EFFICACY OF NAVIGATED SUBTHRESHOLD YELLOW MICROPULSE LASER FOR THE TREATMENT OF DIABETIC MACULAR EDEMA

Diabetic retinopathy (DR) is a leading cause of vision loss among adults, affecting millions of people worldwide. The main cause behind vision impairment in DR is diabetic macular edema (DME), which is characterized by the accumulation of fluid and inflammatory factors in the retina. DME can be divided into two categories: center-involving DME (CI-DME) and non-center-involving DME (nCI-DME), depending on whether the macula is affected. Traditional laser therapy was the primary approach for DME treatment, but the introduction of anti-VEGF treatments has changed the landscape. Traditional laser therapy had significant drawbacks, including damage to the retina and various complications. The subthreshold micropulse laser (SMPL) has emerged as an alternative to traditional laser therapy, as it avoids the retinal damage associated with conventional laser treatments. SMPL uses short bursts of laser energy with specific duty cycles to minimize heat effects. It appears to induce a biological response in the damaged retinal pigmented epithelium (RPE) and has been associated with reduced VEGF levels and improved macular capillary permeability. However, there is currently no standard protocol for SMPL treatment, leading to variations in laser power, duty cycle, and pulse duration. The introduction of the Navilas system (Navilas®, OD-OS GmBH, Teltwo, Germany) allows for the integration of various imaging modalities, such as fluorescein angiography, indocyanine green angiography, and spectral domain-optical coherence tomography (SD-OCT), to identify visible leakage points and area of retinal edema. These images are used to plan laser treatment. The aim of this study is to evaluate the safety and effectiveness of subthreshold micropulse laser in treating non-center-involving DME over a 6-month follow-up period. This treatment was administered using a navigated laser system that utilizes OCT maps to precisely delineate the treatment area. Additionally, the study involves a comparison between two groups of patients: one group received treatment with fixed laser parameters, while the other have personalized laser parameters determined through titration testing. Both groups underwent treatment with subthreshold yellow micropulse laser at a 5% duty cycle for DME. This research aims to provide valuable insights into optimizing navigated subthreshold micropulse laser as a treatment for DME.