Abstract
We evaluated subthreshold photocoagulation using endpoint management (EPM) for the treatment of diabetic macular edema (DME). The study enrolled 10 eyes from 10 patients (6 men and 4 women) with DME. The entry criteria included central macular thickness (CMT) ≥ 300 μm and decimal visual acuity (VA) ≤ 0.5. The primary endpoints were VA (logMAR) and CMT at 6 months follow-up. Secondary endpoints included fundus autofluorescence, macular volume (MV), and macular sensitivity (MS). We used the PASCAL Streamline Yellow® (wavelength, 577 nm) system to perform grid pattern laser photocoagulation at 50% of the threshold (size, 100 μm; duration, 0.015 s; spacing, 0.5; and energy, 4.5–7.8 mJ). At 6 months posttreatment, CMT was significantly decreased, while there were no significant changes in macular sensitivity, mean BCVA (logMAR), or macular volume. Autofluorescence imaging revealed no changes after treatment in 6 of 10 eyes. No eyes exhibited subjective symptoms of scotoma after photocoagulation. Optical coherence tomography showed the complete resolution of macular edema in 4 eyes (40%) after a single treatment; MS was increased in all 4 of these eyes at 6 months posttreatment. In conclusion, subthreshold photocoagulation using EPM is safe and effective for DME treatment and preserves MS. This trial is registered with UMIN000012401.
Highlights
Over 200 million people worldwide have diabetes mellitus
In 1985, the Early Treatment Diabetic Retinopathy Study (ETDRS) showed that laser photocoagulation decreased the risk of vision impairment in clinically significant macular edema (CSME) by 50% [4]
The results showed that at 6 months posttreatment, central macular thickness (CMT) was significantly decreased, while there were no significant changes in macular sensitivity, mean best-corrected visual acuity (BCVA), or macular volume
Summary
Over 200 million people worldwide have diabetes mellitus. diabetic retinopathy is a significant cause of impaired vision in working-age populations in developed countries [1,2,3]. In 1985, the Early Treatment Diabetic Retinopathy Study (ETDRS) showed that laser photocoagulation decreased the risk of vision impairment in clinically significant macular edema (CSME) by 50% [4]. Photocoagulation and/or grid photocoagulation include scotoma, visual field defects, and chorioretinal atrophy [5,6,7]. To address these risks, less invasive laser treatments have been proposed. Subthreshold micropulse photocoagulation is a minimally invasive form of laser photocoagulation in which no coagulation spot is observed; this treatment modality is useful for relieving edema while preserving macular function [10, 12, 15,16,17,18,19]. PASCAL streamline yellow (Topcon Medical Laser Systems, Santa Clara, CA, USA) with endpoint
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