Subthreshold Laser Treatment Versus Threshold Laser Treatment for Symptomatic Retinal Arterial Macroaneurysm

Abstract

PURPOSE. This study was designed to compare the effects of subthreshold laser treatment (STLT) with threshold laser treatment (TLT) in patients affected by symptomatic retinal arterial macroaneurism (RAM). METHODS.Patients affected by symptomatic RAM, characterized by exudative manifestations involving the fovea and bestcorrected visual acuity (BCVA) worse than 20/80 Snellen equivalent, were recruited. Patients were randomly assigned to STLT or TLT and regularly followed up for 12 months. Primary outcome measures were changes in central point thickness (CPT) at the end of the follow-up. Secondary outcome measures were changes in mean BCVA at the end of the follow-up and identification of postlaser alterations.RESULTS. In this single center, randomized, clinical trial, 12 patients were randomized to STLT and 13 to TLT. CPT in STLT was 332 lm at baseline and changed to 249 lm at the 12-month examination. CPT in TLT was 341 lm and reduced to 226 lm at the end of the follow-up. BCVA in STLT changed from 0.72 logMAR to 0.28 logMAR. BCVA in TLT changed from 0.76 logMAR to 0.26 logMAR. The statistical analyses revealed a significant difference comparing the baseline values for both CPT and BCVA in each subgroup from the third month (P < 0.001). No difference was found comparing the two subgroups at any point in time. Three eyes (23%) treated with TLT developed an epiretinal membrane with subjective metamorphopsia.CONCLUSIONS. This pilot randomized clinical trial shows that both STLT and TLT can achieve similar improvements in BCVA and CPT. The lower laser energy delivered by STLT can reduce the complication rate. (Clinicaltrials.gov number, NCT01301326.) (Invest Ophthalmol Vis Sci.

Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography

“…The primary management of submacular hemorrhage differs according to the cause of subretinal hemorrhage. Treatments for retinal arterial macroaneurysm include direct laser photocoagulation or simple observation with good visual prognosis [15,16,17]. Submacular hemorrhage from trauma may require pneumatic displacement or pars plana vitrectomy without the use of anti-VEGF agents.…”

Ruptured Retinal Arterial Macroaneurysm Secondary to Toxoplasmic Kyrieleis Arteriolitis: A Case Report

“…Visual outcome for ruptured RAM is favorable [ 9 , 10 ]. Treatment options for ruptured RAM include observation, focal laser coagulation, and intravitreal bevacizumab for secondary macular edema [ 9 , 10 , 11 , 12 , 13 , 14 ]. Observation is sufficient in some uncomplicated cases, as aneurysmal hemorrhaging usually spontaneously undergoes sclerosis and occlusion as part of its natural course [ 10 ].…”

“…Observation is sufficient in some uncomplicated cases, as aneurysmal hemorrhaging usually spontaneously undergoes sclerosis and occlusion as part of its natural course [ 10 ]. Conventional laser photocoagulation of the macroaneurysm has been the most commonly utilized treatment for symptomatic RAM; however, it may carry the risk of an increased rate of arterial occlusion, capillary dropout, subretinal fibrosis, enlargement of laser scar, and choroidal neovascularization compared to nontreatment [ 10 , 11 , 12 , 13 , 14 ]. A recent clinical trial suggests that subthreshold laser treatment may carry fewer risks [ 12 ].…”

Is Laser Still Important in Diabetic Macular Edema as Primary or Deferral Therapy

“…Macular laser can be performed, especially using subthreshold laser treatment, which minimizes the retinal damage. Subthreshold laser treatment was employed for DME and other retinal vascular disorders [8][9][10] , especially with the micropulse application, which allows heat dispersion during the treatment avoiding any collateral damage. The mechanism of action of subthreshold laser is still uncertain, but it is thought that laser application initiates the upregulation of several cytoprotective factors (pigment-epithelium-derived factor, thrombospondin-1, heat shock protein) chiefly from the adjacent cells receiving sublethal photothermal damage.…”