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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 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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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 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 explore the clinical effect of leizhumab combined with 577nm multi-point scanning matrix laser photocoagulation in the treatment of diabetic macular edema(DME).<p>METHODS:Totally 127 eyes of 94 patients(January 2017-June 2018)with DME were selected. According to the different treatment methods, RA group was divided into two groups. RA group was only treated with razumab group: the patients in this group were treated with razumab injection; RL group: razumab combined with 577nm multi-point scanning matrix laser group: the patients in this group were treated with razumab combined with 577nm multi-point scanning matrix laser photocoagulation. To observe the treatment effect of RA group and RL group 1mo after three times of leizhumab injection; to check the visual improvement of RA group and RL group before treatment and 1mo, 3mo and 6mo after three times of leizhumab injection; to detect the macular fovea thickness(CMT)of RA group and RL group by optical coherence tomography(OCT); to detect the retinal neogenesis by FFA Vascular leakage area and postoperative complications.<p>RESULTS: The effective rate(100%)of the patients in the combined group was higher than that in the single group(97%), but the difference was not statistically significant(<i>P</i>>0.05). Before treatment, the BCVA of the two groups of patients were 0.57±0.20 and 0.56±0.18(<i>P</i>>0.05). After completing three injections of ranibizumab, the BCVA of the single group of patients at 1, 3, and 6mo were 0.39±0.05, 0.23±0.06,0.18±0.05, the BCVA of the combined group were 0.28±0.08,0.18±0.07, 0.12±0.06, the BCVA of the combined group was better than the control group(<i>P</i><0.001). Before treatment, the CMT of the two groups of patients were 389±42.54 and 386±38.25, respectively(<i>P</i>>0.05).After completing three injections of ranibizumab, the CMT of the single group at 1, 3,and 6mo were 333.84±38.18, 297.12±27.10, 278.15±26.24μm, the CMT of the combined group were 315.04±39.07, 274.35±28.63, 253.65±25.91μm, the improvement of the CMT of the combined group was better than that of the single group(<i>P</i><0.001). Before treatment, the leakage area of retinal neovascularization in the two groups was 22.31±3.26 and 21.98±3.18mm2(<i>P</i>>0.05). After the injection of ranibizumab was completed 3 and 6mo, the single group leaked The areas were 18.34±2.19, 7.81±1.28mm2, and the leakage area of the combined group were 14.92±1.98, 5.39±1.42mm2, respectively(<i>P</i><0.001). Complications occurred in 3 eyes of a single group of patients and complications in 4 eyes of a combined group(<i>P</i>>0.05).<p>CONCLUSION: Leizhumab and 577nm multi-point scanning matrix laser photocoagulation are effective and safe in the treatment of DME patients, but the long-term effect of leizhumab combined with 577nm multi-point scanning matrix laser group is better than that of single line intravitreal injection of leizhumab.
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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 explore the clinical effect of leizhumab combined with 577nm multi-point scanning matrix laser photocoagulation in the treatment of diabetic macular edema(DME).