The efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Wenqing ,  Song Yanping , Ding Qin , Yan Ming , Huang Xiaoli , Ye Ya , Huang Zhen

Department of Ophthalmology, Wuhan General Hospital of the PLA, Clinical Research Center for Fundus laser in Hubei Province, Wuhan 430070, China;

Corresponding author：

Song Yanping, Email: songyanping@medmail.com.cn

Keywords：

Diabetic retinopathy/therapy; Macular Edema/therapy; Laser coagulation; Treatment outcome

DOI：

10.3760/cma.j.issn.1005-1015.2018.05.010

Video：

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Objective To evaluate the clinical efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema (DME). Methods Retrospective case series study. A total of 30 patients (35 eyes) with center−involving DME were enrolled in this study. All the patients received the examinations of best corrected visual acuity (BCVA), fundus colorized photography, fluorescein fundus angiography (FFA) and optical coherence tomography (OCT). BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. The average retinal thickness (ART), total macular volume (TMV) and the retinal thickness (RT) and macular volume (MV) of 9 ETDRS domains were measured by the Japanese Topcon 3D-OCT 2000 instrument. The mean BCVA was 62.4±10.5 letters. The mean ART was 327.3±41.2 μm. The mean TMV was 9.24±1.17 mm³. All patients were treated with 577 nm subthreshold micropulse laser treatment. Subthreshold micropulse laser were performed in the micropulse mode, using a 200 μm spot diameter, a 0.2 s duration with 5% duty cycle and its treatment energy was 6−7 times of threshold energy. Three months after treatment, re-treatment was performed on patients with incomplete absorption of macular edema. The treatment was the same as before. The BCVA, ART, TMV and the RT and MV of each ETDRS domain were compared and analyzed before and after treatment. The possible complications of micropulse laser treatment were also observed and the safety was evaluated. Results The difference of BCVA were statistically significant in month 3 and month 6 (t=−5.58, −7.24; P＜0.05), but not in month 1 (t=−1.82, P＞0.05). The average CRT (t=4.11, 4.17, 5.96), CMV (t=3.92, 4.05, 5.80) significantly decreased in 1, 3 and 6 months after treatment, the difference was statistically significant (P＜0.05). At sixth months, the average retinal thickness (t=3.53, 5.07, 5.02, 4.87, 4.94, 3.48, 4.03, 3.17, 3.73) and retinal volume (t=3.54, 5.16, 4.99, 4.91, 5.05, 3.47, 4.08, 3.10, 3.70) of the 9 ETDRS subdomains significantly decreased, and the difference was statistically significant (P＜0.05). There was no visible laser spots, changes in the outer retina and complications of neovascularization and subretinal fibrosis in the fundus of all patients. Conclusion577 nm subthreshold micropulse laser can reduce the CMT, CMV and improve the BCVA of DME patients with high security.

Citation： Li Wenqing, Song Yanping, Ding Qin, Yan Ming, Huang Xiaoli, Ye Ya, Huang Zhen. The efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema. Chinese Journal of Ocular Fundus Diseases, 2018, 34(5): 462-466. doi: 10.3760/cma.j.issn.1005-1015.2018.05.010 Copy

