[Retinal pigment epithelial tears after photocoagulation in age-related macular degeneration]

Retinal pigment epithelial tears after photocoagulation for subretinal new-vessels complicating age related macular degeneration were observed in 20 patients between 1980 and 1988. The patients, 4 males and 16 females, aged from 60 to 86 years (mean: 72.5) were followed up between 12 and 53 months (mean: 21 months). Laser photocoagulation was performed for directly visible lacy subretinal new-vessels (6 cases) or vascularized pigment epithelial detachment (10 cases) or both lesions associated (4 cases). Krypton laser (17 cases), blue-green argon laser and/or orange dye laser (625 nm) (3 cases) were applied in one (9 cases) to four sessions. Retreatment (11 cases) was performed for persistent subretinal new-vessels (3 cases) or recurrences (4 cases) or appearance of a pigment epithelial detachment after photocoagulation for isolated SRNV (4 cases). The tear was observed on fluorescein angiography 10 to 180 days after the last session. It was preceded by occurrence of subretinal hemorrhages, increase in size of the PED or newly formed PED. It appeared on the border of the PED (16 cases) usually temporally, or on the immediate border of the laser scar (4 cases). Further evolution was rapidly defavorable with dramatic impairment of vision and constitution of fibrovascular scar in the macular area. Only 4 eyes progressed to flat atrophic scars after retreatment and retained useful central vision (0.1 to 0.2). Factors which could explain this complication following laser treatment of age related macular degeneration are discussed.