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Laser photocoagulation is one of the important methods for treating retinal diseases, and retinal laser technology continues to advance. For decades, researchers have been striving to find a laser treatment that can minimize tissue damage while achieving optimal results. With low toxicity, low scattering light, strong penetrating power, small compared with the traditional laser damage, light reaction and no pain, the 577 nm subthreshold micropulse laser(SML)turns this goal into reality and ushers in a new era of laser treatment for fundus diseases. This article reviews the concept, mechanism, related parameters and clinical application progress of 577 nm SML in a variety of retinal diseases, aiming to provide references for clinical treatments.
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Central serous chorioretinopathy(CSC)is a common macular degeneration that primarily affects young patients. While the disease may resolve on its own to some extent, delayed or inadequate treatment can result in recurrence and progression to chronic CSC. This can lead to complications such as retinal pigment epithelium(RPE)atrophy and choroidal neovascularization, ultimately causing irreversible damage to central vision. Subthreshold micropulse laser photocoagulation(SMLP)is a type of laser therapy that differs from traditional lasers in that it does not cause damage or thermal injury to RPE cells and photoreceptors. SMLP has become widely used in clinical treatment of CSC due to its effectiveness, safety, and reproducibility, particularly in cases where verteporfin is not available in photodynamic therapy(PDT). The purpose of this review is to explain the mechanism of SMLP in CSC and summarize the effector cells, cytokines, and mechanisms of action involved in its treatment. This will provide a theoretical basis for promoting and rationalizing the use of SMLP in clinical practice.
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Central serous chorioretinopathy (CSC) is a common macular disease, which can lead to the loss of central vision in young patients. Although the disease is self-limited to some extent, there is no shortage of patients with prolonged course and recurrent attacks, eventually leading to irreversible visual impairment. Therefore, taking reasonable treatment in a certain period is particularly important for the visual prognosis of patients. Although thermal laser photocoagulation of leakage points and photodynamic therapy (PDT) have achieved good effects, there are risks of retinal damage and retinal pigment epithelium atrophy. Subthreshold micropulse laser (SMLP) is a kind of subthreshold short pulse laser, which does not cause visible damage to the retina and is safer. In the era of lack of PDT drugs, SMLP has gradually become an important means of clinical treatment for CSC, especially for patients with no obvious leakage point or subfoveal leakage point. An in-depth understanding of the mechanism of action of SMLP and its efficacy and safety in the treatment of CSC is helpful for the promotion and application of SMLP in the clinical treatment of CSC.
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Central serous chorioretinopathy (CSC) is a common macular disease, mainly manifested as a plasma detachment of the macula. Photodynamic therapy (PDT) is an effective treatment for CSC, but with the shortage of the photosensitizer Verteporfin, the effective treatment of CSC has become a common concern for ophthalmologists. In this paper, based on the latest research results on the relationship between the changes in the thickness of the outer nuclear layer and the natural course of the disease and PDT therapy, we propose that patients with CSC should receive effective treatment as early as possible to prevent irreversible damage to visual function due to the thinning of the outer nuclear layer. In addition to PDT, it is recommended that laser photocoagulation or subthreshold micropulse laser treatment of the leaking spot should be considered first, depending on the presence of the leaking spot and its location in relation to the macula center. Anti-vascular endothelial growth factor therapy can be considered if there is a combination of choroidal neovascularization and/or polypoidal choroidal vasculopathy. Other treatments that have not been demonstrated to be effective in evidence-based medicine are not recommended.
