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Alessandro Dare, Jose Cardillo, Rodrigo Jorge, Rubens Belfort, Michel Farah, Pan-American Collaborative Retina Study (PACORES); Reduced Energy Macular Laser Phototherapy for the Treatment of Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2375. doi: https://doi.org/.
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Exploiting optimized parameters and treatment guidelines will be the key to progress macular photocoagulation for an ultimate tissue injury minimization and vision restoration. The purpose of this investigation is to determine the anatomical and functional outcome of this suggested optimized treatment technique consisting of confluent (high density) and barely visible photocoagulation lesions in patients with diabetic macular edema (DME).
Twenty-eight eyes of 21 patients with DME were treated using a yellow diode laser (577 nm) clinically adjusted to show barely visible photocoagulation lesions at 20 ms exposure time. The mean retinal sensitivity within the central 10 degrees measured with a fundus-related microperimeter, MP1, ETDRS-best corrected visual acuity (BCVA), optical coherence tomography-determined central macular thickness (CMT), and fluorescein angiography (FA) were performed before, 1, 3 and 6 months after a single treatment.
Central macular thickness decreased by an average of 277 μm. At 6 months main change in visual acuity was 5 letters better. Mean macular sensitivity improved (P<0.005) at 3 and 6 months. Laser lesions were not clinically observed, but detected on the early phase of the FA examination.
An extensive destruction of retinal tissue with laser burns may not be necessary to achieve an effective laser therapy. In the effort to minimize the side effects while maintaining the efficacy, short pulsed and low energy laser delivery targeting a barely visible lesion endpoint may characterize a more selective alternative to the present standard of care.
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