Micropulsed Diode Laser Therapy: Evolution and Clinical Applications

Sivaprasad, Sobha; Elagouz, Mohammed; McHugh, Dominic; Shona, Olajumoke; Dorin, Giorgio

doi:10.1016/j.survophthal.2010.02.005

Cited by 112 publications

(90 citation statements)

References 62 publications

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“…The spot size was 160 µm, the exposure time 0.2 s, and a duty cycle of 5% was used. We chose a duty cycle of 5% because this allows for the heat production time to be shorter than the thermal relaxation time for the space between the RPE and the neural retina, which results in axial confinement of the increase in heat at the RPE [22]. …”

Section: Methodsmentioning

confidence: 99%

Subthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy

et al. 2015

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Purpose: To assess treatment with a 577-nm subthreshold micropulse laser (SML) in patients with chronic central serous chorioretinopathy (cCSC). Methods: This retrospective study included 38 patients treated with a 577-nm SML (Supra Scan; Quantel Medical) for cCSC. We included a subgroup of 18 patients with persistent subretinal fluid (SRF) after photodynamic therapy (PDT). Assessment included visual acuity (VA), central retinal thickness (CRT) and resolution of SRF. Results: At the last follow-up (mean 5 months), 74% of patients responded to therapy. The CRT decreased after treatment (mean CRT -115 µm, p < 0.001) and VA improved (mean logMAR -0.06, p = 0.039). No laser burns were detected with any imaging modality. In the subgroup of patients resistant to PDT, 61% of patients responded to therapy with a decrease in CRT (mean CRT -75 µm, p = 0.019). Conclusions: The 577-nm SML is an effective treatment for cCSC even in patients without sufficient improvement after PDT.

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Section: Methodsmentioning

confidence: 99%

Subthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy

et al. 2015

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“…The sub-threshold diode laser has been introduced though mainly for diabetic macular oedema (DMO) 15,16 but has not spread much into use in PDR, possibly because for PRP it requires more sessions and more burns. It allows very short [millisecond (ms)] pulses of laser, shorter than conventional laser, sometimes called 'micro-pulsed'.…”

Section: Treatment Of Diabetic Retinopathymentioning

confidence: 99%

Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

Royle

Mistry

Auguste

et al. 2015

Health Technol Assess

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BackgroundDiabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).ObjectivesThe primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?Eligibility criteriaRandomised controlled trials (RCTs) for efficacy but other designs also used.Data sourcesMEDLINE and EMBASE to February 2014, Web of Science.Review methodsSystematic review and economic modelling.ResultsThe Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.LimitationThe current evidence is insufficient to recommend PRP for severe NPDR.ConclusionsThere is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.Study registrationThis study is registered as PROSPERO CRD42013005408.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Low-intensity/high-density SDM allows for complete and confluent (high-density) coverage of the entire diseased retina, such as the areas of macular thickening constituting diabetic macular edema (DME) or ischemic retina with proliferative diabetic retinopathy (PDR). Subthreshold micropulse laser delivers a series of short pulses to allow thermal dissipation between each pulse [28] . Subthreshold laser has been shown in pathologic and histochemical analyses to reduce the changes to the surrounding choroidal and retinal cells [29] .…”

Section: Micropulse Lasermentioning

confidence: 99%

New Frontiers in Selective Retinal Lasers

Paulus¹

2015

International Journal of Ophthalmic Research

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Micropulsed Diode Laser Therapy: Evolution and Clinical Applications

Cited by 112 publications

References 62 publications

Subthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy

Subthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy

Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

New Frontiers in Selective Retinal Lasers

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