Hybrid threshold laser to treat diabetic macular edema: A retrospective analysis single center cohort study

Ameen Marashi, Aya Zazo, Ameen Marashi, Aya Zazo

Abstract

Background: Diabetic patients suffers from reduction of vision that one of its main causes is clinically significant macular edema (CSME).The purpose of this study to determine if hybrid threshold can reduce macular thickness in Diabetic Macular Edema.

Materials and methods: This study is a retrospective analysis single center cohort study. 12 eyes in 10 patients diagnosed with diabetic macular edema using SD-OCT treated with Hybridthreshold laser as the leaking microaneurysms were treated with threshold laser on the 5% duty cycle settings.A complete fundus exam, including best-corrected visual acuity changes, and monthly measuring retinal thickness using SD-OCT for 24 weeks follow up.

Results: Reduction of retinal thickness from 336.58 ± 86.26 μm to 264.33 ± 61.41 μm (p = 0.02) at 24 weeks follow up without significant changes of best-corrected visual acuity from 0.16 LogMAR to 0.08 LogMAR (p = 0.2) with minimal scar formation in 24 weeks follow up.

Conclusion: 532 nm Hybridthreshold laser reduces macular thickness up to 20% and stabilizes diabetic macular edema for 24 weeks follow up.

Keywords: Diabetic macular edema; Hybridthreshold; Laser; Micropulse.

Conflict of interest statement

The authors declare that there is no conflict of interest.

© 2022 The Author(s).

Figures

Fig. 1
Fig. 1
Shows mean changes in central macular thickness within 24 weeks follow up after HT laser treatment.
Fig. 2
Fig. 2
A) OCT scan at baseline showing diabetic macular edema with hyperreflective foci resembling hard exudates B) OCT cross-section after one month of hybrid threshold laser showing diabetic macular edema with RPE scar limited to RPE and outer retinal tissue with decreasing of hard exudates C) OCT cross-section after 24 weeks follow up showing reduction of diabetic macular edema thickness and resolved majority of hard exudates and with reduction of scar size D) Fundus image shows a cluster of hard exudates with microaneurysms and diabetic macular edema with non-proliferative diabetic retinopathy E) One day after the hybrid threshold laser showing laser burns application to leaking microaneurysms F) Fundus image 24 weeks follow up shows resolved hard exudates, and scar formation didn't expand in size.

References

    1. Klein R., Moss S.E., Klein B.E., Dams M.D., DeMets D.L. The Wisconsin epidemiologic study of diabetic retinopathy: XI. The incidence of macular edema. Ophthalmology. 1989;96(10):1501–1510.
    1. Baker C.W., Glassman A.R., Beaulieu W.T., Antoszyk A.N., Browning D.J., Chalam K.V., Grover S., Jampol L.M., Jhaveri C.D., Melia M., Stockdale C.R. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321(19):1880–1894.
    1. Scott I.U., Danis R.P., Bressler S.B., Bressler N.M., Browning D.J., Qin H. Effect of focal/grid photocoagulation on visual acuity and retinal thickening in eyes with non-center involved clinically significant diabetic macular edema. Retina. 2009;29(5):613. Philadelphia, Pa.
    1. Wood J.P., Plunkett M., Casson R.J., Chidlow G. Retinal damage profiles and neuronal effects of laser treatment: comparison of a conventional photocoagulator and a novel 3-nanosecond pulse laser. Investig. Ophthalmol. Vis. Sci. 2013;54(3):2305–2318.
    1. Marashi A. Non-central diabetic clinical significant macular edema treatment with 532nm sub threshold laser. Adv Ophthalmol Vis Syst. 2018;8(3):151–154.
    1. Mathew G., Agha Strocss R. Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int. J. Surg. 2021;96 2021), Article 106165.
    1. Dorin G. vol. 19. Taylor & Francis; 2004, January. Evolution of retinal laser therapy: minimum intensity photocoagulation (MIP). Can the laser heal the retina without harming it? pp. 62–68. (Seminars in Ophthalmology). No. 1-2.
    1. Wilson A.S., Hobbs B.G., Shen W.Y., Speed T.P., Schmidt U., Begley C.G., Rakoczy P.E. Argon laser photocoagulation–induced modification of gene expression in the retina. Investig. Ophthalmol. Vis. Sci. 2003;44(4):1426–1434.
    1. Inagaki K., Shuo T., Katakura K., Ebihara N., Murakami A., Ohkoshi K. Sublethal photothermal stimulation with a micropulse laser induces heat shock protein expression in ARPE-19 cells. J Ophthalmology. 2015 2015.
    1. Vujosevic S., Martini F., Longhin E., Convento E., Cavarzeran F., Midena E. Subthreshold micropulse yellow laser versus subthreshold micropulse infrared laser in center-involving diabetic macular edema: morphologic and functional safety. Retina. 2015;35(8):1594–1603.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다