What is the role of scatter photocoagulation in the treatment of hemoglobinopathy retinopathy?

Updated: Sep 03, 2019
  • Author: Brian A Phillpotts, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Scatter photocoagulation appears to be the most efficacious (and therefore the preferred) treatment of sea fan lesions.

The desired photocoagulation endpoint is regression of extraretinal fibroneovascular tissue.

Localized scatter photocoagulation is effective in treating early proliferative changes, especially neovascular lesions that lie flat against the retina. Once neovascularization invades the vitreous, localized scatter photocoagulation appears to be less effective.

Circumferential scatter photocoagulation places laser burns over a retinal zone of one of the following: at least 3 disc diameter areas of the nonperfused retina, as outlined by fluorescein angiography, or the entire avascular retina, as determined by fluorescein angiography or estimated by the distribution of the occluded vessel.

Unlike feeder vessel coagulation, scatter photocoagulation is easier to perform, more effective, and safer. This technique reduces the incidence of vitreous hemorrhage.

However, in cases where scatter photocoagulation alone does not achieve the desired result (ie, regression of proliferative changes), feeder vessel photocoagulation may be used as an adjunct to induce infarction to the remaining sea fans.

Follow-up care is usually within 1 week after laser surgery to rule out retinal detachment from contracture of the neovascular membrane after laser treatment.

After the first follow-up visit, monthly follow-up visits are advocated to confirm and monitor the regression of the neovascularization.

Insufficient treatment indicated by failure or arrest of the regression of the neovascularization requires further laser treatments at the time of follow-up care.

New or recurrent neovascularization in the treated eye is treated in the similar manner.


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