Grid laser photocoagulation on decompensated retinal pigment epithelium: adjunct to treatment of choroidal neovascularization

ABSTRACT

Decompensated retinal pigment epithelium is believed to be the prime risk factor for development of exudative maculopathy and choroidal neovascularization. Simulataneous treatment of both choroidal neovascularization and decompensated retinal pigment epithelium has not been reported previously. Over a six-year period, we used argon laser photocoagulation to treat 78 eyes with age-related macular degeneration that had juxtafoveal choroidal neovascularization and decompensated retinal pigment epithelium. With fluorescein angiography, decompensated retinal pigment epithelium was characterized by late diffuse leakage around the macula, seen in addition to the typical leakage from choroidal neovascularization, either well or poorly defined. The choroidal neovascularization received standard laser treatment, and grid laser treatment was applied to the decompensated retinal pigment epithelium as well. Follow-up of 36 months or more was observed in 38 eyes; 27 [71%] of these eyes still had visual acuity of 20/200 or better at 36 months, and 11 [29%] had visual acuity less than 20/200. We suggest that whenever a juxtafoveal neovascular membrane is accompanied by decompensated retinal pigment epithelium in an eye with age-related macular degeneration, the treatment protocol should include grid pattern photocoagulation to the decompensated retinal pigment epithelium, in addition to the traditional treatment of choroidal neovascularization