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|Year : 1986 | Volume
| Issue : 1 | Page : 37-8
Xenon arc photocoagulation in the treatment of central serous retinopathy.
Bhatti SK, Adrianwala SD, Jehangir RP
|How to cite this article:|
Bhatti S K, Adrianwala S D, Jehangir R P. Xenon arc photocoagulation in the treatment of central serous retinopathy. J Postgrad Med 1986;32:37
|How to cite this URL:|
Bhatti S K, Adrianwala S D, Jehangir R P. Xenon arc photocoagulation in the treatment of central serous retinopathy. J Postgrad Med [serial online] 1986 [cited 2020 Feb 22];32:37. Available from: http://www.jpgmonline.com/text.asp?1986/32/1/37/5368
The use of krypton laser for the treatment of recalcitrant or recurrent episodes of central serous retinopathy is well established. What is not so widely appreciated is that xenon arc photocoagulation can often be used equally effectively, and is indeed theoretically superior to argon laser for this purpose, though not as good as krypton laser. This study documents our experience in five cases of central serous retinopathy treated with xenon arc photocoagulation.
Five cases of central serous retinopathy who did not resolve spontaneously in six weeks or who had recurrence were chosen for this study. Fluorescein angiography or angioscopy was used to document the side of leakage of dye and pigment epithelial defect. Only those cases with a leakage well outside the foveal avascular zone were treated.
A clinitex Log-2 xenon are photocoagulator was used to deliver burns (size 1.5° or 3° with a power of 6 and duration of 1 to 1.5 seconds) varying between 8 and 20 in number to the leaking area as per the accepted procedure. The larger number of burns were used when the initial few did not produce an adequate chorioretinal reaction as estimated visually.
[Fig. 1] shows the side and site affected, leakage site vision of the affected eye before and after photocoagulation. Vision returned to 6/6 in all patients after 7-10 days of treatment. Fundus examination 2 weeks after photocoagulation showed a faint chorioretinal reaction and repeat fluorescein angiographies showed that pigment epithelial leaks were absent. [Fig. 2] and [Fig. 3].
Our results show that xenon are photocoagulation is safe and effective in the treatment of selected cases of central serous retinopathy. The aim of treatment of central serous retinopathy by photocoagulation is to cause a low grade photothermal injury to the pigment epithelial cells. The regenerating cells then slide over and obliterate the pigment epithelial defect responsible for the lesion and its fluoroscein angiographic picture. However, at the same time, the macular pigment should not absorb this radiation; otherwise macular structural damage occurs. The absorption of radiant energy by the retinal pigment epithelium and the macular pigment epithelium respectively is 25% and 3.5% in the case of xenon arc; 78% and 49% in the case of argon laser and 79% and 0% in the case of krypton laser. Thus krypton laser is the safest method of photocoagulation followed by xenon.
In practice, krypton laser is not always available and xenon are photocoagulation close to macula is considered risky because the smallest spot size with xenon are is 1.5° (450 microns) in contrast to a minimum spot size of about 50 microns with the laser and the mode of delivery is by a direct ophthalmoscopic device which does not stabilize the eye as does the contact lens used for laser photocoagulators. The slightest eye movement during the long (1 to 1.5 second) exposure time could cause a foveal burn with disastrous visual consequences.
We minimized the effect of these variables by choosing only those cases with fluoroscein leaks outside the foveal avascular zone and by using 5 ml of local anaesthetic for the retrobulbar injection to cause absolute immobility of the eyeball. Normally about 2 ml of anaesthetic is adequate for most ocular procedures requiring ocular akinesia.
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|2.||Peyman, G. A., Sanders, D. R. and Goldberg, M. F.: "Principles and Practice of Ophthalmology". W. B. Saunders Company, Philadelphia, 1980, p. 928. |
|3.||Spalter, H. F.: Photocoagulation of central serous retinopathy, a preliminary report. Arch. Ophthalmol., 79: 247-263, 1968. |