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. 1997 Jul;81(7):568–573. doi: 10.1136/bjo.81.7.568

Scanning laser fundus perimetry before laser photocoagulation of well defined choroidal neovascularisation

K Rohrschneider 1, R Gluck 1, M Becker 1, F Holz 1, F Kruse 1, T Fendrich 1, H Volcker 1
PMCID: PMC1722252  PMID: 9290371

Abstract

AIM—To assess the centre of fixation before laser photocoagulation of well defined juxtafoveal or extrafoveal choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD), and to better predict visual function after treatment using scanning laser ophthalmoscope (SLO) fundus perimetry.
METHODS—19 consecutive eyes with juxtafoveal or extrafoveal CNV were examined by fundus perimetry before and after laser treatment with documentation of the fixation point using the SLO. The stability of fixation was defined as standard deviation around the mean fixation point. Overlays of fluorescein angiographic pictures and fundus perimetry were obtained using image analysis software.
RESULTS—Fundus perimetry allowed accurate determination of the centre of fixation. Overlays demonstrated the precise geographic relation of the angiographically detectable foveal margin of the CNV and the centre of fixation. Thereby, prediction of the visual outcome with regard to reading ability was facilitated. Stability of fixation did not change significantly after treatment.
CONCLUSIONS—Fundus perimetry using the SLO was helpful in patients who underwent laser treatment for juxtafoveal or extrafoveal CNV secondary to AMD and may aid the pretreatment counselling of such patients.



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Figure 1  .

Figure 1  

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Comparison of the visibility of the choroidal neovascularisation (CNV) using different illumination wavelengths in a left eye. (A) Fundus image using the SLO with argon blue light, as obtained during beginning of the angiography, does not show the CNV. (B) Midphase of angiography clearly outlines the choroidal neovascular membrane. (C) Fundus image obtained using infrared diode laser of the SLO with mean fixation point and a circle demonstrating the standard deviation of fixation; the CNV is clearly visible.

Figure 2  .

Figure 2  

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Results of static fundus perimetry in a right eye of a patient with choroidal neovascularisation (CNV). (A) Standard image with threshold values according to the right hand scale with brightest stimuli at the top and smallest contrast between stimuli and background at the bottom. Single fixation points are drawn as yellow dots. (B) Results converted onto the mid time sequence of fluorescence angiography which enables direct visualisation of mean fixation point in relation to classic CNV.

Figure 3  .

Figure 3  

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Example of subjectively poor visual outcome in a left eye after treatment although visual acuity by conventional testing has remained unchanged. The mean fixation point is located at the right margin of the laser scar at the fundus (yellow points). This will lead to a scotoma at the left of the point of fixation which makes reading more difficult owing to missing of the words or digits which have just been read. Kinetic perimetry shows an absolute scotoma (0 dB, Goldmann II, red circle) and a larger relative scotoma (5 dB purple, 10 dB blue, 15 dB green).

Figure 4  .

Figure 4  

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Right eye of a 67-year-old woman first presenting with decrease of visual acuity in the left eye. Right eye showed nearly normal perimetric results with the SLO (right hand scale with brightest stimuli at the top and smallest contrast between stimuli and background at the bottom) and central fixation (yellow dots) while angiography demonstrates macular degeneration without defined leakage (A). (B) Six months later juxtafoveolar CNV nasally of the fovea can be seen during fluorescein angiography, mean fixation point has shifted temporally and stability of fixation is worse (red circle). (C) Four months after laser treatment no recurrence can be seen, visual acuity is 0.4, and reading ability is improved subjectively. Location and stability of fixation as measured during SLO perimetry are about the same.    

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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