Micropulse Laser Treatment of Retinal Diseases

Abstract

Subthreshold micropulse laser treatment has been intensively used for selected retinal diseases in the last decade; however, the exact mechanism of the action of lasers in the subthreshold micropulse mode is not yet fully understood. This kind of treatment is safe and cheap, and contrary to classic laser photocoagulation, it leaves the retinal cells intact. A modern theory of micropulse laser interaction with retinal tissue and a possible explanation of this mechanism are presented in this review. The authors present all the relevant literature on the application of micropulse lasers in different retinal disorders. The efficacy of this treatment is analyzed on the basis of available studies and then placed in the perspective of other therapeutic methods that are used in retinal diseases.

Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

“…With regard to other local, ocular treatments that exhibit potential effects toward treatment or prevention of retinopathy, more recently the application of a new mode of nonthermal, high-density micropulsed retinal laser treatment has been introduced that has demonstrated in animal studies to produce anti-inflammatory and neuro-reparative cytokines that improve retinal pigment epithelium function, as well as retinal vascular autoregulation, while reducing the markers of chronic inflammation, and neurodegeneration (129,130). The generated reparative enzymes, formerly termed "heat shock proteins" that resulted from retinal pigment epithelium non-lethal laser heating that have thus far been measured include reductions in thiobarbituric acid reactive substances (TBARS), increased glutathione (GSH) and superoxide dismutase 1 (SOD1) as well as a reduction in cytochrome c, caspase 3 expression and activity along with cleaved caspase 9, and increased Beclin 1, p62, and LC3b (131).…”

The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema

“…The efficacy of SMYL for the treatment of some retinal diseases, such as central serous chorioretinopathy (CSC), diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO), has been previously reported in the literature [12]. However, to the best of our knowledge, there are no other works reporting on its application for chronic refractory PCME.…”

“…Some studies have investigated the efficacy and safety of SMYL in treating different macular conditions [9,12]. Indeed, it induces the expression of anti-angiogenic and restorative biological factors within the retinal pigment epithelium cells, thus leading to the overexpression of both pigment epithelium derived factor (PEDF) and vascular endothelial growth factor (VEGF) inhibitors, and the sub-regulation of VEGF inducers and permeability factors [19,20].…”

“…The use of subthreshold micropulse yellow laser (SMYL) has widespread benefits for the treatment of different macular disorders [12]. Compared to a conventional continuous wavelength laser, the micropulse yellow laser is a revolutionary alternative, as tissue is preserved due to its use of a photo-stimulation process with repetitive short pulses at low temperatures.…”

“…The efficacy of the SMYL for some macular disorders, such as diabetic macular edema (DME), retinal vein occlusion (RVO) and central serous chorioretinopathy (CSC), has been described well in the literature and was also reviewed by Gawecki M. [12]; however, there are no cases reporting on its use in the treatment of PCME.…”