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Objective:To observe the efficacy of intravitreal injection of conbercept (IVC) combined with subthreshold micropulse laser photocoagulation (SMLP) in the treatment of diabetic macular edema (DME).Methods:A randomized controlled trial. From December 2020 to January 2022, 100 patients (100 eyes) with DME diagnosed by examination in Shanxi Aier Eye Hospital were included in the study. The patients were randomly divided into IVC group (50 eyes) and IVC+SMLP group (50 eyes). All the eyes were treated with IVC once a month for 3 times, and the eyes in IVC+SMLP group were treated with SMLP within 2 weeks after IVC. All affected eyes were examined by best corrected visual acuity (BCVA), which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by optical coherence tomography. Before the treatment, the logMAR BCVA of patients in IVC group and IVC+SMLP group were 0.56±0.04 and 0.55±0.03, respectively. The CMT were (437.36±11.35) μm and (434.58±10.88) μm, respectively. There was no significant difference in logMAR BCVA and CMT between the two groups ( t= 0.476, 1.027; P>0.05). The patients were followed up for 12 months after treatment. The times of IVC and the changes of BCVA and CMT were compared between the two groups. Independent sample t-test was used to compare the logMAR BCVA, CMT and times of IVC between groups. Results:After 12 months treatment, the logMAR BCVA of IVC group and IVC+SMLP group were (241.63±29.79) μm and (240.47±30.46) μm, respectively. Compared with those before treatment, 12 months after treatment, the BCVA of the two groups increased significantly ( t=7.014, 5.608; P<0.001), while CMT decreased significantly ( t=8.126, 6.013; P<0.001). There was no significant difference in BCVA and CMT between the two groups ( t=0.835, 0.764; P>0.05). The number of IVC in IVC group and IVC+SMLP group were (8.15±2.04) times and (5.91±1.80) times, respectively, and the difference was statistically significant ( t=5.210, P<0.001). Conclusions:Both IVC+SMLP and IVC alone can effectively reduce CMT and increase BCVA in patients with DME. Combination therapy can reduce the number of IVC.
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Central serous chorioretinopathy (CSC) is a primary disease that affects the vision of young and middle-aged people.Its treatment is difficult because of its high incidence and easy recurrence.Currently, the commonly used clinical treatment methods for CSC include photodynamic therapy, traditional laser photocoagulation, subthreshold micropulse laser photocoagulation (SDM), anti-vascular endothelial growth factor therapy, and so on.SDM is a high-frequency, short, subthreshold and selective laser, which is preferred by many clinicians because of its low energy, good safety, small trauma and so on.Different wavelengths of laser can be absorbed by different pigments in the eye, so the therapeutic wavelengths of SDM for different sites of CSC are also different.In SDM treatment, it is necessary to determine the effective treatment range and parameters to avoid undertreatment or overtreatment.In this article, the mechanism of SDM in the treatment of CSC, the difference of SDM under different wavelengths, the selection of treatment site and parameters, the efficacy and safety were reviewed, and the prospect of SDM in the future was envisioned.
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AIM: To analyze the clinical effect of 577nm subthreshold micropulse laser(SML)photocoagulation combined with intravitreal injection of Conbercept in the treatment of diabetic macular edema(DME)after vitrectomy in patients with proliferative diabetic retinopathy(PDR).METHODS:A retrospective analysis was performed on 29 cases(30 eyes)of PDR patients who had DME after vitrectomy in our hospital from January 2019 to June 2021. They were divided into two groups according to different treatment methods: 14 cases(14 eyes)in the single injection group received intravitreal injection of Conbercept, and 15 cases(16 eyes)in the combined treatment group received 577nm SML photocoagulation in the macular area combined with intravitreal injection of Conbercept. The changes in best corrected visual acuity(BCVA)and central macular thickness(CMT)before and at 6 and 12mo after treatment, as well as the changes of multifocal electroretinogram(mfERG)before and at 12mo after treatment were compared between the two groups.RESULTS: The BCVA(LogMAR)of patients in both groups improved and CMT decreased after treatment for 6 and 12mo(all P<0.001). There were no significant differences in BCVA(LogMAR)and CMT before treatment and 6mo, 12mo after treatment between single injection group and combined treatment group(all P>0.05). Compared with the combined treatment group, the amplitude was slightly lower(23.02±3.13 vs. 26.50±3.33 μV/deg2)and the latency time was prolonged(38.75±1.62 vs. 34.21±3.06ms)in single injection group at 12mo(all P≤0.001). The average injection times in single injection group was 8.14±1.46, and 5.05±1.51 in combined treatment group at 12mo after treatment(P<0.05).CONCLUSION: 577nm SML photocoagulation combined with intravitreal injection of conbercept can effectively relieve macular edema, improve BCVA and visual function of macular area and reduce the injection times of conbercept for DME patients.
