New advances in the study of subthreshold micropulse laser photocoagulation for central serous chorioretinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Qi Yuan ,  Liu Liya , Ma Feiyan , Shang Qingli

Department of Ophthalmology, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;

Corresponding author：

Liu Liya, Email: liuliya81@sina.com

Keywords：

Central serous chorioretinopathy; Laser coagulation; Subthreshold micropulse laser; Review

DOI：

10.3760/cma.j.cn511434-20230306-00108

Video：

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Central serous chorioretinopathy (CSC) is a common macular disease, which can lead to the loss of central vision in young patients. Although the disease is self-limited to some extent, there is no shortage of patients with prolonged course and recurrent attacks, eventually leading to irreversible visual impairment. Therefore, taking reasonable treatment in a certain period is particularly important for the visual prognosis of patients. Although thermal laser photocoagulation of leakage points and photodynamic therapy (PDT) have achieved good effects, there are risks of retinal damage and retinal pigment epithelium atrophy. Subthreshold micropulse laser (SMLP) is a kind of subthreshold short pulse laser, which does not cause visible damage to the retina and is safer. In the era of lack of PDT drugs, SMLP has gradually become an important means of clinical treatment for CSC, especially for patients with no obvious leakage point or subfoveal leakage point. An in-depth understanding of the mechanism of action of SMLP and its efficacy and safety in the treatment of CSC is helpful for the promotion and application of SMLP in the clinical treatment of CSC.

Citation： Qi Yuan, Liu Liya, Ma Feiyan, Shang Qingli. New advances in the study of subthreshold micropulse laser photocoagulation for central serous chorioretinopathy. Chinese Journal of Ocular Fundus Diseases, 2023, 39(4): 337-340. doi: 10.3760/cma.j.cn511434-20230306-00108 Copy

