Macular Degeneration: Luttrull JK

Luttrull JK, Spink CJ. · · Retina. · Pubmed #17621176 No free full text.

Abstract: PURPOSE: To determine the incidence and effect of persistent/prolonged choroidal hypofluorescence (PCH) following combined verteporfin photodynamic therapy and intravitreal triamcinolone acetate injection (PDT + IVTA) for age-related subfoveal choroidal neovascularization (CNVM). METHOD: A retrospective review of all patients undergoing PDT + IVTA for CNVM from December 2003 through November 2004 was performed. Included patients underwent intravenous fundus fluorescein angiography (FA) preoperatively and 1 week and 3 months following PDT. FA presence of persistent choroidal hypofluorescence (PCH) 3 months postoperatively was graded in each eye by comparison with the 1 week postoperative FA. Twenty-seven eyes treated with PDT alone before December 2003 served as controls. RESULTS: A total of 53 eyes of 46 patients were identified for study. At 3 months post treatment, PCH was noted in 37/53 eyes (70%) receiving PDT + IVTA combination therapy compared to only 3/27 (11%) control eyes treated with PDT alone (P<0.0001; Fisher two-tailed exact test). CONCLUSION: The findings suggest that IVTA prolongs the native PDT effect manifest by post treatment FA CH. This phenomenon may reflect a mechanism by which IVTA enhances the effectiveness of PDT. Further study is necessary to confirm and elucidate this possible association.

Luttrull JK, Spink CJ. · No affiliation provided · Ophthalmic Surg Lasers Imaging. · Pubmed #17017196 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: To use serial optical coherence tomography (OCT) to evaluate low-intensity, high-density subthreshold diode laser micropulse photocoagulation treatment of clinically significant diabetic macular edema. PATIENTS AND METHODS: Eighteen consecutive eyes of 14 patients with clinically significant diabetic macular edema and a minimum foveal thickness of 223 microm or greater were prospectively evaluated by OCT preoperatively and 1, 4, and 12 weeks following treatment. RESULTS: Overall, estimated macular edema 3 months postoperatively (minimum foveal thickness--223 microm) was reduced a mean of 24% (P = .02). Eleven eyes treated for recurrent or persistent clinically significant diabetic macular edema following prior treatment more than 3 months before study entry were most improved, with a mean reduction in estimated macular edema 3 months postoperatively of 59%. No treatment complications were observed. No patient demonstrated laser lesions following treatment. CONCLUSIONS: Low-intensity, high-density subthreshold diode laser micropulse photocoagulation can reduce or eliminate clinically significant diabetic macular edema measured by OCT. Further study is warranted.

Luttrull JK, Musch DC, Mainster MA. · Private Practice, 3160 Telegraph Road, Suite 230, Ventura, CA, 93003, USA. · Br J Ophthalmol. · Pubmed #15615751 links to  free full text

Abstract: AIM: To report the visual and clinical outcomes of a pilot study of subthreshold diode micropulse (SDM) laser photocoagulation for clinically significant diabetic macular oedema (CSMO). METHODS: The results of infrared (810 nm) SDM laser photocoagulation for CSMO were retrospectively reviewed in 95 eyes of 69 consecutive patients with mild to moderate non-proliferative diabetic retinopathy. The same laser parameters were used for each patient. Only the number of laser applications varied between patients, depending on their macular findings. Primary outcome measures were Snellen visual acuity, fluorescein angiographic leakage, and CSMO status. RESULTS: Visual acuity was stable or improved in 85% of treated eyes, with a mean follow up of 12.2 months (range 3-29 months). CSMO decreased in 96% and resolved in 79% of treated eyes. No adverse laser events occurred. No laser lesions were detectable ophthalmoscopically or angiographically after treatment, consistent with calculations based on ANSI Z136.1 laser safety standards suggestive of only histologically detectable tissue effects at the laser exposure levels. No laser scarring was observed during the follow up period. CONCLUSION: Subthreshold diode micropulse laser photocoagulation minimises chorioretinal damage in the management of CSMO and demonstrates a beneficial effect on visual acuity and CSMO resolution. Prospective studies are needed to fully evaluate this technique.