A RANDOMISED, COMPARATIVE STUDY OF GRID LASER AND SUBTHRESHOLD MICROPULSE DIODE LASER IN THE TREATMENT OF DIFFUSE DIABETIC MACULOPATHY


Vikram Chellakumar, Rajarathnam ., Cornelius Vijai

Abstract


Objective: Diabetic retinopathy is a major cause of visual impairment in both developing and developed countries. The two important complications
are macular edema and proliferative diabetic retinopathy. Laser treatment can reduce vision loss in both proliferative diabetic retinopathy and
diabetic macular edema. Early treatment of diabetic retinopathy study shows that immediate laser treatment reduces the risk of moderate visual
loss by at least 50%. Thermal tissue damage is the main cause of many potential complications of conventional photocoagulation that may lead to
immediate and late visual loss. A subthreshold diode micropulse (SDM) laser targets retinal pigment epithelium (RPE); it is maximally absorbed by
the melanosomes of the RPE and underlying choroid while sparing the neurosensory retina. SDM laser minimizes chorioretinal damage as there is
no thermal effect or injury despite achieving photocoagulation effects. To compare, the effectiveness of SDM laser versus grid laser photocoagulation
for the treatment of clinically significant macular edema in diabetic patients. To study, the outcome and adverse effects of laser treatments in both
modalities.
Methods: All Type 2 diabetic patients presenting to the ophthalmology department outpatient department were screened for diffuse diabetic macular
edema and 60 eyes were enrolled in the study. They were divided into two groups of 30 eyes each and randomly assigned to receive either conventional
grid laser or SDM laser. A detailed clinical examination which included visual acuity, color vision, visual fields (central 10°), fundus photos, and fundus
flourescein angiography were done prior to the laser treatment and at 6 weeks and 3 months follow-up.
Results: Conventional grid laser caused a significant resolution of macular edema, angiographically, whereas SDM laser showed worsening at
3 months follow-up. Our study did not show an alteration of central 10° of visual field or color vision defects in both the groups, which suggest
significant functional damage is not caused by both treatment modalities. We found in our study that conventional Grid laser was better at 3 months
follow-up in improving/stabilizing visual acuity and macular edema (angiographically). A single sitting of grid laser is better than SDM laser in diffuse
diabetic maculopathy.
Keywords: Diabetic retinopathy, Diabetic macular edema, Grid laser, Subthreshold micropulse diode laser.


| PDF |

References


Singh R, Ramasamy K, Abraham C, Gupta V, Gupta A. Diabetic

retinopathy: An update. Indian J Ophthalmol 2008;56(3):178-88.

Shaya FT, Aljawadi M. Diabetic retinopathy. Clin Ophthalmol

;1(3):259-65.

Williams R, Airey M, Baxter H, Forrester J, Kennedy-Martin T,

Girach A. Epidemiology of diabetic retinopathy and macular oedema:

A systematic review. Eye (Lond) 2004;18(10):963-83.

Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M. Risk factors

for diabetic retinopathy in a South Indian Type 2 diabetic population –

The Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4.

Diabet Med 2008;25(5):536-42.

The relationship of glycemic exposure (HbA1c) to the risk of

development and progression of retinopathy in the diabetes control and

complications trial. Diabetes 1995;44(8):968-83.

Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin

epidemiologic study of diabetic retinopathy 3. Prevalence and risk of

diabetic retinopathy when age at diagnosis 30 years or more. Arch

Ophthalmol 1984b;102(4):527-32.

Tight blood pressure control and risk of macrovascular and

microvascular complications in type 2 diabetes: UKPDS 38. UK

Prospective Diabetes Study Group. BMJ 1998;317(7160):703-13.

Bhavsar AR. In: Roy H, editor. Diabetic Retinopathy Textbook.

New York: Springer; 2010.

Mavrikakis E. Macular edema in diabetes. In: Roy H, editor.

Diabetic Retinopathy Textbook. ???:???; ???.

Kanski JJ. Diabetic retinopathy. Clinical Ophthalmology: A Systematic

Review. 6

ed. Edinburgh: Elsevier; 2007. p. 566-84.

Rosenblatt BJ, Benson WE. Diabetic retinopathy. In: Yanoff M,

th

Duker JS, editors. Ophthalmology. St. Louis, MO: Mosby, Elsevier;

p. 613-21.

Neubauer AS, Ulbig MW. Laser treatment in diabetic retinopathy.

Ophthalmologica 2007;221(2):95-102.

Dowler JG. Laser management of diabetic retinopathy. J R Soc Med

;96(6):277-9.

Keshav BR, Zacharia G, Bhat VK, Joseph MK, Ideculla T. Laser

therapy in diabetic macular edema. Oman Med J 2008;23(1):28-31.

Preliminary report on effects of photocoagulation therapy. The

Diabetic Retinopathy Study Research Group. Am J Ophthalmol

;81(4):383-96.

Photocoagulation treatment of proliferative diabetic retinopathy: The

second report of diabetic retinopathy study findings. Ophthalmology

;85:82-106.

Four risk factors for severe visual loss in diabetic retinopathy. The third

report from the diabetic retinopathy study. The diabetic retinopathy

Study Research Group. Arch Ophthalmol 1979;97(4):654-5.

Photocoagulation treatment of proliferative diabetic retinopathy:

Relationship of adverse treatment effects to retinopathy severity.

Diabetic retinopathy study report no 5. Dev Ophthalmol 1981;2:248-61.

Treatment techniques and clinical guidelines for photocoagulation of

diabetic macular edema. Early treatment diabetic retinopathy Study

Report number 2. Early treatment diabetic retinopathy Study Research

Group. Ophthalmology 1987;94(7):761-74.

