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Micropulse Versus Continuous Wave Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma
摘要： The aim of this study was to compare the safety and efficacy of micropulse cyclophotocoagulation (MP-CPC) and transscleral continuous wave cyclophotocoagulation (CW-CPC) for the treatment of refractory glaucoma in the pediatric age group. This prospective study included 45 eyes of 36 children requiring transscleral cyclophotocoagulation, in the period spanning from September 2016 to August 2017, using micropulse (MP-CPC) or continuous wave (CW-CPC) modes. The intraocular pressure (IOP) reduction, success rates, and complications were compared for both groups. Success was defined as an IOP of 5 to 21 mm Hg, in the absence of vision-threatening complications at 6 months. The MP-CPC group included 17 eyes, in patients aged 67.8 ± 48 months, and the CW-CPC group included 28 eyes, in patients aged 61.3 ± 38.3 months. There was a tendency toward lower IOP in the MP-CPC group at all follow-ups, almost reaching statistical significance at 2 weeks and 3 months (P = 0.05). IOP reduction was 63% in the MP-CPC group and 67% in the CW-CPC group (P = 0.6). The success rate was higher in the MP-CPC group (71% vs. 46% in the CW-CPC group), but the difference was not significant (P = 0.1). No significant complications were noted in the MP-CPC group whereas, in the CW-CPC group, 1 eye developed phthisis bulbi, and 2 eyes had severe pain and uveitis (P = 0.3). Both the MP-CPC and CW-CPC are effective in lowering the IOP in children with refractory glaucoma. However, the rate of complications, pain, and inflammation seem to be lower with the micropulse mode, making it a safer alternative for cyclophotocoagulation, especially since retreatments are often needed.
关键词： micropulse laser,cyclophotocoagulation,pediatric glaucoma
更新于2025-09-23 15:23:52
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Management of cystoid macular edema secondary to retinitis pigmentosa via subliminal micropulse yellow laser
摘要： To investigate the effects of subliminal micropulse yellow laser application on the central macular thickness and best-corrected visual acuity in cystoid macular edema secondary to retinitis pigmentosa patients. This prospective open-label clinical trial, conducted between January 2018 and October 2019, included 32 eyes of 29 patients who had cystoid macular edema secondary to retinitis pigmentosa. Patients were treated by subliminal micropulse yellow laser for one session. Central macular thickness and best-corrected visual acuity changes were investigated just before the treatment and 1 year later after the one session of the treatment. The mean central macular thickness was 651.3 μm before the treatment and 247.7 μm at 12 months after the treatment. The decrease in mean central macular thickness was statistically significant (p = 0.01). Median best-corrected visual acuity was 66.8 ETDRS letters before the treatment and 70.0 letters at 12 months after the treatment. The increase in best-corrected visual acuity was not statistically significant (p = 0.18). Eighty-six percent of the patients stated that the quality of central vision increased and that color vision, contrast sensitivity, and distortion improved. We did not encounter any serious adverse events related to the application of subliminal micropulse yellow laser. The subliminal micropulse yellow laser seems to be a therapeutic, effective, and safe option for the treatment of non-inflammatory and resistant cystoid macular edema secondary to retinitis pigmentosa patients. ClinicalTrials.gov ID: NCT04234438, January 17, 2020.
关键词： Intraretinal cysts,Retinitis pigmentosa,Subliminal micropulse laser,Cystoid macular edema
更新于2025-09-23 15:21:01
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<p>532-nm Subthreshold Micropulse Laser for the Treatment of Chronic Central Serous Retinopathy</p>
摘要： Introduction: Subthreshold micropulse laser treatment with a 532 nm (532-SML) wavelength has been suggested as a treatment option for the treatment of chronic central serous retinopathy (cCSR). The objective is to present its effects and complications. Methods: We present a retrospective cohort study of cCSR patients submitted to 532-SML. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) parameters – central macular thickness, subfoveal outer nuclear layer, external limiting membrane, ellipsoid band, interdigitation band, subretinal ?uid and choroidal thickness – were evaluated before and 12 weeks after treatment. A power of 50%, a duty cycle of 5%, exposure time of 200 ms and a spot size of 160 μm were the applied laser parameters. Results: We included 26 eyes. Overall there were no signi?cant changes in visual acuity (median 0.20 (IQR 0) logMAR before and after treatment) or SD-OCT parameters. However, visual bene?ts occurred in 42.3% (n=11) of the patients and in half of the cases, subretinal ?uid was completely reabsorbed. There were no complications. Conclusion: In this study, 532-SML was overall ineffective on cCSR as it did not lead to signi?cant changes in the overall median visual acuity and SD-OCT parameters. However, some patients may have bene?ted functionally and anatomically from the treatment; further investigation is necessary to understand the potential of 532-SML.
