Subthreshold Laser Treatment for Serous Retinal Detachment Associated with Tilted Disc Syndrome

Persistent serous retinal detachment (SRD) is a common complication of tilted disc syndrome (TDS). The purpose of this study is to evaluate the efficacy of subthreshold laser photocoagulation for SRD associated with TDS. This retrospective, single-center study included 5 eyes of 5 patients with TDS-associated SRD treated by subthreshold laser treatment. SRD was completely absorbed in 4 eyes within 4 months after initial treatment. However, it recurred in 2 eyes; one required additional laser treatment and one showed spontaneous resolution. Eventually, all 4 eyes showed complete SRD resorption. The mean visual acuities at enrollment and 1 and 3 months showed no significant differences. The mean central macular thickness showed a significant decrease at 3 months. Two eyes showed changes in fundus autofluorescence findings at the laser ablation site. However, there were no instances of laser scotoma and no laser-induced retinal scarring on color fundus photography performed at the end of treatment. In conclusion, subthreshold laser photocoagulation is an effective treatment for SRD associated with TDS. Thus, the clinical indications of subthreshold laser photocoagulation may be extended to SRD in patients with TDS.

Comparison of the effectiveness of micropulse laser treatment in central serous chorioretinopathy and complicated forms of dome-shaped macula

The purpose of the study was to evaluate the effectiveness of micropulse subthreshold laser coagulation (SML) in patients with complicated form of sclerogenic macular degeneration (SMD), acute and chronic central serous chorioretinopathy (CSR). Material and methods. SML was performed in 3 groups of patients. Group 1 – 15 patients with SMD from 28 to 63 years old, median age 55.0 (40; 62) years. Group 2 with acute CSR – 16 patients from 21 to 51 years old, median age – 37.0 (32; 42.5) years. Group 3 of patients with chronic CSR consisted of 15 people from 26 to 56 years old, the median age was 43.0 (40; 51). In group 1, women prevailed (93%), in groups 2 and 3 – men (94% and 80%, respectively). SML was performed with a diode laser (810 nm) in a subthreshold mode, a 10% microimpulse was used, 2-3 sessions were performed with an interval of 2-4 months. The observation period was 6-12 months. The criterion of efficiency was the complete disappearance of the liquid. Results. In group 1 of patients, serous retinal detachment (SRD) completely adhered in 7 out of 15 people (46.7%), there were no relapses during the year of follow-up. In group 2, the treatment effect was achieved in 11 out of 16 people (68.8%), 3 relapses of SRD. In group 3 with chronic CSR, complete regression of SRD was achieved in 10 out of 15 people (66.7%) with 1 recurrence of SRD. Significant dynamics of BCVA and retinal thickness in the central zone were observed only in the group with acute CSR. Conclusions. SML accelerates the resorption of subretinal fluid as efficiently as possible in patients with acute CSR. In the other two groups, this method of treatment cannot be considered completely satisfactory due to the very slow rate of regression of SRD and the absence of a significant effect on visual acuity. Key words: central serous chorioretinopathy, dome-shaped macula, sclerogenic macular degeneration, subthreshold laser micropulse coagulation.

Clinical efficacy of subthreshold laser treatment for focal diabetic macular edema using a navigation system (short-term results)

Purpose. To evaluate the clinical efficacy of subthreshold laser treatment for focal DME with continuous and micropulse mode based on navigated technology. Methods. We observed 17 patients (17 eyes) with DME at the age from 25 to 71 years (on average 44±1.6 years). After the stage of diagnostic search for morphological changes in the retina and preoperative planning all patients underwent navigational laser treatment in and continuous and micropulse mode. The study evaluated the retinal thickness in the foveal avascular zone and outside it, the area of retinal ischemia, microaneurysms and edema zones at the level of the superficial vascular plexus and deep vascular complex. Follow-up periods were 1 and 3 months. Results. One month after laser treatment, all patients had positive dynamics, expressed in a decrease of edema height. BCVA increased on average to 0.8±0.06; mean central retinal sensitivity – up to 24.65±0.47 dB. After 3 months, a further decrease in the height of the edema was observed. BCVA increased on average for the group to 0.85±0.06, mean central retinal sensitivity – 25.5±0.3 dB. Сonclusion. Our preliminary results indicate the effectiveness of navigational subthreshold laser treatment for DME, based on targeted topographically oriented laser exposure according to OCT-angiography. Keywords: diabetic macular edema, navigational laser treatment, subthreshold laser therapy.