Early photocoagulation for diabetic retinopathy. ETDRS Report

number 9. Early treatment diabetic retinopathy Study Research Group.

Ophthalmology 1991;98 5 Suppl:766-85.

Meunier I, Soubrane G, Coscas G. Laser photocoagulation treatment of

diabetic maculopathy. Bull Soc Belge Ophtalmol 1995;256:81-4.

Lang GE. Laser treatment of diabetic retinopathy. Dev Ophthalmol

;39:48-68.

Hamilton AM, Ulbig MW, Polkinghorne P. Management of Diabetic

Retinopathy. London: BMJ Publishing Group; 1996.

Lewis H, Schachat AP, Hairmann MH, Haller JA, Quinlan P, Von

Fricken MA, et al. Choroidal neovascularisation after laser photocoagulation

for diabetic macular edema. Arch Ophthalmol 1991;109:1549-51.

Varley MP, Frank E, Purnell EW. Subretinal neovascularization

after focal argon laser for diabetic macular edema. Ophthalmology

;95(5):567-73.

Han DP, Mieler WF, Burton TC. Submacular fibrosis after

photocoagulation for diabetic macular edema. Am J Ophthalmol

;113(5):513-21.

Schatz H, Madeira D, McDonald HR, Johnson RN. Progressive

enlargement of laser scars following grid laser photocoagulation

for diffuse diabetic macular edema. Arch Ophthalmol

;109(11):1549-51.

Kumar V, Ghosh B, Mehta DK, Goel N. Functional outcome of

subthreshold versus threshold diode laser photocoagulation in diabetic

macular oedema. Eye (Lond) 2010;24(9):1459-65.

Luttrull JK. Is effective photocoagulation without laser induced damage

possible? Retina Today 2006;???:???.

Kim SY, Sanislo SR, Dalal R, et al. The selective effect of micropulse

diode laser upon the retina. Invest Ophthalmol Vis Sci 1996;37:???.

Vujosevic S, Bottega E, Casciano M, Pilotto E, Convento E, Midena E.

Microperimetry and fundus autofluorescence in diabetic

macular edema: Subthreshold micropulse diode laser versus

modified early treatment diabetic retinopathy study laser

photocoagulation. Retina 2010;30(6):908-16. Nakamura Y,

Mitamura Y, Ogata K, Arai M, Takatsuna Y, Yamamoto S.

Functional and morphological changes of macula after subthreshold

micropulse diode laser photocoagulation for diabetic macular oedema.

Eye (Lond) 2010;24(5):784-8.

Luttrull JK, Musch DC, Mainster MA. Subthreshold diode micropulse

photocoagulation for the treatment of clinically significant diabetic

macular oedema. Br J Ophthalmol 2005;89(1):74-80.

Asian J Pharm Clin Res, Vol 8, Issue 6, 2015, 240-243

Chellakumar et al.

Sivaprasad S, Sandhu R, Tandon A, Sayed-Ahmed K, McHugh DA.

Subthreshold micropulse diode laser photocoagulation for clinically

significant diabetic macular oedema: A three-year follow up. Clin

Experiment Ophthalmol 2007;35(7):640-4.

Sivaprasad S, Elagouz M, McHugh D, Shona O, Dorin G. Micropulsed

diode laser therapy: Evolution and clinical applications. Surv

Ophthalmol 2010;55(6):516-30.

Figueira J, Khan J, Nunes S, Sivaprasad S, Rosa A, de Abreu JF,

et al. Prospective randomised controlled trial comparing sub-threshold

micropulse diode laser photocoagulation and conventional green laser

for clinically significant diabetic macular oedema. Br J Ophthalmol

;93(10):1341-4.

Friberg TR. Infrared micropulsed laser treatment for diabetic macular

edema – subthreshold versus threshold lesions. Semin Ophthalmol

;16(1):19-24.

Ohkoshi K, Yamaguchi T. Subthreshold micropulse diode laser

photocoagulation for diabetic macular edema in Japanese patients. Am

J Ophthalmol 2010;149(1):133-9.

Rykov S, Saksonov S. Infrared laser in the micropulse mode for

the treatment of diabetic macular edema. Retina Today 2011;???:???.

Lavinsky D, Cardillo JA, Melo LA Jr, Dare A, Farah ME, Belfort R Jr.

Randomized clinical trial evaluating mETDRS versus normal or highdensity

micropulse photocoagulation for

diabetic macular

edema.

Invest

Ophthalmol Vis

Sci 2011;52(7):4314-23.

Tewari HK, Gupta V, Kumar A, Verma L. Efficacy of diode laser

for managing diabetic macular oedema. Acta Ophthalmol Scand

;76(3):363-6.

Gupta V, Gupta A, Kaur R, Narang S, Dogra MR. Efficacy of various

laser wavelengths in the treatment of clinically significant macular

edema in diabetics. Ophthalmic Surg Lasers 2001;32(




About this article

Title

A RANDOMISED, COMPARATIVE STUDY OF GRID LASER AND SUBTHRESHOLD MICROPULSE DIODE LASER IN THE TREATMENT OF DIFFUSE DIABETIC MACULOPATHY

Date

01-11-2015

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 8 Issue 6 (November - December) 2015 Page: 240-243

Print ISSN

0974-2441

Online ISSN

2455-3891

Statistics

111 Views | 147 Downloads

Authors & Affiliations

Vikram Chellakumar
Sree Balaji Medical College and Hospital Bharat University Chennai India
India

Rajarathnam .

Cornelius Vijai


Article Tools


Email this article (Login required)
Email the author (Login required)

Refbacks

  • There are currently no refbacks.