Department of Ophthalmology, School of Medicine and Hansen Experimental Physics Laboratory, Stanford University, Palo Alto, California, USA.
Retina. 2012 Feb;32(2):375-86. doi: 10.1097/IAE.0b013e3182206f6c.
To determine the long-term safety of high-density subvisible diode micropulse photocoagulation (810 nm), compare the clinical findings with computational modeling of tissue hyperthermia and to report results for a subset of eyes treated for diabetic macular edema (ME) documented pre- and postoperatively by spectral-domain optical coherence tomography.
All eyes treated for ME from diabetic retinopathy (diabetic ME) and branch retinal vein occlusion between April 2000 and January 2010 were reviewed for subvisible diode micropulse laser-induced retinal damage. Therapeutic outcomes were reviewed for a subgroup treated for diabetic ME with pre- and postoperative spectral-domain optical coherence tomography. Laser-induced retinal thermal effects were modeled computationally using Arrhenius formalism.
A total of 252 eyes (212 diabetic ME, 40 branch retinal vein occlusion) of 181 patients qualified. None of the 168 eyes treated at irradiance <350 W/cm2 and 7 of 84 eyes at ≥ 590 W/cm2 had retinal damage (P = 0.0001) (follow-up 3-120 months, median, 47). Sixty-two eyes of 48 patients treated for diabetic ME with pre- and postoperative spectral-domain optical coherence tomography with median 12 months follow-up had no retinal injury by infrared, red-free, or fundus autofluorescence photos; fluorescein angiography or indocyanine green angiography; or spectral-domain optical coherence tomography. Central foveal thickness (P = 0.04) and maximum macular thickness decreased (P < 0.0001). Modeling of retinal hyperthermia demonstrates that the sublethal clinical regimen corresponds to Arrhenius integral >0.05, while damage is likely to occur if it exceeds 1.
Subvisible diode micropulse can effectively treat retinovascular ME without laser-induced retinal damage, consistent with Arrhenius modeling of pulsed hyperthermia.
确定高密度亚可见二极管微脉冲光凝（810nm）的长期安全性，将组织热疗的临床发现与计算建模进行比较，并报告经谱域光相干断层扫描术前和术后治疗糖尿病性黄斑水肿（ME）的一部分眼的结果。
对 2000 年 4 月至 2010 年 1 月期间因糖尿病性视网膜病变（糖尿病 ME）和分支静脉阻塞而接受 ME 治疗的所有眼进行亚可见二极管微脉冲激光诱导视网膜损伤的回顾性研究。对经谱域光相干断层扫描术前和术后治疗的糖尿病 ME 亚组进行治疗效果回顾。使用阿仑尼乌斯公式对激光诱导的视网膜热效应进行计算建模。
共有 181 例患者的 252 只眼（212 只为糖尿病 ME，40 只为分支静脉阻塞）符合条件。在照射强度<350 W/cm2 的 168 只眼中，没有一只眼发生视网膜损伤，而在≥590 W/cm2 的 84 只眼中，有 7 只眼发生了视网膜损伤（P=0.0001）（随访 3-120 个月，中位数 47 个月）。48 例糖尿病 ME 患者中有 62 只眼接受了术前和术后的谱域光相干断层扫描检查，中位随访时间为 12 个月，红外、无赤光和眼底自发荧光照片；荧光素血管造影或吲哚青绿血管造影；或谱域光相干断层扫描均未见视网膜损伤。中央凹视网膜厚度（P=0.04）和最大黄斑厚度均减少（P<0.0001）。视网膜热疗的建模表明，亚致死性临床方案对应的阿仑尼乌斯积分>0.05，而如果超过 1，则可能发生损伤。
亚可见二极管微脉冲可有效治疗血管性 ME，而不会引起激光诱导的视网膜损伤，这与脉冲热疗的阿仑尼乌斯建模一致。
