Efficacy of YAG Laser Embolysis in Retinal Artery Occlusion

Abstract

Objective: To compare the anatomical and functional success between conventional medical method and Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) laser embolysis in retinal artery occlusion.
 Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi from July 2018 to May 2020. A total of 14 eyes of 14 patients were received with fovea involving branch or hemiretinal artery occlusion within 24 hours of onset of symptoms. They were divided randomly in two groups. Initial treatment was given to all cases, and seven eyes received Nd:YAG laser treatment for embolysis. Both groups were analysed for anatomical success (reperfusion) and functional success (defined as improvement in visual acuity to better than 6/60 on Snellen’s visual acuity chart from baseline visual acuity).
 Results: In conventional group, anatomical success was achieved in 2 (28.6%) eyes, while significant visual improvement was seen in 3 (42.8%) eyes. In Nd:YAG laser embolysis group, anatomical success was achieved in 5 (71.4%) eyes, while significant visual improvement was seen in 6 (85.7%) eyes. All eyes which showed functional improvement underwent Nd:YAG laser embolysis within 6 hours of onset of symptoms.
 Conclusions: Nd:YAG laser embolysis is more effective in management of fovea threatening retinal artery occlusion, as compared to conventional medical treatment, if performed within six hours of onset of symptoms.
 doi: https://doi.org/10.12669/pjms.37.1.3196
 How to cite this:Mehboob MA, Khan A, Mukhtar A. Efficacy of YAG Laser Embolysis in Retinal Artery Occlusion. Pak J Med Sci. 2021;37(1):71-75. doi: https://doi.org/10.12669/pjms.37.1.3196
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aetiology, Diagnosis and Treatment of Arterial Occlusions of the Retina—A Narrative Review

“…If the occluding embolus is visible, transluminal YAG-Laser embolysis can be considered [81][82][83]. This procedure should be performed within 6 h after the onset of the symptoms.…”

“…Shots of 0.5 mJ (milli-Joule) were applied directly to the embolus in order to eject it into the vitreous via an opening in the arteriole. However, this procedure comes with risks of severe complications such as retinal or vitreous hemorrhage, retinal breaks, choroidal neo-vascularization and the formation of epiretinal membranes [1,[81][82][83].…”

Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases

“…Surgical interventions, including neodymium-doped yttrium aluminum garnet (Nd:YAG) laser embolysis and thrombolysis therapy using tPA (tissue-type plasminogen activator), are still controversial because they do not have established evidence, and there are several risks of hemorrhagic complications [ 79 , 80 ]. Besides, fibrinolytic agents cannot dissolve cholesterol nor calcified material [ 9 ].…”