1.	Shiraya T, Araki F, Nakagawa S, et al. Differential gene expression analysis using RNA sequencing: retinal pigment epithelial cells after exposure to continuous-wave and subthreshold micropulse laser[J]. Jpn J Ophthalmol, 2022, 66(5): 487-497. DOI: 10.1007/s10384-022-00925-0.
2.	Van Rijssen TJ, Van Dijk EHC, Yzer S, et al. Central serous chorioretinopathy: towards an evidence-based treatment guideline[J/OL]. Prog Retin Eye Res, 2019, 73: 100770[2019-07-15]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(18)30094-6. DOI:10.1016/j.preteyeres.2019.07.003.
3.	Spaide RF, Gemmy Cheung CM, Matsumoto H, et al. Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100973[2021-05-21]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00034-3. DOI:10.1016/j.preteyeres.2021.100973.
4.	Prasuhn M, Miura Y, Tura A, et al. Influence of retinal microsecond pulse laser treatment in central serous chorioretinopathy: a short-term qptical coherence tomography angiography study[J]. J Clin Med, 2021, 10(11): 2418. DOI: 10.3390/jcm10112418.
5.	Mainster MA. Wavelength selection in macular photocoagulation. Tissue optics, thermal effects, and laser systems[J]. Ophthalmology, 1986, 93(7): 952-958. DOI: 10.1016/s0161-6420(86)33637-6.
6.	Feenstra HMA, Hahn LC, Van Rijssen TJ, et al. Efficacy of half-dose photodynamic therapy versus high-density subthreshold micropulse laser for treating pigment epithelial detachments in chronic central serous chorioretinopathy[J]. Retina, 2022, 42(4): 721-729. DOI: 10.1097/IAE.0000000000003363.
7.	Van Dijk EHC, Fauser S, Breukink MB, et al. Half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial[J]. Ophthalmology, 2018, 125(10): 1547-1555. DOI: 10.1016/j.ophtha.2018.04.021.
8.	Van Rijssen TJ, Van Dijk EHC, Scholz P, et al. Focal and diffuse chronic central serous chorioretinopathy treated with half-dose photodynamic therapy or subthreshold micropulse laser: PLACE trial report No. 3[J]. Am J Ophthalmol, 2019, 205: 1-10. DOI: 10.1016/j.ajo.2019.03.025.
9.	Chang DB, Luttrull JK. Comparison of subthreshold 577 and 810 nm micropulse laser effects on heat-shock protein activation kinetics: implications for treatment efficacy and safety[J]. Transl Vis Sci Technol, 2020, 9(5): 23. DOI: 10.1167/tvst.9.5.23.
10.	Sun Z, Huang Y, Nie C, et al. Efficacy and safety of subthreshold micropulse laser compared with threshold conventional laser in central serous chorioretinopathy[J]. Eye (Lond), 2020, 34(9): 1592-1599. DOI: 10.1038/s41433-019-0692-8.
11.	Zhou L, Lai K, Jin L, et al. Subthreshold micropulse laser vs. conventional laser for central serous chorioretinopathy: a randomized controlled clinical trial[J/OL]. Front Med (Lausanne), 2021, 8: 682264[2021-07-16]. https://europepmc.org/article/MED/34336888. DOI:10.3389/fmed.2021.682264.
12.	Altınel MG, Acikalin B, Gunes H, et al. Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy[J]. Lasers Med Sci, 2021, 36(7): 1505-1514. DOI: 10.1007/s10103-020-03225-6.
13.	Uzlu D, Erdöl H, Kola M, et al. The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy[J]. Lasers Med Sci, 2021, 36(5): 981-988. DOI: 10.1007/s10103-020-03129-5.
14.	Huang Y, Zheng W, Sun Z, et al. Optical coherence tomography biomarkers as predictors of transition to chronic central serous chorioretinopathy after retinal laser photocoagulation[J/OL]. Ther Adv Chronic Dis, 2023, 14: 20406223221146720[2023-01-21]. https://europepmc.org/article/MED/36704642. DOI:10.1177/20406223221146721.
15.	Malik KJ, Sampat KM, Mansouri A, et al. Low-intensity/high-density subthreshold micropulse diode laser for chronic central serous chorioretinopathy[J]. Retina, 2015, 35(3): 532-536. DOI: 10.1097/IAE.0000000000000285.
16.	Yadav NK, Jayadev C, Mohan A, et al. Subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy: safety profile and treatment outcome[J]. Eye (Lond), 2015, 29(2): 258-264; quiz 265. DOI:10.1038/eye.2014.315.
17.	Ho M, Lai FHP, Ng DSC, et al. Analysis of choriocapillaris perfusion and choroidal layer changes in patients with chronic central serous chorioretinopathy randomised to micropulse laser or photodynamic therapy[J]. Br J Ophthalmol, 2021, 105(4): 555-560. DOI: 10.1136/bjophthalmol-2020-316076.