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2.	Iliuşi FG, Preda M.The adaptometry study in patients with diabetic retinopathy[J]. Oftalmologia, 2004, 48(1): 43-47.
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4.	Luttrull JK, Dorin G.Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review[J].Curr Diabetes Rev, 2012, 8(4): 274-284.
5.	Inagaki K, Ohkoshi K, Ohde S, et al.Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema[J]. Jpn J Ophthalmol, 2015, 59(1): 21-28. DOI: 10.1007/s10384-014-0361-1.
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8.	Holz FG, Amoaku W, Donate J, et al.Safety and efficacy of a flexible dosing regimen of ranibizumab in neovascular age-related macular degeneration: the SUSTAIN study[J]. Ophthalmology, 2011, 118(4): 663-671.DOI: 10.1016/j.ophtha.2010.12.019.
9.	Brader HS, Young LH.Subthreshold diode micropulse laser: a review[J].Semin Ophthalmol, 2016, 31(1-2): 30-39.DOI:10.3109/08820538.2015.1114837.
10.	Vujosevic S, Martini F, Longhin E, et al.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.DOI: 10.1097/IAE.0000000000000521.
11.	Latalska M, Prokopiuk A, Wróbel-Dudzińska D, et al. Subthreshold micropulse yellow 577 nm laser therapy of diabetic macular oedema in rural and urban patients of south-eastern Poland[J]. Ann Agric Environ Med, 2017, 24(1): 96-99.DOI: 10.5604/12321966.1233899.
12.	Kwon YH, Lee DK, Kwon OW.The short-term efficacy of subthreshold Micropulse yellow (577-nm) laser photocoagulation for diabetic macular edema[J]. Korean J Ophthalmol, 2014, 28(5): 379-385.DOI:10.3341/kjo.2014.28.5.379.
13.	Nicolò M, Musetti D, Traverso CE.Yellow micropulse laser in diabetic macular edema: a short-term pilot study[J].Eur J Ophthalmol, 2014, 24(6): 885-889.DOI:10.5301/ejo.5000495.
14.	Inagaki K, Shuo T, Katakura K, et al.Sublethal Photothermal stimulation with a micropulse laser induces heat shock protein expression in ARPE-19 cells[J/OL]. J Ophthalmol, 2015, 2015: 729792[2015-11-30] .http://dx.doi.org/10.1155/2015/729792.DOI: 10.1155/2015/729792.
15.	Beckham JT, Wilmink GJ, Mackanos MA, et al.Role of HSP70 in cellular thermotolerance[J]. Lasers Surg Med, 2008, 40(10): 704-715.DOI: 10.1002/lsm.20713.
16.	Li Z, Song Y, Chen X, et al.Biological modulation of mouse RPE cells in response to subthreshold diode micropulse laser treatment[J]. Cell Biochem Biophys, 2015, 73(2): 545-552. DOI:10.1007/s12013-015-0675-8.
17.	Vujosevic S, Martini F, Convento E, et al., Subthreshold laser therapy for diabetic macular edema: metabolic and safety issues[J]. Curr Med Chem, 2013, 20(26): 3267-3271.
18.	Rajmohan M, Naidu RM, Thamaraiselvi D, et al.In vivo autofluorescence spectroscopic study and evaluation of DNA damage by comet assay in smokers[J]. J Clin Diagn Res, 2015, 9(5): 16-19. DOI: 10.7860/JCDR/2015/13805.5874.
19.	Luttrull JK, Sramek C, Palanker D, et al.Long-term safety, high-resolution imaging, and tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema[J].Retina, 2012, 32(2): 375-386.DOI:10.1097/IAE.0b013e3182206f6c.
20.	Luttrull JK, Musch DC, Mainster MA.Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular oedema[J].Br J Ophthalmol, 2005, 89(1): 74-80.
21.	Gao X, Xing D.Molecular mechanisms of cell proliferation induced by low power laser irradiation[J].J Biomed Sci, 2009, 16:4. DOI:10.1186/1423-0127-16-4.

