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. 2020 Jul 6;20(1):266.
doi: 10.1186/s12886-020-01536-4.

Subthreshold yellow laser for fovea-involving diabetic macular edema in a series of patients with good vision: effectiveness and safety of a fovea-sparing technique

Alejandro Filloy  1 , Victor Chong  2 , Eduard Solé  3
Affiliations

Subthreshold yellow laser for fovea-involving diabetic macular edema in a series of patients with good vision: effectiveness and safety of a fovea-sparing technique

Alejandro Filloy et al. BMC Ophthalmol. .

Abstract

Purpose: Patients with center-involved diabetic macular edema (CI-DME) with good visual acuity (VA) represent a controversial clinical scenario in which a subthreshold laser might be a reasonable approach. We report a case series of patients with CI-DME with VA better than 20/32 who were treated with a subthreshold 577 nm (yellow) laser.

Methods: The area of retinal thickening on OCT was treated with confluent laser spots at individually titrated power. The fovea was spared from treatment. Effectiveness and safety were evaluated through OCT and autofluorescence (AF) as well as BCVA.

Results: A total of 23 eyes from 19 patients were treated. VA ranged from 20/20 to 20/30. The follow-up period ranged from 6 to 18 months. Edema in OCT resolved completely at the end of follow-up in 56.5% (13/23) of the cases. Central retinal thickness was reduced at 12 weeks and at the end of follow-up, with a mean reduction of 16.9 μm and 22 μm, respectively (paired t-test p = 0.001 and 0.0003). VA remained stable. The laser was invisible (OCT, AF, Fundoscopy) in 91,3% (21/23) of eyes.

Conclusions: A fovea-sparing yellow subthreshold laser was safe and effective for treating CI-DME patients with good VA in this case series. This technique is of interest to prevent the progression of mild edema and might avoid or reduce the use of more invasive and expensive therapies. Excluding the fovea from the treated area does not seem to affect the results, which is of interest to novel laser practitioners.

Keywords: Autofluorescence; Diabetic; Fovea; Subthreshold; Yellow.

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Figures

Fig. 1
Fig. 1
This asymptomatic patient was diagnosed with DME during routine examination. Intraretinal cysts and early neurosensory detachment are visible. The CRT at this point was 302 μm. a. Twelve weeks after STL treatment, there was a marked improvement, with a decrease in CRT to 283 μm (b), as well as a lack of visible laser reaction on AF (c). Vision remained 20/20 at all times. The demarcated area on AF shows the treatment zone (also in Fig. 2). The OCT protocol for these images was a macular cube 9 × 9 mm
Fig. 2
Fig. 2
This patient showed remarkable improvement at the first post-laser visit (b, 12 weeks). At the next follow-up visit, we observed a slight additional improvement (c, 24 weeks). AF (d) does not show RPE disturbance. VA remained 20/25. CRT decreased from 282 μm at baseline to 266 μm at the first follow-up visit and finally 252 μm
See this image and copyright information in PMC

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