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Development and clinical application of a fiber optic laser delivery probe for subretinal endophotocoagulation

Development of choroidal neovascularization (CNV) beneath the center of the retina (macula) occurs in a variety of conditions and is a major cause of vision loss. New surgical instruments with sizes smaller than 0.4 mm have been developed to allow direct access to the subretinal space in an effort to treat or remove these subretinal membranes. These instruments include forceps, scissors, aspiration tubes, etc. Laser photocoagulation may add another valuable tool in the treatment of these membranes. Traditional photocoagulation of membranes is achieved by applying transretinal laser, but this damages the retina itself. A direct method of endophotocoagulation via a retinotomy may allow treatment while minimizing damage to the overlying retina. In this paper we describe the development and use of a .23 mm (32 ga) laser delivery probe for endophotocoagulation of subretinal choroidal neovascular tissue. The design consists of a 100 micrometer silica core fiber in a stainless steel needle, shaped for insertion through the retinotomy and into the subretinal space. The fiber tip is designed for beam delivery 27 degrees from the fiber axis, thus allowing direct photocoagulation of the treatment area. Clinical use of the delivery system operating with argon ion (488, 514 nm) laser will be discussed.