Clinical Utility of Ultra-Widefield Fundus Photography with SS-OCT Images in Justifying Prophylactic Laser Photocoagulation of Peripheral Retinal Lesions

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Abstract
We aimed to validate the feasibility of combining ultra-widefield (UWF) fundus photography with targeted swept-source optical coherence tomography (SS-OCT) for clinical decision-making regarding a prophylactic laser therapy. For this purpose we enrolled 119 patients (135 eyes) who, basis on fundus examination, were eligible for prophylactic photocoagulation of degenerative retinal lesions. Eyes were classified into two groups: (1) justified laser, when SS-OCT confirmed vitreoretinal traction and/or subretinal fluid beneath the neurosensory retina; and (2) non-justified laser, when SS-OCT did not confirm these criteria. Using this SS-OCT-guided UWF approach, we found that 25.1% of eyes that initially qualified for laser based on clinical examination did not meet the SS-OCT criteria. Patients in the justified laser group were significantly younger than those in the non-justified group. Horseshoe retinal tears, lattice degeneration and snail-track degenerations, multiple lesions, and lesions located in the far and mid-periphery were significantly more frequent in the justified laser group than in the non-justified group. By contrast, the prevalence of operculated holes, bilateral lesions, and degenerative lesions in patients with a retinal detachment in the fellow eye did not differ between groups. Our findings suggest the SS-OCT-guided UWF imaging may refine patient selection for prophylactic laser therapy.

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