Top

International Ophthalmology

Published in:

01-12-2024 | Laser | Original Paper

Subthreshold laser treatment for non-center involved diabetic macular edema via non-damaging retinal laser therapy (NRT)

Authors: Fatma Sema Akkan Aydogmus, Defne Kalayci, Burcu Polat Gultekin

Published in: International Ophthalmology | Issue 1/2024

Abstract

Purpose

To evaluate the efficacy of subthreshold laser treatment via non-damaging retinal laser therapy (NRT) in patients with non-center involved diabetic macular edema (non-CI DME).

Methods

In this prospective controlled study, NRT with 577 nm wavelength was performed to the edematous inner subfields as needed at 3 monthly intervals, while the control group received no treatment. If CI-DME developed in either group, intravitreal anti-VEGF was performed and the eye was excluded from subsequent analysis.

Results

A total of 75 eyes (36 study eyes, 39 controls) were evaluated. The change in superior, nasal and temporal inner subfield thicknesses over time and between groups was found significant (P = 0.004, P < 0.001, P = 0.04 respectively). Best corrected visual acuity (BCVA) change was not significant over time and between groups (P = 0.69). Rates of CI-DME development requiring intravitreal anti-VEGF treatment were not different during the first and second years (P = 0.171, 0.908). No laser scar was detected in any eye in fundus autofluorescence imaging.

Conclusion

NRT performed as needed at 3 monthly intervals is effective after 21 months of follow up in the treatment of non-CI DME and it was safe. With this method, it may be foreseen that BCVA will be better preserved in the long term by avoiding the possible side effects of conventional laser.

Organization WH. Guideline (2016): daily iron supplementation in infants and children. World Health Organization. 44

Azzolini C, Pagani IS, Pirrone C, Borroni D, Donati S, Oun MA et al (2013) Expression of VEGF-A, Otx homeobox and p53 family genes in proliferative vitreoretinopathy. Mediat Inflamm 2013(2013):857380. https://doi.org/10.1155/2013/857380CrossRef

Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, Berg K, Chakravarthy U, Gerendas BS et al (2017) Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica 237(4):185–222. https://doi.org/10.1159/000458539CrossRefPubMed

Dossarps D, Bron AM, Koehrer P, Aho- Glele LS, Creuzot- Garcher C (2015) Endophthalmitis after intravitreal injections: incidence, presentation, management, and visual outcome. Am J Ophthalmol 160(1):17–25. https://doi.org/10.1016/j.ajo.2015.04.013CrossRefPubMed

Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN et al (2015) DRCR.Net. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 372(13):1193–1203. https://doi.org/10.1056/NEJMoa1414264CrossRefPubMed

Vujosevic S, Bottega E, Casciano M, Pilotto E, Convento E, Midena E (2010) Microperimetry and fundus autofluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. Retina 30(6):908–916. https://doi.org/10.1097/IAE.0b013e3181c96986CrossRefPubMed

Figueira J, Khan J, Nunes S, Sivaprasad S, Rosa A, Abreu JF et al (2009) Prospective randomised controlled trial comparing sub-threshold micropulse diode laser photocoagulation and conventional green laser for clinically significant diabetic macular oedema. Br J Ophthalmol 93(10):1341–1344. https://doi.org/10.1136/bjo.2008.146712CrossRefPubMed

Lavinsky D, Sramek C, Wang J, Huie P, Dalal R, Mandel Y et al (2014) Subvisible retinal laser therapy: titration algorithm and tissue response. Retina 34(1):87–97. https://doi.org/10.1097/IAE.0b013e3182993edcCrossRefPubMed

Lavinsky D, Wang J, Huie P, Dalal R, Lee SJ, Lee DY et al (2016) Nondamaging retinal laser therapy: rationale and applications to the macula. Invest Ophthalmol Vis Sci 57(6):2488–2500. https://doi.org/10.1167/iovs.15-18981CrossRefPubMedCentralPubMed

10.

Inagaki K, Hamada M, Ohkoshi K (2019) Minimally invasive laser treatment combined with intravitreal injection of anti-vascular endothelial growth factor for diabetic macular oedema. Sci Rep 9(1):1–8. https://doi.org/10.1038/s41598-019-44130-5CrossRef

11.

