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SUMMARY A group of 20 patients (28 eyes) with proliferative retinopathy who required extensive argon laser photocoagulation to induce regression of new vessels is presented. The mean number of burns applied to each eye was 7225, with a maximum of 11513. These were delivered in a mean of nine sessions over a mean period of 22.9 months. Twenty-five eyes (89%) had a final visual acuity of 6/18 or better. The remaining three eyes (11%) had severely reduced vision attributable to complications of proliferative diabetic retinopathy (traction retinal detachment involving the macula in two eyes and ischaemic maculopathy and a persistent vitreous haemorrhage in the third). Large amounts of confluent argon laser photocoagulation may be necessary for the elimination of new vessels in some patients, and it is our view that laser photocoagulation should be continued until regression of new vessels occurs. This is compatible with the retention of functional vision and good visual acuity.Proliferative diabetic retinopathy is characterised by neovascularisation at the optic disc or in the peripheral retina. Recurrent vitreous haemorrhage and its sequelae and traction retinal detachment cause visual loss. It is the commonest cause of blindness between the ages of 30 and 65 years.' Several controlled trials have proved the benefit of photocoagulation in the treatment of proliferative diabetic retinopathy.2 The largest of these was the Diabetic Retinopathy Study (DRS), which showed that a single session of photocoagulation reduced the incidence of severe visual loss (defined as a visual acuity of less than 5/200) in treated eyes.2 The beneficial effect of photocoagulation is associated with the regression of retinopathy risk factors (RRF), particularly new vessels on the disc (NVD).' The question whether additional treatment is beneficial was not addressed by these trials, but it is widespread clinical practice to apply further laser photocoagulation until regression of new vessels occurs. How many burns can be applied? We present a group of 20 patients (28 eyes) who were included in the study because their disc new vessels required an excess of 5000 burns to induce regression, an end point which had not been achieved with lesser numbers of burns.Correspondence to Mr R V Pearson. FRCS. 197Patients and methodsThe appointment records of patients attending the Diabetic Clinic at Moorfields Eye Hospital were analysed with the outpatient computer. The case notes of those attending regularly for treatment over the last year were examined. Patients who had received more than 5000 argon laser burns to at least one eye were identified. Patients who had further photocoagulation pending, or who had received xenon arc photocoagulation or direct treatment to disc new vessels, were excluded from the study. Information was extracted from the notes regarding age, duration of diabetes, treatment of diabetes, visual acuity, indication for photocoagulation, presence of maculopathy and its treatment, clarity of media, number of burns, number of treat...

We wish to report a case of sex linked juvenile retinoschisis with optic disc and peripheral retinal neovascularisation. Both forms of neovascularisation resolved following panretinal photocoagulation. Optic disc neovascularisation has not been previously reported with this condition, though peripheral retinal vascular anomalies are well recognised. Case reportThe patient, a 24-year-old white male, first attended Moorfields Eye Hospital at the age of 7 years when referred with poor visual acuity at school eye testing. At that time his best corrected visual acuities were Snellen 6/36 in the right and 6/24 in the left eye. Slitlamp biomicroscopic examination revealed bilateral foveal retinoschisis in a 'wheel-like' configuration ( Fig. 1). Peripheral retinoschisis was absent. A general examination gave normal results. Low visual aids were dispensed when, at the age of 10 years, binocular distance visual acuity had deteriorated to 6/60 unaided.There was a family history of sex linked retinoschisis, the patient's maternal grandfather having the condition. The mother and the twin sister of the patient were not, however, affected.At the age of 20 the patient was re-examined after developing a symptomatic floater in the visual field of the right eye. His best corrected visual acuities at this time were 1/60 right and 6/36 left. Vitreous haemorrhage precluded examination of the fundus of the right eye. The right visual acuity improved to 6/36 as the vitreous haemorrhage cleared, but no source for the haemorrhage could be detected clinically at this stage. A further three vitreous haemorrhages occurred in the right eye during the next seven months, after which time fine, forward new vessels were detected at the right optic disc (Fig. 2) together with tortuosity of the peripheral retinal vessels. Flat new vessels in the retinal periphery were observed in the superonasal quadrant of the left eye.Correspondence to Mr R Pearson, FRCS. 311Fluorescein angiography showed leakage of the dye from new vessels originating on the right optic disc (Fig. 3) and in the retinal periphery, together with areas of non-perfusion of the retinal capillary circulation in the periphery. There was leakage from peripheral retinal new vessels in the left eye, but no disc neovascularisation was present.Panretinal photocoagulation of the right eye with argon blue-green laser was administered in three sessions over a five-month period, with regression of the neovascularisation within four months of the final treatment session (Fig. 4). A horizontal traction fold of the internal limiting membrane was noted to have formed accross the right macula (Fig. 4). Laser treatment was not administered to the left eye, and the peripheral new vessels underwent sheathing followed by spontaneous resolution.Three years after panretinal photocoagulation the best attainable visual acuities were 6/36 right, and 6/60 left. Ophthalmoscopy showed bilateral cystoid macular oedema, peripheral retinoschisis, patchy sheathing of peripheral retinal vessels, many of which were ...