A Combined Low Energy, Short Pulsed 577 nm Mild Macular Grid Photocoagulation with 577 nm-Micropulsed Central Laser Stimulation for Diabetic Macular Edema with Foveal Leakage (The Sandwich Grid)

Abstract

Purpose: : To determine the anatomical and functional outcome of combined barely visible 577nm photocoagulation lesions placed throughout the macula and microaneurysms area with a 577 nm-micropulsed central photo stimulation in patients with diabetic macular edema (DME) with foveal leakage.

Methods: : Twenty-eight eyes of 25 patients with DME were treated using a yellow diode laser (577 nm) clinically adjusted to show barely visible photocoagulation lesions at 10 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 fluorecein angiography (FA) were performed before, 1, 3 and 6 months after a single treatment.

Results: : Central macular thickness decreased by an average of 201µm. At 6 months main change in visual acuity was 3 letters better. Mean macular sensitivity improved (P<0.005) at 3 and 6 months. Laser lesions were not clinically observed, but detected on FA examination. The foveal area no signs of treatment could be observed by any means.

Conclusions: : In the effort to minimize the side effects while maintaining the efficacy, combination of mild macular grid and foveal micropulse may characterize a more selective alternative to progress macular photocoagulation for DME with central foveal leakage.

Keywords: diabetic retinopathy • laser • retina