NEODYMIUM-YLF PICOSECOND LASER SEGMENTATION FOR RETINAL TRACTION ASSOCIATED WITH PROLIFERATIVE DIABETIC-RETINOPATHY

PURPOSE: To determine the applicability of laser segmentation for seve ring fibrovascular tissue and hyaloid interfaces in the treatment of t ractional complications of proliferative diabetic retinopathy. METHODS : A prototype neodymium:yttrium-lithium-fluoride (Nd:YLF) picosecond p ulse photodisruptive laser was used in eight eyes (seven patients) wit h proliferative diabetic retinopathy as part of a Food and Drug Admini stration-approved phase 1 protocol. There were three indications for t reatment: type I: distortion and shallow elevation of the macular caus ed by taut, adherent, posterior hyaloid interface (two eyes); type II: traction retinal detachment involving the fovea (two eyes); and type III: fovea-threatened, traction retinal detachment (four eyes). Tracti on release was accomplished by laser segmentation of the detached hyal oid interfaces and fibrotic, contracted proliferative tissue. The Nd:Y LF uses low pulse energy (0.10 mJ, 1,000 pulses per second for 10 cons ecutive seconds) that allows tissue cutting near the retinal surface. RESULTS: Both type I eyes had relief of traction forces; visual acuity improved from 20/400 to 20/50 in one eye; the other remained stable. Of the two type II eyes, one had anatomic reattachment of the fovea wi th improvement in visual acuity (hand movements to 20/50); the second required vitrectomy. Of the four type III eyes, all had anatomic impro vement; three maintained pretreatment acuity; the fourth eye developed vitreous hemorrhage at 6 months and underwent vitrectomy. Three treat ments (two eyes) caused vitreous hemorrhage that resulted in a transie nt drop in acuity (1 to 2 lines). No patient developed a retinal break or choroidal hemorrhage. CONCLUSION: In a small pilot study, the Nd:Y LF laser segmented proliferative tissue near the retinal surface and e levated hyaloid interfaces. In selected cases, this may enable flatten ing of traction retinal detachment or release of retinal distortion.