PARTIAL LASER-ABLATION OF MASSIVE PERIPAPILLARY SUBRETINAL NEOVASCULARIZATION

Background: Although peripapillary subretinal neovascular membranes (P SRNs) are less common and often larger than neovascular complexes aris ing near the fovea, they may lead to severe visual loss. Very large (m assive) PSRNs (MPSRNs) are 3.5 disc areas or greater in overall size, are even less common, and may contain a significant occult component, leading to slow and unpredictable growth. Such massive lesions may beg in at the nasal margin of the disc and do not become symptomatic until they have extended around the disc toward the macula, threatening cen tral vision. Although complete laser ablation has been used for sympto matic PSRNs with variable success, the optimal treatment of MPSRNs rem ains controversial. Methods: The authors reviewed the clinical course of 12 eyes of seven patients with MPSRNs. Ten eyes received laser trea tment, which was limited to the temporal portion of the subretinal neo vascular complexes only and two received no treatment. Results: Of the ten eyes receiving laser treatment, six showed stabilization of visua l acuity, whereas in four the neovascular membrane progressed beneath the fovea with severe visual loss. In the two untreated eyes, the subr etinal neovascular membrane progressed beneath the macula with the los s of central vision. Conclusions: In contrast to the small symptomatic PSRNs, which are usually treated by complete laser ablation, MPSRNs m ay stabilize with only partial laser treatment. However, both types of lesions may remain stable for long periods of time without any treatm ent and require treatment only if progression toward the fovea occurs.