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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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Purpose: To study the safety and efficacy outcomes of Micropulse Transscleral Cyclophotocoagulation (MP?TSCPC) as a primary versus additional therapy in eyes with uncontrolled glaucoma. Methods: This was a prospective, interventional, comparative study. All patients with advanced and refractory glaucoma treated with MP?TSCPC from April 2020 to December 2020 were recruited in this study. Results: A total of 77 eyes of 77 patients were analyzed. Group A (n = 33), included patients with advanced glaucoma at high risk for invasive surgery, who underwent MP?TSCPC as the primary intervention, and group B (n = 44) included patients who had undergone previous surgical intervention and MP?TSCPC was used additionally to control the intraocular pressure (IOP). Mean IOP and mean number of antiglaucoma medications were 34.06 (13.9) mmHg and 3.64 (0.7), respectively, in group A and 35.61 (11.5) mmHg and 3.73 (0.9), respectively, in Group B. Postoperatively, the mean IOP and percentage of IOP reduction were significantly lower at 1, 3, and 6 months, that is, 20.78 (32%), 22.07 (30%), and 19.09 (37%), respectively, in group A and 23.68 (35%), 19.50 (44%), and 19.61 (42%), respectively, in group B, but there was no difference between the groups at all visits. Postoperative need for ocular hypotensive drugs did not differ in group A (P = 0.231); however, it was significantly lower in group B (P = 0.027). Group A had 87%, 77%, and 74% success rates at 1, 3, and 6 months, respectively, whereas group B had 91%, 86%, and 77% success rates at 1, 3, and 6 months, respectively. Postoperative complications and intervention did not reveal any statistical difference between the two groups. Conclusion: MP?TSCPC may be considered as a temporizing measure both as a primary or as an additional intervention to control the IOP in eyes with refractory and advanced glaucoma that have a high risk of vision?threatening complications with invasive surgery.
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AIM: To investigate the efficacy of micropulse laser combined with intravitreal injection of ranibizumab in the treatment of macular edema(ME)secondary to non-ischemic branch retinal vein occlusion(BRVO).METHODS: A total of 200 cases(200 eyes)of non-ischemic BRVO secondary to ME who were treated in our hospital from January 2020 to March 2022 were selected and divided into the control group(100 cases, 100 eyes)and the observation group(100 cases, 100 eyes)by random number table. The control group was given intravitreal injection of ranibizumab, and the observation group was given micropulse laser combined with intravitreal injection of ranibizumab. The best corrected visual acuity(BCVA), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), total number of injections, macular leakage and complications were compared between two groups.RESULTS: After treatment, the BCVA of the two groups were improved, and the BCVA of the observation group was better than those in the control group at 1, 3, 6 and 12mo after treatment(all P<0.05). After treatment, the CMT and SFCT of the two groups decreased, and the CMT and SFCT of the observation group was lower than those in the control group at 1, 3, 6 and 12mo after treatment(all P<0.05). The total number of injections in the observation group during the treatment period was less than that in the control group [(4.06±1.12)times vs.(5.32±1.15)times](t=5.852, P<0.001). The leakage rates of the control group and the observation group after 12mo of treatment were 69.0% and 27.0% respectively, with statistical significance between the two groups(χ2=35.337, P<0.001). The incidence of complications in the control group and observation group were 11.0% and 5.0% respectively, with no statistical significance between the two groups(χ2=2.446, P=0.118).CONCLUSION: Micropulse laser combined with intravitreal injection of ranibizumab has a significant clinical efficacy in the treatment of ME secondary to non-ischemic BRVO, which is safe and can improve patients' vision and ME, reduce the total doses of ranibizumab without increasing the incidence of complications.
