From the Editor
It has been almost half a century since Meyer-Schwickerath first presented his classic monograph on Lichtkoagulation. Utilizing his recently constructed Zeiss Xenon Photocoagulator, he introduced numerous potential applications and techniques for the treatment of anterior as well as posterior segment ocular diseases with photocoagulation. In spite of his creative genius and his remakable insight, I doubt that he could have possibly envisioned the explosive technological breakthroughs offered by photobiological scientists and the innovative applications introduced by ophthalmic clinicians since his pioneering work. Since in the early 1950s Meyer-Schwickerath successfully used his xenon-arc photocoagulator to treat retinal tears photocoagulating lasers have enjoyed the most widespread application of any type of ophthalmic laser system. Their applications include glaucoma management as well as retinal vascular diseases. When faced with an especially difficult case of glaucoma that has not responded to medical therapy or more conventional surgical intervention, many surgeons have turned to a cyclodestructive procedure in the hope of lowering the intraocular pressure by reducing aqueous production. This surgical approach, however, is considered by most surgeons to be a “last-resort” effort, because the past techniques all cause significant damage to ocular tissues with associated high complication rates. Wahl etal. report on “controlled cyclophotocoagulation”, which is a new laser technique with feedback control capable of guiding the treatment by real-time monitoring offering a significantly less rate of complications.
Stoffelns describes his experience with the infrared diode laser in photocoagulation of parafoveal choroidal neovascular membranes (CNV's) in age-dependent macular degeneration (AMD). The small size and low maintenance of the unit as well as the good penetration of retinal edema and cataractous lenses are advantages that may lead to more widespread use of the diode laser. In developed countries, AMD is the leading cause of severe and irreversible central visual loss in persons aged more than 50 years. Although the neovascular form of AMD is estimated to develop in approximately 14% of patients with AMD, this form accounts for 88% of the legal blindness associated with this condition. Berger et al. and Feucht et al. report on new treatment modalities especially for AMD with subfoveal CNV location, which are much more selective to the neovascular membrane and relatively safe with regard to the surrounding neurosensory retina because of the lower power levels employed in photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) than in photocoagulation.
Frising et al. and Kociecki et al. describe efficacy and histopathological findings after TTT for malignant choroidal melanoma, which is the most common primary malignant intraocular tumor in adults. In comparison to plaque radiotherapy, which is the standard treatment modality for this tumor and leads to disappointing functional results because of radiation side-effects, TTT promises a better visual outcome.
Dick et al. referred on the Erbium: or Neodymium: YAG Laser for phacoemulsification in cataract surgery and vitrectomy. The first results of pilot studies are encouraging, and justify the further examination of this new surgical method.
After more than 30 years of use, laser photocoagulation of retinal disorders remains one of our more efficient therapeutic approaches in our daily practice. Laser surgery is considered by patients and by ophthalmologists less invasive than instrumental endocular surgery. Nowadays laser use in ophthalmology is very diversified, with a laser treatment for refractive disorders, glaucoma management, and cataract surgery. Lasers appear to many patients as the “magic response” to ocular diseases.
Document Type: Miscellaneous
Publication date: 2002-12-01