PROPHYLACTIC LASER TREATMENT IN EARLY AGE-RELATED MACULOPATHY REDUCEDTHE INCIDENCE OF EXUDATIVE COMPLICATIONS

Aim-To investigate the effect of prophylactic laser treatment on druse n area and incidence of exudative lesions in patients with soft drusen maculopathy. Methods-In a prospective study, patients with early age related maculopathy (ARM) and good visual acuity were randomised to la ser treatment or to a control group. Each group consisted of two subgr oups: a fellow eye group and a bilateral drusen group. At 3 years, 36 of 38 enrolled patients remained in the study. Photocoagulation was pe rformed with an argon green laser, approximately 100 mild laser burns being placed on and between the drusen in a perifoveal temporal horses hoe-shaped area. Both cases and controls were subjected to fundus colo ur photographs and fluorescein angiograms at regular intervals, and th e drusen area was calculated in both photographs and angiograms. At ba seline, there were no significant differences (p>0.3-0.8) in drusen ar ea between the groups. Results-In the treatment group, mean drusen are a decreased significantly in the fundus photographs as well as in the angiograms (p<0.001). Visual acuity and colour contrast sensitivity (C CS) did not change significantly. All these results are valid also for the subgroups. In the control group, however, mean drusen area increa sed significantly (p<0.001). Mean visual acuity decreased significantl y (p<0.01) as did the colour contrast sensitivity along the tritan axi s (p=0.02). For the fellow eye control group (n=7), the increase in dr usen area in fundus photographs and the decrease in CCS along the trit an axis were not statistically significant (p=0.57 and p=0.37, respect ively). Furthermore, at 3 years, five patients in the control group sh owed exudative lesions (1/7 in the fellow eye group and 4/12 in the bi lateral drusen group), whereas no such complications occurred in the t reatment group. One patient developed a small atrophy, however. Thus, there is now a significant difference (p=0.047), however with a large 95% confidence interval, 0.06-0.46, regarding exudative complications between the treated group and the control group in our small patient m aterial. Conclusion-Perifoveal mild laser treatment causes a reduction in drusen area in patients with soft drusen maculopathy and may lower the incidence of exudative lesions.