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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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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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Purpose: To determine the efficacy of subliminal cyclophotocoagulation in reducing intraocular pressure (IOP) and to assess the safety profile of the procedure. Methods: We reviewed the charts of all patients who underwent subliminal cyclophotocoagulation between August 2019 and August 2020. The IOP, number of antiglaucoma medications, and visual acuity were compared at baseline and at 6 months. The post-laser complications were noted. Paired t-test, Wilcoxon rank-sum test, and McNemar test were used for analysis. Results: This study included 40 eyes of 40 patients. The most frequent diagnosis was neovascular glaucoma (55%), followed by primary open-angle glaucoma (17.5%). The mean IOP reduced from 32 to 21 mmHg (mean IOP reduction: 32%, 95% confidence interval [CI]: 27%–37%, P < 0.001). Mean number of antiglaucoma medications declined from 3.2 to 1.9 (P < 0.001). Use of oral acetazolamide decreased from 62% to 5% (P < 0.001). The success rate of the procedure at 6 months was 55%. One patient had unexplained visual acuity decline after the procedure. Conclusion: Subliminal sub-cyclophotocoagulation is effective in treating refractory glaucoma in the Indian population. It decreases the medication burden. However, subliminal lasers can also cause vision-threatening complications such as hypotony, uveitis, and optic nerve hypoperfusion. So, clinicians should be cautious when using sub-cyclophotocoagulation in patients with good vision.
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AIM:To observe the clinical effect of ranibizumab combined with 577nm micropulse laser in the treatment of severe diabetic macular edema(DME). METHODS:There were 52 eyes of 52 patients diagnosed with severe DME who admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from June 2016 to September 2019. The patients were randomly divided into the observation group(26 patients with 26 eyes, treated with ranibizumab combined with 577nm micropulse laser)and the control group(26 patients with 26 eyes, treated with ranibizumab alone). Patients in both groups received intravitreal injection of ranibizumab with “3+PRN” regimen. Followed up at 9mo after treatment to observe the central macular thickness(CMT), the best corrected visual acuity(BCVA)and the times of intravitreal injection of ranibizumab in the two groups.RESULTS:Compared with before treatment, the CMT and BCVA of the two groups were significantly improved at each time point after treatment(all P<0.001), but there was no difference between the two groups(P>0.05). During the follow-up period, the times of vitreous injection of ranibizumabin the observation group was significantly less than that in the control group(5.88±1.24 times vs 7.12±1.24 times, P=0.001). CONCLUSION:Both ranibizumab combined with 577nm micropulse laser and ranibizumab alone are effective in reducing edema and improving vision in patients with severe DME, but the combination therapy reduces the times of injection.
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@#AIM: To observe and analyze the efficacy of Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation in the treatment of macular edema(ME)secondary to ischemic branch retinal vein occlusion(BRVO).<p>METHODS: Totally 71 patients(71 eyes)diagnosed as ME secondary to ischemic BRVO during the period from March 2016 to March 2019 were retrospectively included, and they were divided into laser group(<i>n</i>=33, 33 eyes)and combined group(<i>n</i>=38, 38 eyes)according to the different treatment methods. The patients in the laser group all received 577nm yellow subliminal micropulse laser photocoagulation, and the patients in the combined group all received Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation. The best corrected visual acuity(BCVA), central macular thickness(CMT)and total macular volume(TMV)were compared between the two groups before treatment and at 1, 2, 3, 6, 9 and 12mo after surgery, and the therapeutic efficacy was observed and the occurrence of complications were recorded.<p>RESULTS:There were statistically significant differences in the BCVA, CMT and TMV between the two groups before and after treatment(<i>P</i><0.05), and the BCVA, CMT and TMV in the two groups at 1, 2, 3, 6, 9 and 12mo after treatment were significantly lower than those before treatment(<i>P</i><0.05), and the differences between the two groups were statistically significant(<i>P</i><0.05). During follow-up, there were 30 eyes with once laser photocoagulation, 7 eyes with twice and 1 eye with 3 times in combined group, and there were 16 eyes with once laser photocoagulation, 14 eyes with twice and 3 eyes with 3 times in laser group(<i>Z</i>=2.670, <i>P</i><0.05). There were 3 eyes of corneal epithelial exfoliation on the 1d after vitreous injection in combined group, and the symptoms disappeared after symptomatic treatment. All patients did not have serious complications such as persistent intraocular pressure increase, retinal detachment and intraocular inflammation.<p>CONCLUSION: Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation has a significant efficacy in the treatment of ME secondary to ischemic BRVO, and it can effectively improve the visual acuity and promote the macular edema absorption, and it is safe and reliable.
