Dense laser at the papillomacular bundle does not cause loss of visual function

Abstract

Introduction: Juxtapapillary laser (JPL) photocoagulation in the region of the papillomacular bundle, temporal to the optic nerve, has become routine care in disorders such as optic disc pit maculopathy. Despite evidence demonstrating safe and effective use of this approach, there is still a lack of consensus in the literature, due to the perceived risk of loss of visual function. Instances of such misplaced caution could result in inadequate treatment protocols. Methods: An observational series of five cases of optic disc pit maculopathy, treated with dense temporal juxtapapillary endolaser, in a single tertiary ophthalmic hospital. Results: None of the reported cases of optic disc pit maculopathy treated with dense juxtapapillary laser demonstrated anatomical or perimetric findings consistent with nerve fiber layer damage in the region of the papillomacular bundle. Conclusions: This series demonstrates that dense laser photocoagulation, in the vicinity of the papillomacular bundle, does not cause structural damage to the nerve fiber layer or associated loss of visual function in optic disc pit maculopathy. Appropriate application of juxtapapillary laser is a safe and effective treatment for various macular pathologies.

Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature

“…Thus, it should not affect the most superficial layers of the retina and the RNFL. However, there are conflicting evidence on potential damages to the papillomacular bundle, some authors considering them unlikely [31], while others have reported significant visual field defect [32]. In all cases, laser should be performed cautiously, using the lowest energy as possible.…”