18.	Kiraly P, Smrekar J, Jaki Mekjavić P. Morphological parameters predicting subthreshold micropulse laser effectiveness in central serous chorioretinopathy[J]. Lasers Med Sci, 2022, 37(8): 3129-3136. DOI: 10.1007/s10103-022-03574-4.
19.	Keunen JEE, Battaglia-Parodi M, Vujosevic S, et al. International retinal laser society guidelines for subthreshold laser treatment[J]. Transl Vis Sci Technol, 2020, 9(9): 15. DOI: 10.1167/tvst.9.9.15.
20.	Chhablani J, SOLS (Subthreshold Laser Ophthalmic Society) Writing Committee. Subthreshold laser therapy guidelines for retinal diseases[J]. Eye (Lond), 2022, 36(12): 2234-2235. DOI: 10.1038/s41433-022-02136-w.
21.	Işık MU, Değirmenci MFK, Sağlık A. Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy[J]. Int J Ophthalmol, 2020, 13(9): 1404-1410. DOI: 10.18240/ijo.2020.09.11.
22.	Zhou L, Chong V, Lai K, et al. A pilot prospective study of 577-nm yellow subthreshold micropulse laser treatment with two different power settings for acute central serous chorioretinopathy[J]. Lasers Med Sci, 2019, 34(7): 1345-1351. DOI: 10.1007/s10103-019-02721-8.
23.	Yenari MA, Liu J, Zheng Z, et al. Antiapoptotic and anti-inflammatory mechanisms of heat-shock protein protection[J]. Ann N Y Acad Sci, 2005, 1053: 74-83. DOI: 10.1196/annals.1344.007.
24.	Kern K, Mertineit CL, Brinkmann R, et al. Expression of heat shock protein 70 and cell death kinetics after different thermal impacts on cultured retinal pigment epithelial cells[J]. Exp Eye Res, 2018, 170: 117-126. DOI: 10.1016/j.exer.2018.02.013.
25.	Hirabayashi K, Kakihara S, Tanaka M, et al. Investigation of the therapeutic mechanism of subthreshold micropulse laser irradiation in retina[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(5): 1039-1047. DOI: 10.1007/s00417-020-04638-3.
26.	De Cillà S, Vezzola D, Farruggio S, et al. The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes[J]. Acta Ophthalmol, 2019, 97(4): 559-567. DOI: 10.1111/aos.13995.
27.	Gawęcki M, Jaszczuk A, Grzybowski A. Short term presence of subretinal fluid in central serous chorioretinopathy affects retinal thickness and function[J]. J Clin Med, 2020, 9(11): E3429. DOI: 10.3390/jcm9113429.
28.	Li X, Long H, Hu Q. Efficacy of subthreshold micropulse laser for chronic central serous chorioretinopathy: a meta-analysis[J/OL]. Photodiagnosis Photodyn Ther, 2022, 39: 102931[2022-05-27]. https://linkinghub.elsevier.com/retrieve/pii/S1572-1000(22)00217-4. DOI:10.1016/j.pdpdt.2022.102931.
29.	Van Rijssen TJ, Van Dijk EHC, Scholz P, et al. Long-term follow-up of chronic central serous chorioretinopathy after successful treatment with photodynamic therapy or micropulse laser[J]. Acta Ophthalmol, 2021, 99(7): 805-811. DOI: 10.1111/aos.14775.
30.	Van Rijssen TJ, Van Dijk EHC, Scholz P, et al. Crossover to photodynamic therapy or micropulse laser after failure of primary treatment of chronic central serous chorioretinopathy: the REPLACE trial[J]. Am J Ophthalmol, 2020, 216: 80-89. DOI: 10.1016/j.ajo.2020.04.007.
31.	Călugăru D, Călugăru M. Re: van Dijk et al: half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial (Ophthalmology. 2018;125: 1547-1555)[J]. Ophthalmology, 2019, 126(1): 10-11. DOI: 10.1016/j.ophtha.2018.06.037.
32.	Battaglia Parodi M, Iacono P. Re: van Dijk et al. : half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial (Ophthalmology. 2018;125: 1547-1555)[J]. Ophthalmology, 2019, 126(4): 29-30. DOI: 10.1016/j.ophtha.2018.11.004.
33.	Wu L, Roca JA. Comment on: crossover to photodynamic thrapy or micropulse laser after failure of primary treatment of chronic central serous chorioretinopathy[J]. Am J Ophthalmol, 2021, 222: 397. DOI: 10.1016/j.ajo.2020.09.052.
34.	Luttrull JK. Comment on: Focal and diffuse chronic central serous chorioretinopathy treated with half-dose photodynamic therapy or subthreshold micropulse laser: PLACE trial report No. 3[J]. Am J Ophthalmol, 2020, 212: 186-187. DOI: 10.1016/j.ajo.2019.10.037.
35.	Van Rijssen TJ, Van Dijk EHC, Dijkman G, et al. Reply to comment on: crossover to photodynamic therapy or micropulse laser after failure of primary treatment of chronic central serous chorioretinopathy[J]. Am J Ophthalmol, 2021, 222: 397-398. DOI: 10.1016/j.ajo.2020.10.005.