Pei-Pei W, Shi-Zhou H, Zhen T, Lin L, Ying L, Jiexiong O et al (2015) Randomised clinical trial evaluating best-corrected visual acuity and central macular thickness after 532-nm subthreshold laser grid photocoagulation treatment in diabetic macular oedema. Eye 29(3):313–322. https://doi.org/10.1038/eye.2015.1CrossRefPubMedCentralPubMed

12.

Hamada M, Ohkoshi K, Inagaki K, Ebihara N, Murakami A (2018) Subthreshold photocoagulation using endpoint management in the PASCAL® system for diffuse diabetic macular edema. J Ophthalmol. https://doi.org/10.1155/2018/7465794CrossRefPubMedCentralPubMed

13.

Venkatesh P, Ramanjulu R, Azad R, Vohra R, Garg S (2011) Subthreshold micropulse diode laser and double frequency neodymium: YAG laser in treatment of diabetic macular edema: a prospective, randomized study using multifocal electroretinography. Photomed Laser Surg 29(11):727–733. https://doi.org/10.1089/pho.2010.2830CrossRefPubMed

14.

Othman IS, Eissa SA, Kotb MS, Sadek SH (2014) Subthreshold diode-laser micropulse photocoagulation as a primary and secondary line of treatment in management of diabetic macular edema. Clin Ophthalmol 8:653. https://doi.org/10.2147/OPTH.S59669CrossRefPubMedCentralPubMed

15.

Ohkoshi K, Yamaguchi T (2010) Subthreshold micropulse diode laser photocoagulation for diabetic macular edema in Japanese patients. Am J Ophthalmol 149(1):133–139. https://doi.org/10.1016/j.ajo.2009.08.010CrossRefPubMed

16.

Luttrull K, J, Dorin G, (2012) Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review. Curr Diabetes Rev 8(4):274–284. https://doi.org/10.2174/157339912800840523CrossRefPubMedCentralPubMed

17.

Chhablani J, Alshareef R, Kim DT, Narayanan R, Goud A, Mathai A (2018) Comparison of different settings for yellow subthreshold laser treatment in diabetic macular edema. BMC Ophthalmol 18(1):1–8. https://doi.org/10.1186/s12886-018-0841-zCrossRef

18.

Passos RM, Malerbi FK, Rocha M, Maia M, Farah ME (2021) Real-life outcomes of subthreshold laser therapy for diabetic macular edema. Int J Retina Vitr 7(1):1–8. https://doi.org/10.1186/s40942-020-00268-3CrossRef

19.

Luttrull JK, Spink CJ (2006) Serial optical coherence tomography of subthreshold diode laser micropulse photocoagulation for diabetic macular edema. Ophthalmic Surg Lasers Imaging 37(5):370–377. https://doi.org/10.3928/15428877-20060901-03CrossRefPubMed

20.

Glassman AR, Wells JA III, Josic K, Maguire MG, Antoszyk AN, Baker C et al (2020) DRCR-Net. Five-year outcomes after initial aflibercept, bevacizumab, or ranibizumab treatment for diabetic macular edema (Protocol T extension study). Ophthalmology 127(9):1201–1210. https://doi.org/10.1016/j.ophtha.2020.03.021CrossRefPubMed

21.

Cornish EE, Teo KYC, Gillies MC, Lim LL, McAllister I, Sanmugasundram S et al (2018) Five-year outcomes of the Bevordex Study (a multicenter randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone). Invest Ophthalmol 59(9):4847

Title: Subthreshold laser treatment for non-center involved diabetic macular edema via non-damaging retinal laser therapy (NRT)
Authors: Fatma Sema Akkan Aydogmus
Defne Kalayci
Burcu Polat Gultekin
Publication date: 01-12-2024
Publisher: Springer Netherlands
Keywords: Laser
Edema
Published in: International Ophthalmology / Issue 1/2024
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-024-03065-1

At a glance: The STEP trials

Springer Medicine

Subthreshold laser treatment for non-center involved diabetic macular edema via non-damaging retinal laser therapy (NRT)

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Does the introduction of streamlight decrease refractive surgery operating time?

Vision-related quality of life in patients with retinal vein occlusion

Screening for multifocal intraocular lens implantation in cataract patients in a public hospital

Influence of anterior chamber depth and vault on anterior chamber angle morphology after phakic posterior chamber intraocular lens implantation

Impact of removing soft contact lenses 1 day versus 1 month before surgery on the outcomes of microkeratome laser in situ keratomileusis

Ocular cicatricial pemphigoid: is there an association with autoimmune diseases?