Melikhova M V, Gatsu M V
Saint Petersburg branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», St. Petersburg, Russia.
North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia.
Vestn Oftalmol. 2022;138(2):23-30. doi: 10.17116/oftalma202213802123.
Focal dome-shaped prominence of the macular profile due to thickening of the scleral layers leads to the development of sclerogenic macular degeneration (SMD), which causes a decrease in vision when it evolves into complicated forms.
To evaluate the effectiveness of subthreshold micropulse laser (SML) coagulation in patients with SMD complicated by detachment of neuroepithelium.
The study included 14 patients (13 women and 1 man), aged 28 to 63 years, median age 55.5 (50; 62) years. All patients underwent standard ophthalmologic examination, optical coherence tomography, as well as fluorescence and/or indocyanine-green angiography. Subthreshold micropulse laser treatment was performed using a diode laser with a wavelength of 810 nm, and consisted of 2-3 sessions of 10% micropulse duty cycle in subthreshold mode with an interval of 2-4 months. Patient data were recorded at 5 time points, each subsequent data point was compared with the baseline. Treatment was carried out according to the dense "lattice" technique with an additional effect on the dye leakage zones. The follow-up period lasted 6-12 months.
Complete regression of subretinal fluid after all SML sessions was observed in 42.9% of cases. In other cases, persistent positive dynamics in terms of edema decrease was noted. The average values of best corrected visual acuity did not significantly change over the course of the follow-up. According to the OCT data, choroidal thickness in fovea significantly decreased at the 1st, 3rd and 4th time points, while the retinal thickness did not significantly change during the observation period.
Subthreshold micropulse laser treatment accelerates the resorption of subretinal fluid in SMD, but this effect cannot be considered satisfactory due to the very slow rate of resorption of subretinal fluid and the absence of a significant effect on visual acuity of patients. The effectiveness of this technique must be compared with other treatment techniques and the natural course of the disease.