1. Shiraya T, Araki F, Nakagawa S, et al. Differential gene expression analysis using RNA sequencing: retinal pigment epithelial cells after exposure to continuous-wave and subthreshold micropulse laser[J]. Jpn J Ophthalmol, 2022, 66(5): 487-497. DOI: 10.1007/s10384-022-00925-0.
2. Van Rijssen TJ, Van Dijk EHC, Yzer S, et al. Central serous chorioretinopathy: towards an evidence-based treatment guideline[J/OL]. Prog Retin Eye Res, 2019, 73: 100770[2019-07-15]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(18)30094-6. DOI:10.1016/j.preteyeres.2019.07.003.
3. Spaide RF, Gemmy Cheung CM, Matsumoto H, et al. Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100973[2021-05-21]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00034-3. DOI:10.1016/j.preteyeres.2021.100973.
4. Prasuhn M, Miura Y, Tura A, et al. Influence of retinal microsecond pulse laser treatment in central serous chorioretinopathy: a short-term qptical coherence tomography angiography study[J]. J Clin Med, 2021, 10(11): 2418. DOI: 10.3390/jcm10112418.
5. Mainster MA. Wavelength selection in macular photocoagulation. Tissue optics, thermal effects, and laser systems[J]. Ophthalmology, 1986, 93(7): 952-958. DOI: 10.1016/s0161-6420(86)33637-6.
6. Feenstra HMA, Hahn LC, Van Rijssen TJ, et al. Efficacy of half-dose photodynamic therapy versus high-density subthreshold micropulse laser for treating pigment epithelial detachments in chronic central serous chorioretinopathy[J]. Retina, 2022, 42(4): 721-729. DOI: 10.1097/IAE.0000000000003363.
7. Van Dijk EHC, Fauser S, Breukink MB, et al. Half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial[J]. Ophthalmology, 2018, 125(10): 1547-1555. DOI: 10.1016/j.ophtha.2018.04.021.
8. Van Rijssen TJ, Van Dijk EHC, Scholz P, et al. Focal and diffuse chronic central serous chorioretinopathy treated with half-dose photodynamic therapy or subthreshold micropulse laser: PLACE trial report No. 3[J]. Am J Ophthalmol, 2019, 205: 1-10. DOI: 10.1016/j.ajo.2019.03.025.
9. Chang DB, Luttrull JK. Comparison of subthreshold 577 and 810 nm micropulse laser effects on heat-shock protein activation kinetics: implications for treatment efficacy and safety[J]. Transl Vis Sci Technol, 2020, 9(5): 23. DOI: 10.1167/tvst.9.5.23.
10. Sun Z, Huang Y, Nie C, et al. Efficacy and safety of subthreshold micropulse laser compared with threshold conventional laser in central serous chorioretinopathy[J]. Eye (Lond), 2020, 34(9): 1592-1599. DOI: 10.1038/s41433-019-0692-8.
11. Zhou L, Lai K, Jin L, et al. Subthreshold micropulse laser vs. conventional laser for central serous chorioretinopathy: a randomized controlled clinical trial[J/OL]. Front Med (Lausanne), 2021, 8: 682264[2021-07-16]. https://europepmc.org/article/MED/34336888. DOI:10.3389/fmed.2021.682264.
12. Altınel MG, Acikalin B, Gunes H, et al. Optical coherence tomography parameters as predictors of treatment response to a 577-nm subthreshold micropulse laser in chronic central serous chorioretinopathy[J]. Lasers Med Sci, 2021, 36(7): 1505-1514. DOI: 10.1007/s10103-020-03225-6.
13. Uzlu D, Erdöl H, Kola M, et al. The efficacy of subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy[J]. Lasers Med Sci, 2021, 36(5): 981-988. DOI: 10.1007/s10103-020-03129-5.
14. Huang Y, Zheng W, Sun Z, et al. Optical coherence tomography biomarkers as predictors of transition to chronic central serous chorioretinopathy after retinal laser photocoagulation[J/OL]. Ther Adv Chronic Dis, 2023, 14: 20406223221146720[2023-01-21]. https://europepmc.org/article/MED/36704642. DOI:10.1177/20406223221146721.
15. Malik KJ, Sampat KM, Mansouri A, et al. Low-intensity/high-density subthreshold micropulse diode laser for chronic central serous chorioretinopathy[J]. Retina, 2015, 35(3): 532-536. DOI: 10.1097/IAE.0000000000000285.
16. Yadav NK, Jayadev C, Mohan A, et al. Subthreshold micropulse yellow laser (577 nm) in chronic central serous chorioretinopathy: safety profile and treatment outcome[J]. Eye (Lond), 2015, 29(2): 258-264; quiz 265. DOI:10.1038/eye.2014.315.
17. Ho M, Lai FHP, Ng DSC, et al. Analysis of choriocapillaris perfusion and choroidal layer changes in patients with chronic central serous chorioretinopathy randomised to micropulse laser or photodynamic therapy[J]. Br J Ophthalmol, 2021, 105(4): 555-560. DOI: 10.1136/bjophthalmol-2020-316076.
