Title
PASCAL SHORT PULSE PLUS SUBTHRESHOLD ENDPOINT MANAGEMENT LASER FOR DIABETIC MACULAR EDEMA: THE “SANDWICH” TECHNIQUE
Introduction
To evaluate the effect of combined sublethal laser modalities, short pulse photostimulation plus endpoint management subthreshold LASER (the Sandwich technique: SWiT), on central subfield thickness (CST) of patients with diabetic macular edema (DME).
Methods
This study was conducted in eyes with DME in real-life conditions and represents a consecutive retrospective analysis of 37 patients with center-involving DME that were treated with the SWiT laser. The technique consisted of a mean number of 200 (range number: 95-600) short pulse duration (SPD) LASER spots performed on juxta- and perifoveal area (within 6mm ETDRS grid) 500µm away from the foveal center and 500 (range number: 300-800) subthreshold endpoint management (EpM) laser spots performed juxta- and perifoveal area (within 6mm ETDRS grid) 300µm away from the foveal center. All patients underwent ophthalmological evaluations that included ETDRS BCVA and CST measurement on spectral domain optical coherence tomography (SD-OCT) before and after SWiT-laser therapy. The mean follow-up time was 19.2 months (range: 2-60 months).
Results
35 out of 37 cases had an improvement in CSFT and BCVA following treatment. At baseline, mean CST (µm) ± standard error (SE) and mean BCVA (log-MAR) ± SE was 456.95 ± 37.00 and 0.71 ± 0.29 respectively. After a mean follow-up of 19.2 months, mean CSFT (µm) ± SE and BCVA (log-MAR) ± SE were 272.09 ± 9.10 (p < 0.0001) and 0.54 ± 0.26 (p = 0.003). A statistically significant reduction on CSFT (µm) and improvement on BCVA (log-MAR) was noted compared to baseline. The mean number of anti-VEGF intravitreous injection during this period was 3 in 6 patients.
Discussion
This retrospective study take in account diverse real-life cases and the idea to combine refine sublethal techniques as the novel SWiT laser method, revealead promising results in several types of DME worthwhile future prospective studies.
Keywords
Pascal laser, short pulse laser, endpoint management, diabetic macular edema.
Area
CLINICAL CASE
Authors
Murilo Wendeborn Rodrigues, Jose Augusto Cardillo, Rizzia Camargo Oliveira, Andre Messias, Rodrigo Jorge