This 63YO female underwent incredibly intense, confluent, and posterior panretinal photocoagulation (PRP) and macular laser elsewhere before transferring her care to our office. Vision was hand motion OD and 20/400 OS.
The laser performed on this patient is wrong on so many levels, including spots extending to the macula, touching the nerve, and confluent elsewhere. The laser surgeon essentially gave this patient severe iatrogenic retinitis pigmentosa.
Learning Points:
PRP should begin at least 1 disc diameter from the optic nerve and outside the major temporal arcades. Treatment is performed with a wide-angle lens or an indirect ophthalmoscope and should be applied from the posterior retina towards the periphery to prevent accidental macular burns.
The laser spots should be 200-500 microns in size at the retina, spaced about one burn width apart, and extend as far anteriorly as possible.