1. Lavinsky D, Cardillo JA, Melo LA Jr, et al.Randomized clinical trial evaluating mETDRS versus normal or high-density micropulse photocoagulation for diabetic macular edema[J].Invest Ophthalmol Vis Sci, 2011, 52(7): 4314-4323. DOI:10.1167/iovs.10-6828.
2. Iliuşi FG, Preda M.The adaptometry study in patients with diabetic retinopathy[J]. Oftalmologia, 2004, 48(1): 43-47.
3. Wang J, Quan Y, Dalal R, et al.Comparison of continuous-wave and micropulse modulation in retinal laser therapy[J].Invest Ophthalmol Vis Sci, 2017, 58(11): 4722-4732. DOI: 10.1167/iovs.17-21610.
4. Luttrull JK, Dorin G.Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review[J].Curr Diabetes Rev, 2012, 8(4): 274-284.
5. Inagaki K, Ohkoshi K, Ohde S, et al.Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema[J]. Jpn J Ophthalmol, 2015, 59(1): 21-28. DOI: 10.1007/s10384-014-0361-1.
6. Solomon SD, Chew E, Duh EJ, et al.Diabetic Retinopathy: a position statement by the American Diabetes Association[J].Diabetes Care, 2017, 40(3): 412-418.DOI:10.2337/dc16-2641.
7. American Diabetes Association.12. Children and adolescents: Standards of Medical Care in Diabetes-2018[J].Diabetes Care, 2018, 41(Suppl 1): S126-136. DOI:10.2337/dc18-S012.
8. Holz FG, Amoaku W, Donate J, et al.Safety and efficacy of a flexible dosing regimen of ranibizumab in neovascular age-related macular degeneration: the SUSTAIN study[J]. Ophthalmology, 2011, 118(4): 663-671.DOI: 10.1016/j.ophtha.2010.12.019.
9. Brader HS, Young LH.Subthreshold diode micropulse laser: a review[J].Semin Ophthalmol, 2016, 31(1-2): 30-39.DOI:10.3109/08820538.2015.1114837.
10. Vujosevic S, Martini F, Longhin E, et al.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.DOI: 10.1097/IAE.0000000000000521.
11. Latalska M, Prokopiuk A, Wróbel-Dudzińska D, et al. Subthreshold micropulse yellow 577 nm laser therapy of diabetic macular oedema in rural and urban patients of south-eastern Poland[J]. Ann Agric Environ Med, 2017, 24(1): 96-99.DOI: 10.5604/12321966.1233899.
12. Kwon YH, Lee DK, Kwon OW.The short-term efficacy of subthreshold Micropulse yellow (577-nm) laser photocoagulation for diabetic macular edema[J]. Korean J Ophthalmol, 2014, 28(5): 379-385.DOI:10.3341/kjo.2014.28.5.379.
13. Nicolò M, Musetti D, Traverso CE.Yellow micropulse laser in diabetic macular edema: a short-term pilot study[J].Eur J Ophthalmol, 2014, 24(6): 885-889.DOI:10.5301/ejo.5000495.
14. Inagaki K, Shuo T, Katakura K, et al.Sublethal Photothermal stimulation with a micropulse laser induces heat shock protein expression in ARPE-19 cells[J/OL]. J Ophthalmol, 2015, 2015: 729792[2015-11-30] .http://dx.doi.org/10.1155/2015/729792.DOI: 10.1155/2015/729792.
15. Beckham JT, Wilmink GJ, Mackanos MA, et al.Role of HSP70 in cellular thermotolerance[J]. Lasers Surg Med, 2008, 40(10): 704-715.DOI: 10.1002/lsm.20713.
16. Li Z, Song Y, Chen X, et al.Biological modulation of mouse RPE cells in response to subthreshold diode micropulse laser treatment[J]. Cell Biochem Biophys, 2015, 73(2): 545-552. DOI:10.1007/s12013-015-0675-8.
17. Vujosevic S, Martini F, Convento E, et al., Subthreshold laser therapy for diabetic macular edema: metabolic and safety issues[J]. Curr Med Chem, 2013, 20(26): 3267-3271.
18. Rajmohan M, Naidu RM, Thamaraiselvi D, et al.In vivo autofluorescence spectroscopic study and evaluation of DNA damage by comet assay in smokers[J]. J Clin Diagn Res, 2015, 9(5): 16-19. DOI: 10.7860/JCDR/2015/13805.5874.
19. Luttrull JK, Sramek C, Palanker D, et al.Long-term safety, high-resolution imaging, and tissue temperature modeling of subvisible diode micropulse photocoagulation for retinovascular macular edema[J].Retina, 2012, 32(2): 375-386.DOI:10.1097/IAE.0b013e3182206f6c.
20. Luttrull JK, Musch DC, Mainster MA.Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular oedema[J].Br J Ophthalmol, 2005, 89(1): 74-80.
21. Gao X, Xing D.Molecular mechanisms of cell proliferation induced by low power laser irradiation[J].J Biomed Sci, 2009, 16:4. DOI:10.1186/1423-0127-16-4.

Chinese Journal of Ocular Fundus Diseases

The efficacy and safety of 577 nm subthreshold micropulse laser on diabetic macular edema

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