Subthreshold Micropulse Photocoagulation for Persistent Macular Edema Secondary to Branch Retinal Vein Occlusion including Best-Corrected Visual Acuity Greater Than 20/40

To assess the efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP) for persistent macular edema secondary to branch retinal vein occlusion (BRVO), including best-corrected visual acuity (BCVA) > 20/40, thirty-two patients (32 eyes) with macular edema secondary to BRVO were treated by SMDLP. After disease onset, all patients had been followed for at least 6 months prior to treatment. Baseline Snellen visual acuity was used to categorize the eyes as BCVA ≤ 20/40 (Group I) or BCVA > 20/40 (Group II). Main outcome measures were reduction in central macular thickness (CMT) in optical coherence tomography (OCT) and BCVA at 6 months. In the total subject-pool at 6 months, BCVA had not changed significantly but CMT was significantly reduced. Group I exhibited no significant change in CMT at 3 months but exhibited significant reductions at 6 and 12 months. Group II exhibited a marginally significant reduction in CMT at 3 months and a significant reduction at 6 months. In patients with persistent macular edema secondary to BRVO, SMDLP appears to control macular edema with minimal retinal damage. Our findings suggest that SMDLP is an effective treatment method for macular edema in BRVO patients with BCVA > 20/40.

[1]  T. Friberg,et al.  The treatment of macular disease using a micropulsed and continuous wave 810-nm diode laser. , 1997, Ophthalmology.

[2]  S. Hayreh,et al.  Branch retinal vein occlusion: natural history of visual outcome. , 2014, JAMA ophthalmology.

[3]  M. Mainster,et al.  Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular oedema , 2004, British Journal of Ophthalmology.

[4]  C M Moorman,et al.  Clinical applications of the MicroPulse diode laser , 1999, Eye.

[5]  Robert N. Johnson,et al.  Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. , 1991, Archives of ophthalmology.

[6]  W. Mieler,et al.  Submacular fibrosis after photocoagulation for diabetic macular edema. , 1992, American journal of ophthalmology.

[7]  R. Olk,et al.  Modified grid laser photocoagulation for diabetic macular edema. The effect on the central visual field. , 1988, Ophthalmology.

[8]  M. Parodi,et al.  Subthreshold grid laser treatment of macular edema secondary to branch retinal vein occlusion with micropulse infrared (810 nanometer) diode laser. , 2005, Ophthalmology.

[9]  Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group. , 1984, American journal of ophthalmology.

[10]  J. Flanagan,et al.  Short-wavelength sensitive visual field loss in patients with clinically significant diabetic macular oedema , 1998, Diabetologia.

[11]  H. Schatz,et al.  Atrophic creep of the retinal pigment epithelium after focal macular photocoagulation. , 1989, Ophthalmology.

[12]  F. Ferris,et al.  Subretinal fibrosis in diabetic macular edema. ETDRS report 23. Early Treatment Diabetic Retinopathy Study Research Group. , 1997, Archives of ophthalmology.

[13]  P. Presti,et al.  Laser treatment of diabetic macular edema: comparison of ETDRS-level treatment with threshold-level treatment by using high-contrast discriminant central visual field testing. , 1999, Seminars in ophthalmology.

[14]  J. Flanagan,et al.  Influence of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on short-wavelength and conventional automated perimetry , 1998, Diabetologia.

[15]  S. Ohde,et al.  SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF RETINAL CHANGES AFTER CONVENTIONAL MULTICOLOR LASER, SUBTHRESHOLD MICROPULSE DIODE LASER, OR PATTERN SCANNING LASER THERAPY IN JAPANESE WITH MACULAR EDEMA , 2012, Retina.

[16]  M. Parodi,et al.  Intravitreal triamcinolone acetonide combined with subthreshold grid laser treatment for macular oedema in branch retinal vein occlusion: a pilot study , 2008, British Journal of Ophthalmology.

[17]  P. Campochiaro,et al.  Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. , 2011, Ophthalmology.

[18]  J. Luttrull,et al.  Serial optical coherence tomography of subthreshold diode laser micropulse photocoagulation for diabetic macular edema. , 2006, Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye.

[19]  John B. Shoven,et al.  I , Edinburgh Medical and Surgical Journal.

[20]  D. Lavinsky,et al.  Randomized clinical trial evaluating mETDRS versus normal or high-density micropulse photocoagulation for diabetic macular edema. , 2011, Investigative ophthalmology & visual science.

[21]  P. Stanga,et al.  Micropulse laser in the treatment of diabetic macular edema. , 1999, Seminars in ophthalmology.

[22]  J. Flanagan,et al.  Correlation of a scanning laser derived oedema index and visual function following grid laser treatment for diabetic macular oedema , 2003, The British journal of ophthalmology.

[23]  Tatsuo Yamaguchi,et al.  Subthreshold micropulse diode laser photocoagulation for diabetic macular edema in Japanese patients. , 2010, American journal of ophthalmology.

[24]  R. Murphy,et al.  Choroidal neovascularization after laser photocoagulation for diabetic macular edema. , 1990, Ophthalmology.

[25]  J. Roider,et al.  Laser treatment of retinal diseases by subthreshold laser effects. , 1999, Seminars in ophthalmology.

[26]  R. Lewen.  Subretinal neovascularization complicating laser photocoagulation of diabetic maculopathy. , 1988, Ophthalmic surgery.

[27]  G. Doros,et al.  Transitioning from stratus OCT to cirrus OCT: a comparison and a proposed equation to convert central subfield macular thickness measurements in healthy subjects , 2011, Graefe's Archive for Clinical and Experimental Ophthalmology.

[28]  Allen C Ho,et al.  Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. , 2011, Ophthalmology.

[29]  M A Mainster,et al.  Decreasing retinal photocoagulation damage: principles and techniques. , 1999, Seminars in ophthalmology.

[30]  Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Early Treatment Diabetic Retinopathy Study Research Group. , 1995, Archives of ophthalmology.

[31]  S. Okisaka,et al.  Automatic Static Threshold Perimetry Is Useful for Estimating the Effects of Laser Photocoagulation on Diabetic Maculopathy , 1998, Ophthalmic Research.

[32]  Cathy Frey,et al.  Investigative Ophthalmology and Visual Science , 2010 .

[33]  F. Zaidi,et al.  Criteria for improving visual acuity in ischaemic branch retinal vein occlusion using argon laser , 2004, Eye.

[34]  P. Mitchell,et al.  Natural history of branch retinal vein occlusion: an evidence-based systematic review. , 2010, Ophthalmology.

[35]  P. Keane,et al.  Vascular changes in eyes treated with dexamethasone intravitreal implant for macular edema after retinal vein occlusion. , 2013, Ophthalmology.

[36]  B. Sander,et al.  Subthreshold micropulse diode laser treatment in diabetic macular oedema , 2004, British Journal of Ophthalmology.

[37]  R Birngruber,et al.  Response of the retinal pigment epithelium to selective photocoagulation. , 1992, Archives of ophthalmology.

[38]  Sarah Gray,et al.  Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. , 2010, Ophthalmology.

[39]  D. Guyer,et al.  Subretinal fibrosis after laser photocoagulation for diabetic macular edema. , 1992, American journal of ophthalmology.

[40]  I. Wallow,et al.  Sub-pigment epithelial membranes after photocoagulation for diabetic macular edema. , 1993, Archives of ophthalmology.

[41]  D. Finkelstein,et al.  Argon laser photocoagulation for macular edema in branch vein occlusion. , 1986, Ophthalmology.

[42]  P. Campochiaro,et al.  Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. , 2010, Ophthalmology.