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Purpose: To study the effect of subthreshold micropulse yellow laser treatment on central serous chorioretinopathy (CSC) and to compare two laser protocols. As per our knowledge, there are no studies comparing the two protocols of subthreshold laser. Methods: Twenty-three patients with non-resolving CSC of at least three months duration were treated with subthreshold laser (577 nm). Ten patients were treated with 5% duty cycle (group A) and 13 patients with 10% duty cycle (group B). At one month, best corrected visual acuity (BCVA), central macular thickness (CMT), subretinal fluid (SRF), choroidal thickness (CT) and choroidal vascularity index (CVI) were evaluated. Results: In group A, BCVA improved from 0.508 ± 504 to 0.174 ± 0.171 (P = 0.0058), CMT improved from 349.8 ± 168.9 micrometers (mm) to 183.3 ± 70.312 mm (P = 0.0093) and SRF reduced from 202.4 ± 158.024 to 43.8 ± 46.599 mm (P = 0.0069). In group B, BCVA improved from 0.437 ± 0.426 to 0.289 ± 0.470 (P = 0.0026), CMT improved from 280.846 ± 72.668 to 196.769 ± 72.62 mm (P = 0.0002) and SRF reduced from 110.385 ± 57.687 mm to 52.538 ± 52.111 mm (P = 0.0064). No significant difference was found in BCVA and CMT between the groups (P = 0.8716 and P = 0.8523, respectively). CSC completely resolved in 50% of cases in group A and in 69.2% of cases in group B. This difference was not statistically significant (0.423); however, the odds ratio of resolution was 2.25 times more with 10% duty cycle. No change was observed on fundus autofluorescence (FAF) following laser. Conclusion: Subthreshold micropulse laser can lead to resolution of SRF in 60.87% of cases (groups A and B combined). Ten per cent duty cycle had higher odds of resolution without causing any RPE damage.
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Objective:To explore the influence of sub-threshold autistic traits on social avoidance and distress of senior high school freshmen, as well as the mediating effect of perspective taking, and to investigate the intervention effect of perspective taking intervention project on improving the ability of perspective taking and reducing social avoidance and distress behavior of high sub-threshold autistic traits individuals.Methods:A total of 1 401 subjects were investigated with the autism-spectrum quotient (AQ), interpersonal reactivity index-C (IRI-C) and social avoidance and distress (SAD) from September 1st to September 30th, 2018. According to the screening criteria of 27% statistically, totally 378 subjects were selected according to the scores of autistic spectrum quotient scale from high to low as the high sub-threshold autistic traits group. The top 32 subjects with high scores of autistic spectrum quotient scale were selected and randomly divided into intervention group and control group with 16 subjects in each group. The modified viewpoint selection group counseling program was used to conduct intervention research on 16 subjects with high sub-threshold autistic traits. SPSS 26.0 was used for common method deviation test, descriptive analysis, correlation analysis and repeated measurement variance analysis, and SPSS 26.0 PROCESS plug-in was used for intermediary effect analysis.Results:(1) The scores of sub-threshold autistic traits, perspective taking, social avoidance and distress of freshmen in senior high school were (113.26±11.35), (12.34±3.95) and (10.84±6.42) respectively. (2) Sub-threshold autistic traits, perspective taking, social avoidance and distress were significantly correlated with each other( r=-0.11-0.52, all P<0.01). (3) Sub-threshold autistic traits had a significant direct effect on social avoidance and distress, with a direct effect value of 0.28, accounting for 96.55% of the total effect.The total indirect effect of perspective taking on social avoidance and distress was significant, with the total indirect effect value of 0.01, accounting for 3.45% of the total effect. (4) In the intervention group, the perspective taking score of the post-test (15.69±3.86) was significantly higher than that of the pre-test (10.56±4.18) ( P<0.01). In the control group, there was no significant difference in the scores of perspective taking before and after the test((10.63±3.69), (11.44±3.03)) ( P>0.05). (5) In the intervention group, the scores of social avoidance and distress in the post-test (6.38±5.01) were significantly lower than that in the pre-test (15.00±6.07) ( P<0.001). In the control group, the score of social avoidance and distress in the post-test (15.81±6.33) was lower than that in the pre-test (19.00 ±5.38) ( P<0.05), but the scores of social avoidance and distress in the intervention group decreased even more. Conclusion:Perspective taking plays an mediating role between sub-threshold autistic traits and social avoidance and distress. Group counseling based on perspective taking was helpful to improve the perspective taking ability of people with high sub-threshold autistic traits and reduce social avoidance and distress behaviors.
