Combination Therapy of Intravitreal Ranibizumab and Subthreshold Micropulse Photocoagulation for Macular Edema Secondary to Branch Retinal Vein Occlusion

Terashima, Hiroko; Hasebe, H.; Okamoto, Fumiki; Matsuoka, Naoki; Sato, Yoshiaki; Fukuchi, Takeo

doi:10.1097/iae.0000000000002165

Cited by 25 publications

(23 citation statements)

References 34 publications

(24 reference statements)

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“…A description of these trials is presented in Table 1. The studies compared in Table 1 consist of four studies covering DME [10][11][12][13] and one study concerning ME secondary to branch retinal vein occlusion (BRVO) [14]. Among those studies, there were two randomized clinical trials on DME by Khattab et al [12] and Kanar et al [13], respectively.…”

Section: Resultsmentioning

confidence: 99%

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Gawęcki¹

2021

JCM

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Objective: intravitreal therapy for macular edema (ME) is a common clinical approach to treating most retinal vascular diseases; however, it generates high costs and requires multiple follow-up visits. Combining intravitreal anti–vascular endothelial growth factor (VEGF) or steroid therapy with subthreshold diode micropulse laser (SDM) application could potentially reduce the burden of numerous intravitreal injections. This review sought to explore whether this combination treatment is effective in the course of ME secondary to retinal vascular disease, and in particular, determine whether it is comparable or superior to intravitreal therapy alone. Materials and methods: the following terms and Boolean operators were used to search the PubMed literature database: subthreshold micropulse laser, subthreshold diode micropulse OR micropulse laser treatment AND anti-VEGF, anti-VEGF treatment, intravitreal steroids, OR combined therapy.This analysis included all studies discussing the combination of SDM and intravitreal anti-VEGF or steroid treatment. Results: the search revealed nine studies that met the inclusion criteria, including five comparing combined treatment and anti-VEGF treatment alone, four covering diabetic ME, and one covering ME secondary to branch retinal vein occlusion. All of these five studies suggested that combination therapy results in fewer intravitreal injections than anti-VEGF monotherapy with non-inferior functional and morphological outcomes. The remaining four studies report functional and morphological improvements after combined treatment; however, SDM alone was never superior to intravitreal-alone or combined treatment. There were substantial differences in treatment protocols and inclusion criteria between the studies. Conclusions: the available material was too scarce to provide a reliable assessment of the effects of combined therapy and its relation to intravitreal monotherapy in the treatment of ME secondary to retinal vascular disease. One assumption of note is that it is possible that SDM plus anti-VEGF might require fewer intravitreal injections than anti-VEGF monotherapy with equally good functional and morphological results. However, further randomized research is required to confirm this thesis.

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Section: Resultsmentioning

confidence: 99%

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Gawęcki¹

2021

JCM

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“…Studies by Parodi show significantly better results with the use of intravitreal triamcinolone or bevacizumab than SMPLT alone [94,96]. On the other hand, the latest research does not favor intravitreal ranibizumab against SMPLT in the treatment of ME secondary to RVO [97,98]. A number of available clinical trials also have to be taken into consideration.…”

Section: Smplt In Me Secondary To Rvomentioning

confidence: 99%

Micropulse Laser Treatment of Retinal Diseases

Gawęcki¹

2019

JCM

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Subthreshold micropulse laser treatment has been intensively used for selected retinal diseases in the last decade; however, the exact mechanism of the action of lasers in the subthreshold micropulse mode is not yet fully understood. This kind of treatment is safe and cheap, and contrary to classic laser photocoagulation, it leaves the retinal cells intact. A modern theory of micropulse laser interaction with retinal tissue and a possible explanation of this mechanism are presented in this review. The authors present all the relevant literature on the application of micropulse lasers in different retinal disorders. The efficacy of this treatment is analyzed on the basis of available studies and then placed in the perspective of other therapeutic methods that are used in retinal diseases.

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“…The subthreshold micropulse laser (SMPL) is a new technological device, recently introduced in clinical practice and considered an alternative to laser photocoagulation in the treatment of several macular exudative pathologies such as diabetic macular edema (DME), [1][2][3][4][5] central serous chorioretinopathy, [6][7][8][9] and retinal vein occlusion. [10][11][12][13] Unlike continuous wave (CW), laser SMPL does not alter retinal anatomy, avoiding the burning effect typical of traditional photocoagulation. 14 Laser emission is delivered in a series of energy bursts of very short duration, normally 100-200 µs, the ON time, interposed by the OFF time, when no energy is transmitted in order to reduce heat dissipation in the tissues.…”

Section: Introductionmentioning

confidence: 99%

Subthreshold yellow micropulse laser for treatment of diabetic macular edema: Comparison between fixed and variable treatment regimen

Donati

Murro

Mucciolo

et al. 2020

European Journal of Ophthalmology

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Purpose: To compare the efficacy between fixed and variable treatment regimens of subthreshold yellow micropulse laser for the treatment of diabetic macular edema. Methods: This is a retrospective, comparative, 12-month study of 39 eyes: 24 eyes received fixed treatment regimen of subthreshold micropulse laser treatment and 15 eyes underwent variable treatment regimen of subthreshold micropulse laser, all eyes were followed up for 12 months. Subthreshold micropulse laser was performed with the following parameters: 100 μm spot size on slit lamp, 5% duty cycle of 0.2 s, and 250 mW power. To choose the power of the variable treatment regimen of subthreshold micropulse laser group, continuous laser power was titrated to a barely visible burn and then switched to MicroPulse mode, multiplying the test burn power by 4 and using a 5% duty cycle of 0.2 s. Main outcomes included changes in central macular thickness and best-corrected visual acuity. Results: At baseline, the mean LogMAR best-corrected visual acuity was 0.297 ± 0.431 in the variable treatment regimen of subthreshold micropulse laser group and 0.228 ± 0.341 in the fixed treatment regimen of subthreshold micropulse laser group. At the end of follow-up, the mean LogMAR best-corrected visual acuity was 0.289 ± 0.473 (p = 0.785) and 0.245 ± 0.376 (p = 0.480) in the variable and fixed treatment regimens of subthreshold micropulse laser groups, respectively. Similarly, central macular thickness decreased in both groups after treatment; at baseline, the mean central macular thickness was 371.06 ± 37.8 in the variable treatment regimen of subthreshold micropulse laser group and improved to 325.60 ± 110.0 μm (p = 0.025) at the end of the follow-ups, while it was 342.30 ± 35.4 in the fixed treatment regimen of subthreshold micropulse laser group and improved to 308.51 ± 67.5 (p = 0.037). Conclusion: Both treatment regimens are effective for the treatment of mild center-involving diabetic macular edema: fixed treatment appears more suitable minimizing treatment time and reducing the possible errors due to wrong titration in the switch from continuous to micropulse mode.

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Combination Therapy of Intravitreal Ranibizumab and Subthreshold Micropulse Photocoagulation for Macular Edema Secondary to Branch Retinal Vein Occlusion

Cited by 25 publications

References 34 publications

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Micropulse Laser Treatment of Retinal Diseases

Subthreshold yellow micropulse laser for treatment of diabetic macular edema: Comparison between fixed and variable treatment regimen

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