The advantage of fundus-controlled microperimetry is a precise examination of the impact of morphological changes on psychophysical functions of the macula. Due to its simultaneous registration of fixation fundus-oriented microperimetry is a very informative aid in the indication of laser therapy and the selection of different laser procedures in the treatment of subretinal neovascularizations.
After detachment surgery without drainage there can be: (1) convex or (2) concave "residual" detachment and (3) rhegmatogenous residual detachment with new contour (reoperation needed). Favorable longterm results after minimal surgery (6.5% "late" redetachment during 11 years postoperatively) and use of minimal surgery as reoperation (50% a balloon) for reattaching the retina do not support the necessity of a prophylactic cerclage as primary operation, even not as reoperation per se. A simple alternative to a surgical prophylaxis represents a so-called "passive" prophylaxis consisting in explaining the visual field to the patient and asking him to test it regularly.
In 1981 a 47-year-old white woman was given a total of 9 g of DPH for treatment of epilepsy. A rare hereditary defect in the metabolism of this drug caused toxic blood levels for about three months and led to persistent neurologic and ophthalmologic disturbances. In addition to an atrophy of the cerebellum, demonstrated by a CT scan, the predominant ophthalmologic findings were bilateral reduced visual acuity (0.1) and restricted visual fields (15 degrees). Despite intensive clinical and electrophysiologic investigations it proved impossible to localize the site of damage in the ascending visual pathway. Only VECP to patterns of low contrast (0.2) exhibited a pathologic response. It was concluded that persistent visual disturbances due to DPH intoxication are caused by a more centrally located action of this drug.
In contrast to focal laser treatment of large subfoveal neovascular membranes, perifoveal laser treatment sparing the central avascular zone can partially retain central macular function in some cases. The anatomical and functional outcome of this technique was analysed in 26 patients with large subfoveal neovascular membranes (0.6 to 3.0 disc diameter) secondary to age-related macular degeneration (24 cases) or presumed ocular histoplasmosis syndrome (two cases). Patients were followed for six to 39 months. Out of 26 patients 21 had a stable dry scar at the last follow-up examination. Central fixation was retained postoperatively in nine out of 13 patients with central fixation prior to laser treatment. Visual acuity was maintained or improved in 19 out of 26 treated eyes. Statpack analysis (Humphrey Field Analyser) of the long-term results of patients with central fixation indicated an increase in the depth of their relative central scotoma not only immediately after laser treatment but also in the first and second postoperative years. This increasing depth of central scotoma subsequently led to a shift of central fixation to a paracentral area in four out of nine patients six to nine months after treatment. Indocyanine-green angiography showed remaining subfoveal choroidal vasculature corresponding to the area of central fixation, as found in fundus microperimetry by scanning laser ophthalmoscope. Perifoveal laser treatment seems to be effective in maintaining some initial macular function for a limited time in selected patients suffering from subfoveal neovascular membranes.
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