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Objective:To understand the status quo of subthreshold depression and its influencing factors among students in comprehensive universities, and then provide a research basis for promoting their mental health and effectively controlling the occurrence of depression.Methods:From October 2020 to January 2021, 450 undergraduates from 45 comprehensive universities in China were selected as research objects by convenient sampling and snowball sampling, and were investigated by a general information questionnaire and Self-Subthreshold Depression Scale (STDS).Results:The subthreshold depression score of the investigated college students was (83.28 ± 24.81), and the incidence of subthreshold depression was 40.8%(164/450). There were statistically significant differences in the incidence of subthreshold depression among different genders, grades, life satisfaction, family economic status, love status, understanding degree of subthreshold depression, time of depression, psychological counseling related to depression, and behavior after depression ( χ2 values were 5.68-19.48, all P<0.05). Conclusions:The incidence of subthreshold depression among the investigated undergraduates is high, and never falling in love is the protective factor of subthreshold depression. The risk factors of subthreshold depression are freshmen, who think they have never had depression and don′t know much about subthreshold depression.Attention should be paid to the present situation of college students' subthreshold depression, early detection and intervention should be made to prevent the development of depression, so as to improve the mental health level of college students.
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AIM: To comparatively analyze the efficacy of subthreshold laser photocoagulation with the NAVILAS&#xAE; Laser system and subthreshold micropulse laser for patients with chronic central serous chorioretinopathy(cCSC).METHODS: A retrospective clinical study. A total of 36 patients(40 eyes)with cCSC were recruited from January 2020 to January 2021 diagnosed at the Affiliated Eye Hospital of Nanjing Medical University. There were 19 patients(23 eyes)treated with subthreshold navigated laser photocoagulation(the Navilas group), and 17 patients(17 eyes)treated with subthreshold micropulse laser(SML)(the SML group). There was no significant difference in baseline data between the two groups(P>0.05). The best corrected visual acuity(BCVA, LogMAR), central macular thickness(CMT), subretinal fluid(SRF)height, vessel densities of the superficial capillary plexus(SCP), the deep capillary plexus(DCP)and area of the foveal avascular zone(FAZ)were collected at 2wk, 1, 3 and 6mo before and after treatment.RESULTS: The BCVA of the two groups were significantly higher than that before treatment at 3 and 6mo after surgery(P<0.05),which was significantly reduced at 2wk after treatment in the Navilas group and was reduced at 1mo after treatment in the SML group(P<0.05). In both groups, there was significant decrease compared with that before treatment at 3 and 6mo after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05). The difference in SRF absorption between the two groups was statistically significant(P<0.05), and the complete absorption rate of SRF in the Navilas group was higher than that in the SML group. SCP, DCP, the area of the FAZ were not significantly different from each time ofbaseline in the two groups(P >0.05).CONCLUSION: Subthreshold laser photocoagulation with the NAVILAS&#xAE; Laser system can rapidly improve the retinal morphology and shorten the course of cCSC to improve the recovery of visual function with its rapid effect, high cost-effectiveness, non-invasiveness and high repeatability, which can be a new clinical method for patients with cCSC.
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Objective:To observe the safety and effectiveness of targeted navigation laser with continuous wave threshold power in the treatment of chronic central serous chorioretinopathy (CCSC).Methods:A retrospective clinical study. From November 2018 to June 2020, 28 eyes of 28 patients with CCSC diagnosed in the Eye Hospital of Nanjing Medical University were included in the study. Among them, there were 17 males with 17 eyes and 11 females with 11 eyes; all of them had a monocular disease. The average age of the patients was 36.24±5.14 years, and the average course of the diseases was 4.7±1.3 months. All affected eyes underwent best corrected visual acuity (BCVA), fluorescein fundus angiography, fundus autofluorescence, frequency domain optical coherence tomography and angiography, multifocal electroretinogram (mf-ERG) and micro field inspection. BCVA was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. A targeted navigation laser system was used for continuous wave power therapy under the threshold. Two weeks and 1, 3 months after treatment, the same equipment and methods as before treatment were used to perform related examinations to observe the BCVA, subfoveal choroidal thickness (SFCT), foveal retinal thickness (CMT), the mean light sensitivity (MS) in the 10° range of the macular center, and the amplitude density of P 1 wave at ring 1 and 2. The t test was used to compare CMT, SFCT, retinal amplitude density and MS before and after treatment. Results:Before treatment and 2 weeks, 1 and 3 months after treatment, the average logMAR BCVA of the eyes were 0.74±0.16, 0.57±0.16, 0.22±0.05, 0.21±0.06, and the average CMT was 512.33±31.56, 350.40±36.61, 256.49±22.38, 253.45±23.65 μm respectively, the average SFCT was 462.82±25.38, 462.37±39.54, 461.51±29.36, 461.25±34.55 μm, the average MS was 16.32±5.41, 17.53±4.23, 19.52±4.12, 21.35±2.77 dB respectively. At different times before and after treatment, BCVA ( t=6.52, 5.71, 6.01; P=0.00, 0.00, 0.00), CMT ( t=3.08, 6.57, 4.90; P=0.01, 0.00, 0.00), SFCT ( t=7.01, 6.54, 4.85; P=0.08, 0.07, 0.17), MS ( t=6.17, 4.25, 5.46; P=0.02, 0.00, 0.00), the difference was statistically significant. The amplitude density of P 1 wave at ring 1 in the affected eye was 64.37±18.25, 85.31±13.98, 98.35±14.52, 98.40±22.17 nV/deg 2, and the amplitude density of P 1 wave at ring2 was 36.12±18.32, 44.02±17.15, 62.35±14.85, 63.17±15.79 nV/deg 2. The amplitude density of P 1 wave at ring 1 ( t=5.11, 9.03, 4.27; P=0.03, 0.00, 0.00) and ring 2 ( t=5.11, 9.03, 4.27; P=0.03, 0.00, 0.00) before and after treatment showed statistical significance. Conclusion:Targeted navigation laser continuous wave threshold power treatment for CCSC can increase the BCVA, macular retinal amplitude density and macular foveal MS, and reduce CMT and SFCT.
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Purpose: To compare the efficacy of subthreshold micropulse yellow laser (SMYL) and intravitreal aflibercept injection (IAI) combination therapy with IAI monotherapy in the treatment of diabetic macular edema (DME) and to evaluate the number of injections and SMYL sessions required. Methods: This prospective study compared a group of 28 patients treated with a combination of SMYL and IAI with a group of 28 patients treated only with IAI. All patients initially received 3 monthly IAIs, and the monotherapy group was given additional injections as needed. The combination therapy patients additionally received SMYL after the loading phase. The primary outcome measures were the change in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to month 12; the secondary outcomes were the mean number of required injections and SMYL sessions. Results: In the monotherapy group, the BCVA improved from 0.38 � 0.10 to 0.20 � 0.10 logMAR; in the combination group, BCVA improved from 0.40 � 0.09 to 0.17 � 0.06 logMAR at the end of the 12th month. The CMT was reduced from 451.28 � 44.85 to 328.8 � 49.69 ?m in the monotherapy group and from 466.07 � 71.79 to 312.0 � 39.29 ?m in the combination group. Improvement of the mean BCVA and reduction of the mean CMT were similar in each group. The combination group required significantly fewer injections (3.21 � 0.41 vs 5.39 � 1.54; P < 0.001). By month 12, 75% of patients in the monotherapy group had required additional IAIs when compared with 16% in the combination group (P < 0.001). Conclusion: SMYL combination therapy demonstrated significant visual improvements in patients with DME. In the combination group, the retreatment rate and number of required injections were significantly lower compared with the IAI monotherapy group.
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Sub-threshold depression refers to a psychological sub-health state that fails to meet the diagnostic criteria for depression. Appropriate intervention can improve the state and reduce the risks of disease development. In this paper, we focus on music neurofeedback stimulation improving emotional state of sub-threshold depression college students.Twenty-four college students with sub-threshold depression participated in the experiment, 16 of whom were members of the experimental group. Decompression music based on spectrum classification was applied to 16 experimental group participants for 10 min/d music neural feedback stimulation with a period of 14 days, and no stimulation was applied to 8 control group participants. Three feature parameters of electroencephalogram (EEG) relative power, sample entropy and complexity were extracted for analysis. The results showed that the relative power of α、β and θ rhythm increased, while δ rhythm decreased after the stimulation of musical nerofeedback in the experimental group. The sample entropy and complexity were significantly increased after the stimulation, and the differences of these parameters pre and post stimulation were statistically significant ( < 0.05), while the differences of all feature parameters in the control group were not statistically significant. In the experimental group, the scores of self-rating depression scale(SDS) decreased after the stimulation of musical nerofeedback, indicating that the depression was improved. The result of this study showed that music neurofeedback stimulation can improve sub-threshold depression and may provides an effective new way for college students to self-regulation of emotion.