18. Kiraly P, Smrekar J, Jaki Mekjavić P. Morphological parameters predicting subthreshold micropulse laser effectiveness in central serous chorioretinopathy[J]. Lasers Med Sci, 2022, 37(8): 3129-3136. DOI: 10.1007/s10103-022-03574-4.
19. Keunen JEE, Battaglia-Parodi M, Vujosevic S, et al. International retinal laser society guidelines for subthreshold laser treatment[J]. Transl Vis Sci Technol, 2020, 9(9): 15. DOI: 10.1167/tvst.9.9.15.
20. Chhablani J, SOLS (Subthreshold Laser Ophthalmic Society) Writing Committee. Subthreshold laser therapy guidelines for retinal diseases[J]. Eye (Lond), 2022, 36(12): 2234-2235. DOI: 10.1038/s41433-022-02136-w.
21. Işık MU, Değirmenci MFK, Sağlık A. Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy[J]. Int J Ophthalmol, 2020, 13(9): 1404-1410. DOI: 10.18240/ijo.2020.09.11.
22. Zhou L, Chong V, Lai K, et al. A pilot prospective study of 577-nm yellow subthreshold micropulse laser treatment with two different power settings for acute central serous chorioretinopathy[J]. Lasers Med Sci, 2019, 34(7): 1345-1351. DOI: 10.1007/s10103-019-02721-8.
23. Yenari MA, Liu J, Zheng Z, et al. Antiapoptotic and anti-inflammatory mechanisms of heat-shock protein protection[J]. Ann N Y Acad Sci, 2005, 1053: 74-83. DOI: 10.1196/annals.1344.007.
24. Kern K, Mertineit CL, Brinkmann R, et al. Expression of heat shock protein 70 and cell death kinetics after different thermal impacts on cultured retinal pigment epithelial cells[J]. Exp Eye Res, 2018, 170: 117-126. DOI: 10.1016/j.exer.2018.02.013.
25. Hirabayashi K, Kakihara S, Tanaka M, et al. Investigation of the therapeutic mechanism of subthreshold micropulse laser irradiation in retina[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(5): 1039-1047. DOI: 10.1007/s00417-020-04638-3.
26. De Cillà S, Vezzola D, Farruggio S, et al. The subthreshold micropulse laser treatment of the retina restores the oxidant/antioxidant balance and counteracts programmed forms of cell death in the mice eyes[J]. Acta Ophthalmol, 2019, 97(4): 559-567. DOI: 10.1111/aos.13995.
27. Gawęcki M, Jaszczuk A, Grzybowski A. Short term presence of subretinal fluid in central serous chorioretinopathy affects retinal thickness and function[J]. J Clin Med, 2020, 9(11): E3429. DOI: 10.3390/jcm9113429.
28. Li X, Long H, Hu Q. Efficacy of subthreshold micropulse laser for chronic central serous chorioretinopathy: a meta-analysis[J/OL]. Photodiagnosis Photodyn Ther, 2022, 39: 102931[2022-05-27]. https://linkinghub.elsevier.com/retrieve/pii/S1572-1000(22)00217-4. DOI:10.1016/j.pdpdt.2022.102931.
29. Van Rijssen TJ, Van Dijk EHC, Scholz P, et al. Long-term follow-up of chronic central serous chorioretinopathy after successful treatment with photodynamic therapy or micropulse laser[J]. Acta Ophthalmol, 2021, 99(7): 805-811. DOI: 10.1111/aos.14775.
30. Van Rijssen TJ, Van Dijk EHC, Scholz P, et al. Crossover to photodynamic therapy or micropulse laser after failure of primary treatment of chronic central serous chorioretinopathy: the REPLACE trial[J]. Am J Ophthalmol, 2020, 216: 80-89. DOI: 10.1016/j.ajo.2020.04.007.
31. Călugăru D, Călugăru M. Re: van Dijk et al: half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial (Ophthalmology. 2018;125: 1547-1555)[J]. Ophthalmology, 2019, 126(1): 10-11. DOI: 10.1016/j.ophtha.2018.06.037.
32. Battaglia Parodi M, Iacono P. Re: van Dijk et al. : half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial (Ophthalmology. 2018;125: 1547-1555)[J]. Ophthalmology, 2019, 126(4): 29-30. DOI: 10.1016/j.ophtha.2018.11.004.
33. Wu L, Roca JA. Comment on: crossover to photodynamic thrapy or micropulse laser after failure of primary treatment of chronic central serous chorioretinopathy[J]. Am J Ophthalmol, 2021, 222: 397. DOI: 10.1016/j.ajo.2020.09.052.
34. Luttrull JK. Comment on: Focal and diffuse chronic central serous chorioretinopathy treated with half-dose photodynamic therapy or subthreshold micropulse laser: PLACE trial report No. 3[J]. Am J Ophthalmol, 2020, 212: 186-187. DOI: 10.1016/j.ajo.2019.10.037.
35. Van Rijssen TJ, Van Dijk EHC, Dijkman G, et al. Reply to comment on: crossover to photodynamic therapy or micropulse laser after failure of primary treatment of chronic central serous chorioretinopathy[J]. Am J Ophthalmol, 2021, 222: 397-398. DOI: 10.1016/j.ajo.2020.10.005.

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New advances in the study of subthreshold micropulse laser photocoagulation for central serous chorioretinopathy

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