Sorrentino Tania, Allegrini Davide, De Rosa Giacomo, Santoru Francesco, Crepaldi Lorenzo, Feo Alessandro, Zanellati Giacomo, Marconi Stefania, Auricchio Ferdinando, Romano Mario R
Department of Biomedical Sciences, Humanitas University, Via Rita Levi, Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
Eye Center, Humanitas Gavazzeni-Castelli, 24128 Bergamo, Italy.
J Clin Med. 2024 Sep 26;13(19):5729. doi: 10.3390/jcm13195729.
Subthreshold lasers operate below the threshold of visible tissue damage, thereby preventing ophthalmoscopically visible thermal damage to the chorio-retinal layers. They could represent a safe and effective alternative and/or adjunctive procedure to conventional lasers in treating diabetic macula edema (DME), central serous chorioretinopathy (CSCR), and branch retina vein occlusion (BRVO). This review focuses on the use of subthreshold micropulse laser (SMPL), its settings, and clinical applications. Despite their widespread use, a standardized protocol for sub-threshold laser settings has not been established yet, and thus, there is uncertainty in selecting effective and safe parameters for any specific situation. We conducted a comprehensive overview of the existing indications for subthreshold laser therapy and their settings for different retinal diseases. The debate revolves around which parameters could guarantee the safety of the procedure for each case, depending on the duty cycle, the laser wavelength, the spot duration, and the power, with laser power titration on one side or choosing a fixed lowered power value on the other side. SMPL therapy for DME, CSCR, and BRVO-associated macular edema has shown significant effectiveness in reducing the macular thickness, facilitating subretinal fluid absorptions, increasing the best corrected visual acuity (BCVA) and reducing the number of intravitreal injections (IVI) required annually. We presented a broad list of the laser parameters reported in the literature, organized into different tables divided based on the specific pathology, with the aim of providing a useful tool for future studies.
阈下激光在可见组织损伤阈值以下运行，从而防止脉络膜视网膜层出现眼底可见的热损伤。在治疗糖尿病性黄斑水肿（DME）、中心性浆液性脉络膜视网膜病变（CSCR）和视网膜分支静脉阻塞（BRVO）方面，它们可能是传统激光的一种安全有效的替代和/或辅助治疗方法。本综述聚焦于阈下微脉冲激光（SMPL）的使用、其设置及临床应用。尽管其应用广泛，但尚未建立阈下激光设置的标准化方案，因此，在为任何特定情况选择有效且安全的参数时存在不确定性。我们对阈下激光治疗的现有适应证及其针对不同视网膜疾病的设置进行了全面概述。争论围绕哪些参数能够保证每种情况下治疗的安全性展开，这取决于占空比、激光波长、光斑持续时间和功率，一方是激光功率滴定，另一方是选择固定的较低功率值。SMPL治疗DME、CSCR和与BRVO相关的黄斑水肿在减少黄斑厚度、促进视网膜下液吸收、提高最佳矫正视力（BCVA）以及减少每年所需的玻璃体内注射（IVI）次数方面已显示出显著疗效。我们列出了文献中报道的广泛的激光参数列表，根据具体病理情况分为不同表格，旨在为未来研究提供一个有用的工具。
