LOW-INTENSITY/HIGH-DENSITY SUBTHRESHOLD DIODE MICROPULSE LASER FOR CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To review the results of low-intensity/high-density subthreshold micropulse laser (SDM) for treatment of central serous chorioretinopathy. METHOD: The records of all patients treated in a retinal subspecialty practice with SDM for central serous chorioretinopathy were reviewed. RESULTS: Eleven consecutive eyes of 11 patients treated between October 2011 and April 2014 were identified for study, 9 men and 2 women, aged 30 to 55 (mean = 46). Symptom duration before treatment ranged 1 month to 7 months (mean = 3.6 months) and after treatment with SDM laser, follow-up ranged 1 month to 45 months (mean = 14). Preoperative visual acuities ranged 20/20 to 20/100 (mean = 20/37) and postoperative visual acuities were 20/15 to 20/40 (mean = 20/24) (P = 0.01, paired t-test). Maximum retinal thickness ranged 314 µm to 893 µm (mean = 508) preoperatively and 222 µm to 365 µm (mean = 250) postoperatively for an average 258 µm reduction in retinal thickness (P = 0.002, paired t-test). Subretinal fluid was eliminated in all eyes by 3 months after treatment (mean = 1.3 months). The number of SDM laser spot applications ranged 295 to 1431 per treatment session (mean = 772). One eye required retreatment, but for a new leakage locus 4 months after initial treatment. There were no adverse treatment effects. CONCLUSION: An SDM laser seems to be safe and effective for the treatment of central serous chorioretinopathy. As advocated in the literature, a higher treatment density and larger treatment area, as reported in this article, may improve clinical results.

Safety of transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema in eyes with good visual acuity.

PURPOSE: To determine the safety of transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema. METHODS: The records of all patients treated with transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema in two retina clinics were reviewed. The eligibility included fovea-involving diabetic macular edema by spectral domain optical coherence tomography and pretreatment visual acuity of 20/40 or better. RESULTS: Thirty-nine eyes of 27 patients aged 50 years to 87 years (mean, 69 years) were included. Postoperative follow-up ranged from 3 months to 36 months (mean, 11 months). Fourteen patients were insulin dependent, and 19 had nonproliferative retinopathy. The preoperative visual acuity was 20/20 (10 eyes), 20/25 (10 eyes), 20/30 (8 eyes), and 20/40 (11 eyes). No eye had evidence of laser-induced macular damage by any imaging means postoperatively. There were no adverse treatment effects. Logarithm of the minimum angle of resolution visual acuity was improved on average of 0.03 units at 4 months to 7 months of follow-up (P = 0.0449, paired t-test) and otherwise stable. The central foveal thickness was improved at 4 months to 7 months (P = 0.05, paired t-test) and 8 months to 12 months, postoperatively (P = 0.04, mixed model accounting). Maximum macular thickness was improved at 4 months to 7 months postoperatively (P = 0.01, paired t-test and mixed model accounting). CONCLUSION: In a small retrospective series, transfoveal subthreshold diode micropulse laser was safe and effective for the treatment of fovea-involving diabetic macular edema in eyes with good preoperative visual acuity that were not the candidates for conventional photocoagulation or intravitreal injection. Further study is warranted.

Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review.

PURPOSE: To present the state-of-the-art of subthreshold diode laser micropulse photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema (DME). METHOD: To review the role and evolution of retinal laser treatment for DME. RESULTS: Thermal laser retinal photocoagulation has been the cornerstone of treatment for diabetic macular edema for over four decades. Throughout, laser induced retinal damage produced by conventional photocoagulation has been universally accepted as necessary to produce a therapeutic benefit, despite the inherent risks, adverse effects and limitations of thermally destructive treatment. Recently, SDM, performed as invisible retinal phototherapy for DME, has been found to be effective in the absence of any retinal damage or adverse effect, fundamentally altering our understanding of laser treatment for retinal disease. SUMMARY: The discovery of clinically effective and harmless SDM treatment for DME offers exciting new information that will improve our understanding of laser treatment for retinal disease, expand treatment indications, and improve patient outcomes.