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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 clinical efficacy and safety of full macular coverage micropulse laser in the treatment of refractory macular edema secondary to Irvine-Gass syndrome.Methods:A retrospective case study. From April 2018 to November 2019, 21 cases of Irvine-Gass syndrome patients with 24 eyes were included in the study. Among them, there were 11 females with 12 eyes and 10 males with 12 eyes; the average age was 54.5±10.1 years. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA was performed using a standard logarithmic visual acuity chart, and the results were converted into the logarithmic minimum angle of resolution (logMAR) visual acuity when recording. The frequency domain OCT instrument was used to measure the foveal retinal thickness (CMT) and the retinal volume (MRV) of the macular area with a diameter of 1, 6 mm. All the affected eyes were treated with a micropulse laser under the threshold of 577 nm, with a spot diameter of 200 μm, an exposure time of 200 ms, a power of 400 mW, and a 5% duty cycle. The treatment scope was in the upper and lower vascular arches of the macula, covering the entire macula (including the fovea). One or 3 months after treatment, the eyes with macular edema were treated twice with micropulse laser, the method was the same as before. 1, 3, and 6 months after the treatment, the same equipment and methods as before the treatment were used for related inspections. The changes of BCVA, CMT, MRV and the occurrence of complications in the affected eye were observed.Results:The average logMAR BCVA of the eyes before treatment and 1, 3, and 6 months after treatment were 0.440±0.320, 0.333±0.286, 0.250±0.245, 0.166±0.184, and the average CMT were 395.88±79.21, 349.17±78.07, 317.67±53.72, 285.29±37.03 μm, respectively; the average MRV of diameter 1, 6 mm were 0.310±0.063, 0.275±0.060, 0.245±0.035, 0.221±0.219 mm 3 and 9.866±0.846, 9.494±1.002, 9.005±0.885, 8.190±0.850 mm 3. Compared with before treatment, the BCVA of the eyes at 1, 3, and 6 months after treatment was significantly increased ( t=5.060, 5.564, 6.466), and CMT was significantly decreased ( t=4.854, 5.777, 7.349), and the differences were statistically significant ( P<0.01); the average MRV of diameters 1, 6 mm decreased significantly, and the difference was statistically significant (1 mm diameter: t=4.527, 5.394, 7.380; P<0.01; diameter 6 mm: t=4.577, 7.980, 11.209; P<0.01). The average number of micropulse laser treatments for the affected eye was 1.25 times. Conclusion:Full macular coverage micropulse laser can safely and effectively treat refractory macular edema secondary to Irvine-Gass syndrome and can be used as an alternative treatment.
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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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@#AIM: To appraise the therapeutic effect of dual laser(micro-pulse laser and traditional laser)and single intravitreal injection with conberceptin on macular edema secondary to ischemic branch retinal vein occlusion.<p>METHODS: A prospective cohort study was conducted. 83 patients(83 eyes)participated in the study from November 2017 to November 2018. They were randomly divided into two groups. Group A(42 eyes)accepted the treatment of dual laser and single intravitreal injection with conbercept and group B(41 eyes)accepted only traditional laser treatment and single intravitreal injection with anti-VEGF, and the aim is to analysis the data including BCVA, CMT in follow-up visit after treatment 1, 3, 6mo.<p>RESULTS: After 1mo: in group A, BCVA improved from 0.88±0.11 to 0.43±0.19(<i>P</i><0.01), CMT changed from 595.00±61.12 to 379.8±76.08μm(<i>P</i><0.01). In group B, BCVA changed from 0.82±0.19 to 0.39±0.16(<i>P</i><0.01)while CMT changed from 601.70±81.37 to 381.50±70.92 μm(<i>P</i><0.01). There were no difference between two groups(<i>P</i>>0.05). After 3mo: in group A, BCVA raised to 0.13±0.07(<i>P</i><0.01), CMT reduced to 282.80±31.93μm(<i>P</i><0.01); in group B, BCVA hold on 0.41±0.09(<i>P</i>=1.00), CMT retained 395.80±34.53μm(<i>P</i>=0.99). The improvement of BCVA and CMT were better in group A(<i>P</i><0.01). After 6mo: in group A, BCVA maintained 0.28±0.12(<i>P</i><0.01), CMT keeped 335.60±33.98μm(<i>P</i>=0.02); in group B, BCVA rebounded to 0.77±0.15(<i>P</i><0.01), CMT was 579.60±19.61μm(<i>P</i><0.01). Both BCVA and CMT were better in group A than group B(<i>P</i><0.01). No serious complications happened in all phases.<p>CONCLUSION: The treatment of dual laser and single intravitreal injection with conbercept for macular edema secondary to ischemic branch retinal vein occlusion can maintain good effect more than 3mo.
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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 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.