关键词： 532 nm wavelength,subthreshold micropulse laser,outer retina bands,SD-OCT,central serous retinopathy
更新于2025-09-23 15:19:57
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Prospective evaluation of changes in choroidal vascularity index after half-dose photodynamic therapy versus micropulse laser treatment in chronic central serous chorioretinopathy
摘要： Purpose To assess whether treatment of chronic central serous chorioretinopathy (cCSC) with photodynamic therapy (PDT) and high-density subthreshold micropulse laser (HSML) results in choroidal vascularity index (CVI) changes that may account for the treatment effect. Methods Patients with cCSC were prospectively included and analyzed. Patients received either half-dose PDT or HSML treatment. CVI of the affected and unaffected eye was obtained before treatment, 6 to 8 weeks after treatment, and 7 to 8 months after treatment. Results At baseline, 29 eyes (29 patients) were included both in the PDT and in the HSML group. The mean (± standard deviation) CVI change in the HSML group between before PDT and 6 to 8 weeks after PDT was ? 0.009 ± 0.032 (p = 0.127), whereas this was 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and final visit. The patients in the PDT group had a CVI change of ? 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and first visit after PDT, and a mean CVI change of ? 0.013 ± 0.038 (p = 0.080) between the visit before PDT and final visit. There was no significant correlation between CVI and BCVA at the measured time points, in both the HSML group (p = 0.885), and in the PDT group (p = 0.904). Moreover, no significant changes in CVI occurred in the unaffected eye at any time point. Conclusions PDT and HSML do not significantly affect CVI, and therefore a CVI change may not be primarily responsible for the treatment effect. The positive treatment effect of both interventions may rely on other mechanisms, such as an effect on choriocapillaris and/or retinal pigment epithelium function.
关键词： Choroidal vascularity index,Photodynamic therapy,Central serous chorioretinopathy,Micropulse laser
更新于2025-09-23 15:19:57
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Investigation of the therapeutic mechanism of subthreshold micropulse laser irradiation in retina
摘要： Purpose Subthreshold micropulse laser irradiation has been used for the treatment of retinal edema; however, there are few reports about the mechanism of its therapeutic effect. In this study, we compared threshold short pulse and subthreshold micropulse laser irradiation in mice and investigated their mechanism. Methods Nine to 12-week-old male C57BL/6J mice were used in this study. After general anesthesia, threshold short pulse or subthreshold micropulse laser irradiation was performed on the right eye using IQ577. Enucleation was performed 24 h after the laser irradiation, and histological and gene expression analyses were carried out. Results Coagulation spots and atrophy of the retinal pigment epithelium were observed after threshold short pulse laser irradiation but not after subthreshold micropulse laser irradiation. Twenty-four hours after laser, aquaporin (AQP) 1, 2, 7, and 11 levels were significantly elevated by 1.7- to 3-fold in the threshold short pulse laser group compared with non-treated control group. AQP 3 was increased significantly and prominently by 100-fold. VEGF-A and VEGFR2 were upregulated 1.5- and 2.3-fold, respectively. In the subthreshold micropulse laser group, AQP 3 was increased by 6-fold compared with the non-treated control group. Angiopoietin-1 and the adrenomedullin (AM) receptor CLR were decreased by 0.6-fold and 0.5-fold, respectively. Conclusion Threshold short pulse laser irradiation caused retinal damage and prominent changes in the expression of various genes. Contrarily, subthreshold micropulse laser irradiation did not induce retinal damage; it upregulated AQP 3, which might have improved retinal edema by drainage of subretinal fluid.
关键词： Retinal edema,Aquaporin-3,Gene expression,Subthreshold micropulse laser
更新于2025-09-19 17:13:59
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Subthreshold laser therapy for macular oedema from branch retinal vein occlusion: focused review
摘要： Retinal vein occlusion is the second- leading cause of vision loss by retinal vascular disease. Subthreshold micropulse laser therapy (SLT) is safer than conventional laser photocoagulation (CLP), yet existing reviews of its use for branch retinal vein occlusion (BRVO) are limited in scope. A literature search of PubMed, Google Scholar, Embase, Cochrane Library and ClinicalTrials.gov databases was conducted in August 2019 without restriction on language or publication date. Outcomes included changes in macular oedema (ME) and visual acuity (VA), and rates of complications or retreatments. Fourteen studies involving 315–405 eyes diagnosed with BRVO were evaluated. Treatment with SLT is associated with significant and durable reduction of ME and VA as early as 1 month. SLT performs comparably with conventional photocoagulation and intravitreal injections (IVIs) of ranibizumab. Subthreshold laser therapy is safer and as effective as CLP for the treatment of ME associated with BRVO. SLT may be used in combination with anti- VEGF IVIs to enhance improvement in VA and ME resolution.