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@#AIM: To systematically review the difference between the efficacy of 577nm subthreshold micropulse diode laser and conventional laser in the treatment of diabetic macular edema(DME).<p>METHODS:Retrieved from PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, CQVIP, and CECDB databases, randomized controlled trials(RCT)and retrospective clinical control trials(CCT)about the difference between the efficacy of 577nm subthreshold micropulse diode laser and conventional laser in the treatment of diabetic macular edema were collected. The search time was from the establishment of the library until August 2019. Meta-analysis was performed by using RevMan 5.3/Stata 14.0 software after screening the literature, extracting the data, and evaluating the quality of the literature by two researchers.<p>RESULTS: A total of 7 studies, 6 RCTs and 1 CCT involving 401 patients and 545 eyes were included. The results of Meta-analysis showed that the best corrected visual acuity(BCVA)measured values in the 577nm subthreshold micropulse diode laser group were higher than the conventional laser group \〖95% <i>CI</i>(0.02, 0.08), <i>P</i>=0.002\〗. The macular retinal thicken measured values in the 577nm subthreshold micropulse diode laser group was significantly lower the conventional laser group \〖95% <i>CI</i>(-26.96 to -10.88), <i>P</i><0.00001\〗. The mean sensitivity within macular 10° examination measured values in the 577nm subthreshold micropulse diode laser group was significantly higher than that conventional laser group \〖95% <i>CI</i>(1.56 to 2.39), <i>P</i><0.00001\〗.<p>CONCLUSION: 577nm subthreshold micropulse diode laser can not only better improve the visual function of patients with DME, but also have a higher safety in treatment. 577nm subthreshold micropulse diode laser has good research value for the treatment of DME, it's worthy of application and promotion in clinical practice.
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@#AIM: To analyze the morphological changes of macular soft drusen and drusenoid pigmental epithulium detachment(DPED)after subthreshold micropulse laser treatment(SMLT).<p>METHODS: Fourteen patients(20 affected eyes)with soft drusen and DPED clinically confirmed from August 2016 to October 2018, were included in this study. 577 nm yellow laser of SMLT was applied for soft drusen and DPED. The changes of soft drusen and DPED in best corrected visual acuity(BCVA)(LogMAR)and height, diameter and cross-sessional area according to fundus autofluorescence and SD-OCT examinations were observed after SMLT.<p>RESULTS: BCVA was not significant difference after treatment of soft drusen(<i>P</i>=0.260), and the DPED(<i>P</i>=0.736)than that of the baseline. Compared with the baseline values, the height and cross-sessional area of soft drusen were reduced at the 6mo after treatment(<i>P</i>=0.008, <i>P</i>=0.034). Compared with the baseline values, the differences were not statistically significant in height, diameter and cross-sectional area of DPED after treatment.<p>CONCLUSION: BCVA was not reduced for drusen and DPED after SMLT, however, the height and cross-sessional area of soft drusen was reduced compared with those before treatment, and the differences were not statistically significant in height, diameter and cross-sectional area of DPED before and after treatment. The results indicated that SMLT was effective for soft drusen, but was not effective for short-term treatment of DPED. SMLT caused no damage to the visual acuity in treatment of soft drusen and DPED, but prospective, controlled, large sample and long-term follow-up studies should be required.
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@#Subthreshold micropulse laser(SML)consists of short repetitive pulses of laser. This kind of treatment is safe and cheap, and contrary to conventional laser photocoagulation(LPC), SML doesn't involve destruction of retinal cells and leave no scars. The possible mechanism of SML is to stimulate retinal pigment epithelium(RPE)cells for the production of heat shock proteins(HSPs)and regulate its metabolism and improve its function. The clinical indication of SML includes central serous chorioretinopathy(CSC), diabetic retinopathy edema(DME), nonproliferative diabetic retinopathy(NPDR)and proliferative diabetic retinopathy(PDR)and macular edema(ME)secondary to retinal vein occlusion(RVO). This article discussed the mechanism and safety of SML and reviewed the updates of its application.
