Selektive behandlung des RPE unter verwendung eines gescannten cw-laserstrahls im kaninchenmodell

Background. Selective RPE laser therapy with sparing of the neurosensory layer is possible by applying repetitive microsecond laser pulses. Macular diseases such as diabetic maculopathy, soft confluent drusen due to age-related macular degeneration or central serous chorioretinopathy were shown to be treated successfully-without concurrent laser scotoma-by this technique. It was the goal of this study to show, if selectivity could also be achieved using a conventional green cw-laser by scanning the beam across the retina during irradiation. Material and methods. A cw-laser beam at 532 nm was coupled to a slitlamp via a single mode optical fiber. The spot (18 μm) was scanned across the retina of Dutch-belted rabbits through a contact lens using a two-dimensional acusto-optical deflector. The scan-field was 300 μm x 300 μm in size and consisted of six separate scan lines. The scanning speed was adjusted so as to produce 5 μs exposure at each absorber in the center of the scan line. The entire scan pattern was applied 100 times at each site at a frame rate of 100 Hz. Dose response curve was measured by variation of the laser power. ED₅₀-thresholds for RPE damage were calculated by fluorescein angiographic leakage in irradiated areas after exposure to different laser intensities. The extent of selectivity was examined by light microscopy. Results. Clinically the selective laser-induced RPE defect was demonstrated by fluorescein angiographic leakage and concurrent absence of ophthalmoscopic visibility. The angiographic ED₅₀-damage threshold was 161 mJ/cm ² (66 mW). Ophthalmoscopic visibility was not noticed even with the maximum available radiant exposure of 438 mJ/cm² (180 mW). Thus the safety range between angiographic and ophthalmoscopic thresholds had a factor of at least 2.7. First histological examinations revealed selective RPE destruction with intact photoreceptors for irradiation at laser power levels 2 times above angiographic threshold. Conclusion. Selective RPE targeting is feasible with a conventional green cw-laser when scanning the focused laser beam across the fundus with a speed such that every point in exposed RPE is irradiated for duration of 5 μs.