<p>METHODS:Totally 127 eyes of 94 patients(January 2017-June 2018)with DME were selected. According to the different treatment methods, RA group was divided into two groups. RA group was only treated with razumab group: the patients in this group were treated with razumab injection; RL group: razumab combined with 577nm multi-point scanning matrix laser group: the patients in this group were treated with razumab combined with 577nm multi-point scanning matrix laser photocoagulation. To observe the treatment effect of RA group and RL group 1mo after three times of leizhumab injection; to check the visual improvement of RA group and RL group before treatment and 1mo, 3mo and 6mo after three times of leizhumab injection; to detect the macular fovea thickness(CMT)of RA group and RL group by optical coherence tomography(OCT); to detect the retinal neogenesis by FFA Vascular leakage area and postoperative complications.<p>RESULTS: The effective rate(100%)of the patients in the combined group was higher than that in the single group(97%), but the difference was not statistically significant(<i>P</i>>0.05). Before treatment, the BCVA of the two groups of patients were 0.57±0.20 and 0.56±0.18(<i>P</i>>0.05). After completing three injections of ranibizumab, the BCVA of the single group of patients at 1, 3, and 6mo were 0.39±0.05, 0.23±0.06,0.18±0.05, the BCVA of the combined group were 0.28±0.08,0.18±0.07, 0.12±0.06, the BCVA of the combined group was better than the control group(<i>P</i><0.001). Before treatment, the CMT of the two groups of patients were 389±42.54 and 386±38.25, respectively(<i>P</i>>0.05).After completing three injections of ranibizumab, the CMT of the single group at 1, 3,and 6mo were 333.84±38.18, 297.12±27.10, 278.15±26.24μm, the CMT of the combined group were 315.04±39.07, 274.35±28.63, 253.65±25.91μm, the improvement of the CMT of the combined group was better than that of the single group(<i>P</i><0.001). Before treatment, the leakage area of retinal neovascularization in the two groups was 22.31±3.26 and 21.98±3.18mm2(<i>P</i>>0.05). After the injection of ranibizumab was completed 3 and 6mo, the single group leaked The areas were 18.34±2.19, 7.81±1.28mm2, and the leakage area of the combined group were 14.92±1.98, 5.39±1.42mm2, respectively(<i>P</i><0.001). Complications occurred in 3 eyes of a single group of patients and complications in 4 eyes of a combined group(<i>P</i>>0.05).<p>CONCLUSION: Leizhumab and 577nm multi-point scanning matrix laser photocoagulation are effective and safe in the treatment of DME patients, but the long-term effect of leizhumab combined with 577nm multi-point scanning matrix laser group is better than that of single line intravitreal injection of leizhumab.
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@#AIM: To compare the efficacy and safety of 577nm subthreshold micropulse laser(SML)and photodynamic therapy(PDT)in patients with chronic central serous chorioretinopathy(cCSC).<p>METHODS: Thirty patients(30 eyes)with cCSC were treated in our hospital from February 2015 to April 2018. And 15 patients(15 eyes)were treated with SML(577 nm)while the others were treated by PDT. The BCVA and CMT as well as complications were observed at 1, 3, 6mo after treatment.<p>RESULTS: At 1mo after treatment, BCVA was increased to 0.37±0.13 in SML group and 0.20±0.11 in PDT group(<i>t</i>=-3.93, <i>P</i><0.001); CMT was decreased to 382.80±76.54μm in SML group and 247.60±28.46μm in PDT group(<i>t</i>=-6.41, <i>P</i><0.001). Although improvements of BCVA and CMT were both achieved in two groups, improvements in PDT group were better than those in SML group. At 3mo and 6mo after treatment, both BCVA and CMT were no significant difference between the two groups(<i>P</i>>0.05). During the follow-up period, there were no obvious complications or recurrence observed.<p>CONCLUSION: Both SML(577nm)and PDT were effective and safe in the treatment of cCSC, but the theraputic effects of PDT was slightly quicker than SML. Further, with the prolongation of recovery time, the curative effects of these treatments were similar. Additionally, SML(577nm)costs was much cheaper than PDT and had no risk of injury or allergy for patients, and patients with cCSC could also be treated repeatedly using it.
