Macular Degeneration Clinical Trial
To determine whether scatter argon laser photocoagulation can prevent the development of
neovascularization.
To determine whether peripheral scatter argon laser photocoagulation can prevent vitreous
hemorrhage.
To determine whether macular argon laser photocoagulation can improve visual acuity in eyes
with macular edema reducing vision to 20/40 or worse.
Retinal branch vein occlusion (BVO) is the second most common retinal vascular disease after
diabetic retinopathy. Many treatments for this disorder were attempted before 1977, but none
were proven to be effective. The only treatment that seemed at all promising in preventing
visual loss from BVO was laser photocoagulation.
Approximately 500 patients were enrolled in the study. One-half were randomly assigned to
treatment with argon laser photocoagulation; the other one-half remained untreated as
controls. For BVO with or without neovascularization, scatter treatment of 100 to 400 laser
burns was applied in the drainage area of the occluded vein site, avoiding the fovea and
optic disc. Individual laser burns were 200 to 500 microns in diameter with an exposure time
of 0.1 to 0.2 seconds. For macular edema, burns of 50 to 100 microns in diameter with
exposure time of 0.05 to 0.1 seconds were used. A fluorescein angiogram less than 1 month
old had to have been available for each patient. Treatment was performed under topical
anesthesia using the argon laser to achieve a grid pattern over the area of capillary
leakage identified by fluorescein in the macular region. Photocoagulation was extended no
closer to the fovea than the edge of the foveal avascular zone and did not extend
peripherally beyond the major vascular arcade. The efficacy of treatment was judged on the
basis of visual acuity measurements as well as assessment of the subsequent development of
neovascularization and/or vitreous hemorrhage. Patients were followed for at least 3 years.
;
Allocation: Randomized, Primary Purpose: Treatment
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