of an asymptomatic detachment.14 The premise of symptom-based treatment is inherently unreliable owing to its subjective nature: a...