Zas Marcelo, Cotic Mariano, Wu Max, Wu Andres, Wu Lihteh
Department of Ophthalmology, Jose de San Martin Clinics Hospital, Universidad de Buenos Aires, Buenos Aires, Argentina, USA.
Department of Ophthalmology, Jose de San Martin Clinics Hospital, College of Engineering, Cornell University, Ithaca, NY, USA.
Taiwan J Ophthalmol. 2020 May 19;10(2):87-94. doi: 10.4103/tjo.tjo_16_20. eCollection 2020 Apr-Jun.
Macular laser photocoagulation (MLP) is inferior to intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of center-involved diabetic macular edema (DME). Ultra-widefield fluorescein angiography-guided laser photocoagulation to presumed ischemic areas of the peripheral retina or MLP do not reduce the treatment burden nor improve the visual outcomes of eyes treated with anti-VEGF drugs. Destruction of retinal tissue is not necessary to induce a therapeutic response in DME. Modern lasers are capable of producing invisible laser "burns" that do not destroy the targeted tissue using micropulse subthreshold (ST) mode where the laser's duty cycle is modified or alternatively selective retinal therapy (SRT) where ultrashort pulses of continuous wave laser selectively target the RPE. The best results with micropulse ST laser are obtained in eyes with a central macular thickness ≤400 μm. Eyes need to be treated in a continuous manner with no spaces between burns in the edematous area. Micropulse ST-MLP downregulates inflammatory biomarkers produced by activated microglial cells and Müller cells. Micropulse ST-MLP may reduce the anti-VEGF injection burden in DME. In SRT, the diseased RPE is targeted and heated with the laser with the hope that the adjacent RPE migrates and proliferates into these areas to heal the diseased RPE. There is much less experience with SRT, but the results are promising and deserve further study.
在治疗累及黄斑中心的糖尿病性黄斑水肿（DME）方面，黄斑激光光凝术（MLP）不如玻璃体内血管内皮生长因子（VEGF）抑制剂。超广角荧光素血管造影引导下对周边视网膜推测的缺血区域进行激光光凝或MLP，既不能减轻治疗负担，也不能改善接受抗VEGF药物治疗的眼睛的视力结果。在DME中诱导治疗反应并不需要破坏视网膜组织。现代激光能够产生不可见的激光“灼伤”，在微脉冲阈下（ST）模式下不破坏目标组织，该模式下激光的占空比被改变，或者采用选择性视网膜治疗（SRT），即连续波激光的超短脉冲选择性地靶向视网膜色素上皮（RPE）。微脉冲ST激光在中心黄斑厚度≤400μm的眼睛中能取得最佳效果。眼睛需要连续治疗，水肿区域的灼伤之间不能有空隙。微脉冲ST-MLP可下调由活化的小胶质细胞和Müller细胞产生的炎症生物标志物。微脉冲ST-MLP可能减轻DME患者抗VEGF注射的负担。在SRT中，患病的RPE被激光靶向并加热，希望相邻的RPE迁移并增殖到这些区域以修复患病的RPE。关于SRT的经验较少，但结果很有前景，值得进一步研究。