关键词： macular oedema,visual acuity,intravitreal injections,Retinal vein occlusion,subthreshold micropulse laser therapy
更新于2025-09-19 17:13:59
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Efficacy and safety of subthreshold micropulse laser compared with threshold conventional laser in central serous chorioretinopathy
摘要： Purpose To compare the efficacy and safety of subthreshold micropulse laser (SML) with threshold conventional laser (TCL) in central serous chorioretinopathy (CSC). Methods Prospective, randomized, double-masked, non-inferiority, 12-week clinical trial. Patients were randomly assigned 1:1 to SML group or TCL group. Patients in the SML group were treated with 577 nm micropulse laser. The spot size was 160 μm, the duty cycle was 5% and exposure time was 0.2 s. The power was 50% threshold tested. Patients in the TCL group were treated with 577 nm continuous laser. The power was 100% threshold tested. The primary outcome was the mean change in best-corrected visual acuity (BCVA) at week 12, with a non-inferiority limit of five letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts. Results Eighty-eight patients were enroled. Seventy-seven patients were male. Forty-four patients were in SML group and 44 in TCL group. At week 12, SML was equivalent to TCL with a gain of 6.23 ± 8.59 and 6.61 ± 6.35 letters, respectively, (SML–TCL difference: ?0.38 letters; 95% confidence interval (CI):?3.58–2.81; Pnon-inferiority = 0.0026). There was no statistically significant difference between the two groups (t = 0.240, P = 0.811). At week 12, the proportion of patients whose SRF had been totally absorbed was 63.63 and 81.82% respectively for SML and TCL groups. There was no statistically significant difference between the two groups (χ2 = 3.67, P = 0.056). Conclusions Both SML and TCL can improve visual acuity in CSC. SML was non-inferior to TCL in the improvement of BCVA.
关键词： efficacy,central serous chorioretinopathy,subthreshold micropulse laser,safety,threshold conventional laser
更新于2025-09-11 14:15:04
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Effect of a single session of micropulse laser trabeculoplasty on corneal endothelial parameters
摘要： Background: To evaluate the effect of a single session of micropulse laser trabeculoplasty on the cornea in eyes with primary open-angle glaucoma and pseudoexfoliation glaucoma. Methods: This single-centre, prospective, case series enrolled patients with primary open-angle and pseudoexfoliation glaucoma under treatment with glaucoma agents that required additional intraocular pressure reduction. Eyes underwent 360 degrees treatment with 532 nm micropulse laser trabeculoplasty. Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-ef?cient of variation of endothelial cells were measured before micropulse laser trabeculoplasty and at one, three and six months after treatment. Results: Twenty eyes of 20 patients (mean age 67.6 (cid:1) 8.0 years) with primary open-angle glaucoma and 18 eyes of 18 patients (mean age 71.44 (cid:1) 6.43 years) with pseudoexfoliation glaucoma were included in the study. Treatment with micropulse laser trabeculoplasty resulted in statistically signi?cantly lower intraocular pressure compared to baseline in both primary open-angle and pseudoexfoliation glaucoma eyes (p < 0.0001 at both comparisons). Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-ef?cient of variation of the endothelial cell size showed no signi?cant change between baseline and six months after micropulse laser trabeculoplasty in both primary open-angle and pseudoexfoliation glaucoma eyes. Conclusion: A single session of micropulse laser trabeculoplasty did not affect central corneal thickness and corneal endothelium parameters in eyes with primary open-angle and pseudoexfoliation glaucoma.
关键词： micropulse laser trabeculoplasty,corneal endothelium,hexagonal cell ratio,pseudoexfoliation,glaucoma
更新于2025-09-11 14:15:04
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Transfoveal Micropulse Laser Treatment of Central Serous Chorioretinopathy within Six Months of Disease Onset
摘要： Background: It has been recommended that any invasive treatment performed in patients with central serous chorioretinopathy (CSCR) not be initiated earlier than four months after disease onset due to the potential for spontaneous remission of symptoms. The goal of this study was to examine the outcome of transfoveal subthreshold micropulse laser treatment (SMPLT) of CSCR performed at six months or less after disease onset. Materials and methods: The study included 32 cases of CSCR lasting between three weeks and six months (mean: 3.4 ± 2.3 months). All patients had transfoveal SMPLT applied and were followed for at least three months after each session of SMPLT. Two sessions of SMPLT in total were planned in case of an insu?cient response to the ?rst instance of treatment. Evaluation parameters included any change in best-corrected visual acuity (BCVA) and retinal morphology. Results: Total resolution of subretinal ?uid (SRF) was noted in 26 cases (81.25%). Final BCVA improved signi?cantly from 0.37 ± 0.22 logMAR to 0.22 ± 0.20 logMAR after treatment. Overall, early SMPLT correlated with better ?nal BCVA (p = 0.0005, Spearman rank correlation). For eyes achieving a total resolution of SRF, BCVA improved from 0.33 ± 0.21 logMAR to 0.17 ± 0.14 logMAR (p = 0.004, Spearman rank correlation). The analysis of SMPLT nonresponders revealed a tendency for poorer baseline visual acuity. Conclusions: Patients with CSCR lasting six months or less treated with transfoveal SMPLT achieve better functional results with early application of this procedure. As baseline BCVA predicts ?nal visual acuity, earlier treatment, permitted by the safety of SMPLT, may improve ?nal visual outcomes.
关键词： central serous chorioretinopathy,photodynamic therapy,subthreshold micropulse laser,subretinal ?uid
更新于2025-09-11 14:15:04