Subthreshold laser therapy with a standardized macular treatment pattern in chronic central serous chorioretinopathy

Purpose There is an ongoing controversial debate about the effectiveness of laser treatments in chronic central serous chorioretinopathy (cCSC). We performed a prospective non-randomized interventional study to learn about the effects of a subthreshold laser treatment (Topcon Endpoint Management™, Topcon Healthcare Inc., Tokyo, Japan) in patients with cCSC. Methods Patients with cCSC and a minimum symptom duration of 4 months were included and treated with a standardized laser pattern covering the macular area. Retreatment was performed every 3 months if persistent subretinal fluid was observed. The primary endpoint was resolution of subretinal fluid at 6 months. Further outcome parameters included best corrected visual acuity, microperimetry, central macular and subfoveal choroidal thickness. Results A total of 42 eyes of 39 patients were included. Mean patient age was 48 ± 10.6 years (range 25–67). Mean symptomatic time before inclusion into the study was 134 ± 133.4 weeks (16–518). Before inclusion, 78.6% of the patients had failed to resolve subretinal fluid under mineralocorticoid receptor antagonists and 14.3% had a recurrence after half-dose photodynamic therapy. Complete resolution of subretinal fluid was observed in 42.9% at 6 months and in 53.8% at 12 months after baseline. Central retinal thickness decreased from 398 ± 135 µm to 291 ± 68 µm (p < 0.001), subfoveal choroidal thickness changed slightly (430 ± 116 µm to 419 ± 113 µm, p = 0.026), microperimetry-derived macular function improved by 19.1 ± 4.7 dB to 21.3 ± 4.8 dB (p = 0.008) and mean BCVA improved by 4.9 ± 8.6 ETDRS letters (p < 0.001). Conclusion The results show that the investigated laser treatment is effective in reducing subretinal fluid and leads to an improvement of functional parameters.

Subthreshold laser treatment for reticular pseudodrusen secondary to age-related macular degeneration

There is a lack of treatment aimed at the regression of reticular pseudodrusen (RPD) secondary to age-related macular degeneration (AMD). The aim of this prospective, pilot study is to evaluate the safety and short-term efficacy of subthreshold laser treatment (SLT) in patients affected by RPD secondary to dry AMD (dAMD). Twenty eyes of 20 patients (mean age 78.4 ± 6.8 years) with RPD secondary to dAMD were prospectively enrolled. All patients were treated in an extrafoveal area of 1.27 mm2 using end-point management yellow subthreshold laser and followed for 3 months. Best-corrected visual acuity was 0.140 ± 0.09 LogMAR at the baseline and no changes were observed during the follow-up (p = 0.232). No significant worsening was disclosed before and after the treatment analyzing the macular sensitivity of the treated area (p = 0.152). No topical and/or systemic side effects were disclosed during the 3-month follow-up. The distribution among the RPD stages changed after the treatment (p < 0.001). In detail, in the treated area, we observed a significant increase in the number of Stage 1 RPD during the follow-up (p = 0.002), associated with a significant decrease of Stage 3 RPD (p = 0.020). Outer nuclear layer (ONL) thickness analysis showed a significant increase after the treatment associated with RPD regression (p = 0.001). End-point management SLT appears a safe treatment for RPD secondary to dAMD, showing short-term safety outcomes. Our results suggest that SLT could be effective in inducing a RPD regression in terms of RPD stage and ONL thickening.

Real-life outcomes of subthreshold laser therapy for diabetic macular edema

Background Diabetic macular edema (DME) is a major cause of visual impairment and its treatment is a public health challenge. Even though anti-angiogenic drugs are the gold-standard treatment, they are not ideal and subthreshold laser (SL) remains a viable and promising therapy in selected cases. The aim of this study was to evaluate its efficacy in a real-life setting. Methods Retrospective case series of 56 eyes of 36 patients with center-involving DME treated with SL monotherapy. Treatment was performed in a single session with the EasyRet® photocoagulator with the following parameters: 5% duty cycle, 200-ms pulse duration, 160-µm spot size and 50% power of the barely visible threshold. A high-density pattern was then applied to the whole edematous area, using multispot mode. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and around 3 months after treatment. Results Fifty-six eyes of 36 patients were included (39% women, mean age 64.8 years old); mean time between treatment day and follow-up visit was 14 ± 6 weeks. BCVA (Snellen converted to logMAR) was 0.59 ± 0.32 and 0.43 ± 0.25 at baseline and follow-up, respectively (p = 0.002). Thirty-two percent had prior panretinal photocoagulation (p = 0.011). Mean laser power was 555 ± 150 mW and number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) was seen in 96 and 41% of eyes at baseline and improved in 35 and 74% of those after treatment, respectively. Quantitative analysis of central macular thickness (CMT) change was performed in a subset of 23 eyes, 43% of which exhibited > 10% CMT reduction post-treatment. Conclusions Subthreshold laser therapy is known to have RPE function as its main target, modulating the activation of heat-shock proteins and normalizing cytokine expression. In the present study, the DME cases associated with SRF had the best anatomical response, while intraretinal edema responded poorly to laser monotherapy. BCVA and macular thickness exhibited a mild response, suggesting the need for combined treatment in most patients. Given the effect on SRF reabsorption, subthreshold laser therapy could be a viable treatment option in selected cases.

Central Serous Chorioretinopathy: Treatment with Laser

Currently, no general consensus exists regarding the management of central serous chorioretinopathy (CSC). Laser treatments include three different therapeutic approaches: conventional laser, subthreshold laser and photodynamic therapy. Conventional focal laser, addressed to seal the leaking points, as evidenced on fluorescein angiography, was largely used in the past, but now, it is almost completely abandoned, owing to the potential complications. Several studies confirmed the positive effects achieved by subthreshold laser treatment in CSC, even though its improper application in the PLACE trial has questioned the effectiveness.