Abstract
PurposePatients with center-involved diabetic macular edema (CI-DME) with good visual acuity (VA) represent a controversial clinical scenario in which a subthreshold laser might be a reasonable approach. We report a case series of patients with CI-DME with VA better than 20/32 who were treated with a subthreshold 577 nm (yellow) laser.MethodsThe area of retinal thickening on OCT was treated with confluent laser spots at individually titrated power. The fovea was spared from treatment. Effectiveness and safety were evaluated through OCT and autofluorescence (AF) as well as BCVA.ResultsA total of 23 eyes from 19 patients were treated. VA ranged from 20/20 to 20/30. The follow-up period ranged from 6 to 18 months. Edema in OCT resolved completely at the end of follow-up in 56.5% (13/23) of the cases. Central retinal thickness was reduced at 12 weeks and at the end of follow-up, with a mean reduction of 16.9 μm and 22 μm, respectively (paired t-test p = 0.001 and 0.0003). VA remained stable. The laser was invisible (OCT, AF, Fundoscopy) in 91,3% (21/23) of eyes.ConclusionsA fovea-sparing yellow subthreshold laser was safe and effective for treating CI-DME patients with good VA in this case series. This technique is of interest to prevent the progression of mild edema and might avoid or reduce the use of more invasive and expensive therapies. Excluding the fovea from the treated area does not seem to affect the results, which is of interest to novel laser practitioners.
Highlights
A fovea-sparing yellow subthreshold laser was safe and effective for treating center-involved diabetic macular edema (CI-Diabetic macular edema (DME)) patients with good visual acuity (VA) in this case series. This technique is of interest to prevent the progression of mild edema and might avoid or reduce the use of more invasive and expensive therapies
Excluding the fovea from the treated area does not seem to affect the results, which is of interest to novel laser practitioners
Diabetic macular edema (DME) is a complex disease that presents itself in a wide variety of clinical scenarios that drive the need for individualized treatment [1]
Summary
Diabetic macular edema (DME) is a complex disease that presents itself in a wide variety of clinical scenarios that drive the need for individualized treatment [1]. The use of a subthreshold laser (STL), which does not cause cicatricial or tissue-changing effects, is considered a safe technique to work around and even on the fovea [5,6,7,8,9] since no clinically visible effects appear on the fundus, optical coherence tomography (OCT) or autofluorescence (AF), the latter being especially sensitive to any disturbances/damages in the retinal pigment epithelium (RPE) [10]. We present a study on the effectiveness of a subthreshold 577 nm (yellow) subliminal laser on VA and OCT and safety on AF for the treatment of CI-DME patients with good VA (20/32 or better). We administered the laser through a “fovea-sparing” technique, which avoids delivering laser treatment on the fovea itself and up to 100 μm from the fovea
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