Can subthreshold micropulse yellow laser treatment change the anti-vascular endothelial growth factor algorithm in diabetic macular edema? A randomized clinical trial

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.

Subthreshold micropulse yellow laser (577 nm) for chronic central serous chorioretinopathy with foveal leakage / 眼科新进展

Objective To assess the safety and efficacy of subthreshold micropulse yellow laser (577 nm) in the treatment of chronic central serous chorioretinopathy with foveal leakage.Methods This was a prospective study of 12 patients (12 eyes) with chronic central serous chorioretinopathy (CSC).All patients had been treated using multiple spots of subthreshold micropulse yellow laser at 577 nm with a duty cycle of 5％ over areas of focal and diffuse leakage.And lweeks,1 months,3 months,and 6 months after treatment,the best corrected visual acuity (BCVA),central macular thickness (CMT) and reduction in subretinal fluid (SRF) were recorded.Results The mean BCVA measured at 6 months after laser treatment was 0.19 ±0.11,which was in comparison to 0.27 ± 0.08 before laser treatment,and the difference was statistically significant (P =0.016).The mean CMT was significantly reduced from (432.42 ±134.17) μm before laser treatment to (248.75 ±36.06) μm after 6 months (P =0.002).The mean SRF height was significantly decreased from (213.58 ± 132.60) μm at baseline to (17.25 ±21.90) μm (P =0.002).At the last follow-up,the SRF had disappeared completely in 6 out of 12 eyes,but there were still 6 eyes suffering from SRF.There was no evidence of retinal or choroidal damage during 6-month follow up.Conclusion Subthreshold micropulse yellow laser (577 nm) is an effective treatment option for chronic CSC with foveal leakage.

Recent developments in retinal lasers and delivery systems.

Photocoagulation is the standard of care for several ocular disorders and in particular retinal conditions. Technology has off ered us newer lasing mediums, wavelengths and delivery systems. Patt ern scan laser in proliferative diabetic retinopathy and diabetic macular edema allows laser treatment that is less time consuming and less painful. Now, it is possible to deliver a subthreshold micropulse laser that is above the threshold of biochemical eff ect but below the threshold of a visible, destructive lesion thereby preventing collateral damage. The advent of solid-state diode yellow laser allows us to treat closer to the fovea, is more eff ective for vascular structures and off ers a more uniform eff ect in patients with light or irregular fundus pigmentation. Newer retinal photocoagulation options along with their advantages is discussed in this review.