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?AIM:To analyze the morphological changes of macular soft drusen and drusenoid pigmental epithulium detachment ( DPED ) after subthreshold micropulse laser treatment ( SMLT) .?METHODS: Fourteen patients ( 20 affected eyes ) with soft drusen and DPED clinically confirmed from August 2016 to October 2018, were included in this study. 577 nm yellow laser of SMLT was applied for soft drusen and DPED. The changes of soft drusen and DPED in best corrected visual acuity ( BCVA ) ( LogMAR ) and height, diameter and cross-sessional area according to fundus autofluorescence and SD - OCT examinations were observed after SMLT.?RESULTS: BCVA was not significant difference after treatment of soft drusen (P=0.260), and the DPED (P=0. 736 ) than that of the baseline. Compared with the baseline values, the height and cross-sessional area of soft drusen were reduced at the 6mo after treatment ( P=0. 008, P=0.034) . Compared with the baseline values, the differences were not statistically significant in height, diameter and cross - sectional area of DPED after treatment.?CONCLUSION: BCVA was not reduced for drusen and DPED after SMLT, however, the height and cross -sessional area of soft drusen was reduced compared with those before treatment, and the differences were not statistically significant in height, diameter and cross -sectional area of DPED before and after treatment. The results indicated that SMLT was effective for soft drusen, but was not effective for short-term treatment of DPED. SMLT caused no damage to the visual acuity in treatment of soft drusen and DPED, but prospective, controlled, large sample and long-term follow-up studies should be required.
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@#AIM: To compare the clinical effects and safety of single subthreshold micropulse(STMP)yellow laser and combined ranibizumab intravitreal injection on the treatment of diabetic macular edema(DME).<p>METHODS: Totally 33 patients(58 eyes)with DME were divided into two groups. Group A(laser group)received STMP yellow laser, and group B(combined treatment group)received ranibizumab intravitreal injection combined with STMP yellow laser. The best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT), total macular volume(TMV), fluorescein fundus angiography(FFA), multifocal ERG(MERG), autofluorescence(AF)and macular pigment optical density(MPOD)were compared before and after the treatments. And treatment times were counted. <p>RESULTS:Compared with those before treatment, there were significant differences in BCVA and TMV 6, 9, 12mo after treatment in the laser group(<i>P</i><0.05). And there were significant differences in BCVA and TMV 3, 6, 9, 12mo after treatment in the combined treatment group(<i>P</i><0.05). For both groups, there were significant differences in CMT before and 3, 6, 9, 12mo after treatment(<i>P</i><0.01). Compared with the P1 amplitude of MEG, Max OD and Mean OD before treatment, there were significant differences for the two groups 12mo after treatment(<i>P</i><0.01). And the differences were significant in TMV and P1 amplitudes between the two groups after 12mo of treatment(<i>P</i><0.01). During the follow-up period, the laser times was 3.32±1.09 in the laser group and 3.30±1.18 in the combined treatment group(<i>P</i>=0.943).<p>CONCLUSION:Both single STMP laser and combined with intravitreal injection of ranibizumab can effectively reduce macular edema, improve vision and safety in DME patients. And the combined treatment group has faster and better effect.
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@#AIM: To systematically review the difference between the efficacy of 577nm subthreshold micropulse diode laser and conventional laser in the treatment of diabetic macular edema(DME).<p>METHODS:Retrieved from PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, CQVIP, and CECDB databases, randomized controlled trials(RCT)and retrospective clinical control trials(CCT)about the difference between the efficacy of 577nm subthreshold micropulse diode laser and conventional laser in the treatment of diabetic macular edema were collected. The search time was from the establishment of the library until August 2019. Meta-analysis was performed by using RevMan 5.3/Stata 14.0 software after screening the literature, extracting the data, and evaluating the quality of the literature by two researchers.<p>RESULTS: A total of 7 studies, 6 RCTs and 1 CCT involving 401 patients and 545 eyes were included. The results of Meta-analysis showed that the best corrected visual acuity(BCVA)measured values in the 577nm subthreshold micropulse diode laser group were higher than the conventional laser group \〖95% <i>CI</i>(0.02, 0.08), <i>P</i>=0.002\〗. The macular retinal thicken measured values in the 577nm subthreshold micropulse diode laser group was significantly lower the conventional laser group \〖95% <i>CI</i>(-26.96 to -10.88), <i>P</i><0.00001\〗. The mean sensitivity within macular 10° examination measured values in the 577nm subthreshold micropulse diode laser group was significantly higher than that conventional laser group \〖95% <i>CI</i>(1.56 to 2.39), <i>P</i><0.00001\〗.<p>CONCLUSION: 577nm subthreshold micropulse diode laser can not only better improve the visual function of patients with DME, but also have a higher safety in treatment. 577nm subthreshold micropulse diode laser has good research value for the treatment of DME, it's worthy of application and promotion in clinical practice.