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@#AIM: To explore the clinical effect of micro-pulse laser at 577nm threshold in treatment of diabetic macular edema(DME).<p>METHODS: The clinical data of 48 patients with DME(64 eyes)were retrospectively analyzed. The patients with micro-pulse laser at 577nm threshold were included in observation group(26 cases, 35 eyes), and the patients who underwent conventional grid-like laser were included in control group(22 cases, 29 eyes). The best corrected visual acuity(BCVA)(LogMAR visual acuity chart), central macular foveal thickness(CFT), mean tetinal sensitive(MS)and mean visual deviation(MD)were compared before surgery and at 1, 3 and 6mo after surgery. And duration of fundus hard exudate and the occurrence of complications after surgery were analyzed in the two groups.<p>RESULTS: At 1, 3 and 6mo after surgery, the LogMAR visual acuity test results and CFT levels in the two groups were significantly decreased compared with those before surgery, and the indexes in observation group were significantly lower than those in control group at the same time(0.30±0.09 <i>vs</i> 0.35±0.10, 0.19±0.07 <i>vs</i> 0.26±0.09, 0.13±0.04 <i>vs</i> 0.18±0.05; 349.26±21.80 μm <i>vs</i> 364.37±23.91μm, 314.46±20.49μm <i>vs</i> 335.07±22.68μm, 328.35±21.74μm <i>vs</i> 352.43±23.60μm)(all <i>P</i><0.05). Compared with preoperative, the MS and MD levels in observation group were significantly increased, and significantly higher than that in control group at the same time(5.83±1.16dB <i>vs</i> 4.22±1.04dB, 6.38±1.29dB <i>vs</i> 4.49±1.17dB, 6.75±1.22dB <i>vs</i> 4.68±1.20dB, -5.53±1.41dB <i>vs</i> -7.66±1.52dB, -5.09±1.30dB <i>vs</i> -7.26±1.39dB, -4.68±1.14dB <i>vs</i> -7.05±1.26dB)(all <i>P</i><0.05). The duration of fundus hard exudate in observation group was significantly lower than that in control group(3.39±0.80mo <i>vs</i> 4.25±1.14mo)(<i>P</i><0.05). Within 6mo after surgery, the incidence rate of eyeball pain in observation group was significantly lower than that in control group \〖3%(1/35)<i>vs</i> 24%(7/29)\〗(<i>P</i><0.05), but there were no statistically significant differences in the incidence rates of anterior chamber inflammatory response, visual field defect, intraocular hypertension and corneal edema.<p>CONCLUSION: Micro-pulse laser at 577nm threshold is safe and effective for DME.
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Objective To investigate the effects of subthreshold micropulse yellow laser (577 nm) on vascular endothelial growth factor (VEGF),nerve growth factor (NGF) and Chemerin expressions in retina of early stage diabetic rats.Methods A total of 40 Brown Norway rats were treated with streptozocin (65 mg · kg-1) to establish the diabetic model.20 diabetic BN rats' right eyes were received subthreshold micropulse yellow laser (577 run) therapy after 2 weeks.The left eyes were used as control group.At 3 days,7 days,14 days,28 days after laser therapy,5 BN rats were randomly chosen to perform RT-PCR and Weston-blot.The expressions of mRNA and protein of VEGF,NGF and Chemerin were analyzed.Results The expression of VEGF mRNA and protein increased in control group at 3 days,7 days,14 days and 28 days (all P ＜ 0.05).Compared with the control group,VEGF mRNA and protein decreased in the subthreshold micropulse yellow laser (577 nm) group (all P ＜ 0.05).The expression of NGF mRNA and protein decreased in the control group at 3 days,7 days,14 days and 28 days (all P ＜ 0.05),however,the difference was not statistically significant between 3 days and 7 days(P ＞0.05).Compared with control group,NGF mRNA and protein increased in the subthreshold micropulse yellow laser (577 nm) group (all P ＜ 0.05),with maximum expression at 14 days.The expression of chemerin mRNA and protein increased at 3 days,7 days,14 days and 28 days in the control group (all P ＜0.05).Compared with the control group,chemerin mRNA and protein decreased in the subthreshold micropulse yellow laser (577 urn) group (all P ＜ 0.05).Conclusion Subthreshold micropulse yellow laser (577 urn) can suppress VEGF,Chemerin expression and upregulate NGF expression in early stage diabetic rats.
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AlM: To investigate the influences of 577nm panretinal photocoagulation ( PRP ) on the retinal thickness of macular fovea on diabetic retinopathy ( DR) .METHODS:A total of 45 eyes of 37 cases suffering from preproliferative diabetic retinopathy ( PPDR ) and proliferative diabetic retinopathy ( PDR ) undergoing 577nm PRP were enrolled in this study. The alterations of the retinal thickness of macular fovea measured by optovue optical coherence tomography( OCT) before and 1, 3, 6mo following PRP were comparatively analyzed.RESULTS: The macularfoveal retinal thickness after 1, 3mo of PRP had significantly increased that before operation (P0. 05).CONCLUSlON: After the treatment of PRP, it appeared a transient increase on the retinal thickness of macular fovea, but after 6mo following-up, the macular foveal retinal thickness decreased nearly to the levels before PRP.