PMID- 35655248
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2056-9920 (Print)
IS  - 2056-9920 (Electronic)
IS  - 2056-9920 (Linking)
VI  - 8
IP  - 1
DP  - 2022 Jun 2
TI  - Pascal short-pulse plus subthreshold endpoint management laser therapy for 
      diabetic macular edema: the "sandwich technique".
PG  - 32
LID - 10.1186/s40942-022-00381-5 [doi]
LID - 32
AB  - BACKGROUND: Diabetic macular edema (DME) is the main cause of visual loss in 
      diabetic patients. Despite the use of anti-VEGF therapy as first-line treatment, 
      there are many patients whose response to treatment is poor or transient at best. 
      Sophisticated laser techniques have emerged aiming at low-intensity retinal 
      damage, avoiding excessive heat that causes tissue necrosis and related 
      collateral effects. OBJECTIVE: To evaluate the effect of combined sublethal laser 
      modalities from short-pulse duration (SPD) with endpoint management (EpM) 
      subthreshold laser [named the "sandwich technique" (SWiT)] on central subfield 
      thickness (CST) and best-corrected visual acuity (BCVA) in patients with DME. 
      MATERIAL AND METHODS: In this consecutive retrospective study, 37 patients (37 
      eyes) with center-involved (CI) DME were treated with SWiT laser therapy from 
      April 2017 to June 2021. The technique consisted of a mean number of 200 (range 
      number 50-400) SPD laser burns OCT-guided thickened area performed on the juxta- 
      and perifoveal area 500 microm away from the foveal center, overlapping with a mean 
      number of 1000 (range number 800-1200) EpM laser burns focused on 6 mm macular 
      diameter area but saving 300 microm toward the foveal center. All patients underwent 
      ophthalmological evaluations, including BCVA and CST measurement by 
      spectral-domain optical coherence tomography (SD-OCT), before and after SWiT 
      laser therapy. The mean follow-up time was 19.2 months (range 2-60 months). 
      RESULTS: Thirty-five out of 37 cases showed an improvement in CST and BCVA 
      following treatment. At baseline, mean CST (microm) +/- standard error (SE) and mean 
      BCVA (logMAR) +/- SE was 456.95 +/- 37.00 and 0.71 +/- 0.29, respectively. After a mean 
      follow-up of 19.2 months, mean CST (microm) +/- SE and BCVA (logMAR) +/- SE were 
      272.09 +/- 9.10 (p < 0.0001) and 0.54 +/- 0.26 (p = 0.003), respectively. A 
      statistically significant reduction in CST and improvement in BCVA was noted 
      after laser therapy application. The anti-VEGF injection frequency was reduced 
      during the mean 19.2 months of the study period. CONCLUSIONS: The novel 
      "sandwich" laser therapy aid reduced CST and improved BCVA in this retrospective 
      case series. Further prospective studies are warranted.
CI  - (c) 2022. The Author(s).
FAU - Cardillo, J A
AU  - Cardillo JA
AD  - Department of Ophthalmology, CRESEP- Eye Hospital public service, Araraquara, SP, 
      Brazil.
FAU - Rodrigues, M W
AU  - Rodrigues MW
AUID- ORCID: 0000-0001-9734-8617
AD  - Department of Ophthalmology, Ribeirao Preto Medical School, University of Sao 
      Paulo, 3900, Bandeirantes Avenue, Ribeirao Preto, SP, 14049-900, Brazil. 
      murilowrj@yahoo.com.br.
FAU - Oliveira, R C
AU  - Oliveira RC
AD  - Department of Ophthalmology, CRESEP- Eye Hospital public service, Araraquara, SP, 
      Brazil.
FAU - Messias, A M V
AU  - Messias AMV
AD  - Department of Ophthalmology, Ribeirao Preto Medical School, University of Sao 
      Paulo, 3900, Bandeirantes Avenue, Ribeirao Preto, SP, 14049-900, Brazil.
FAU - Jorge, R
AU  - Jorge R
AD  - Department of Ophthalmology, Ribeirao Preto Medical School, University of Sao 
      Paulo, 3900, Bandeirantes Avenue, Ribeirao Preto, SP, 14049-900, Brazil. 
      rjorge@fmrp.usp.br.
LA  - eng
PT  - Journal Article
DEP - 20220602
PL  - England
TA  - Int J Retina Vitreous
JT  - International journal of retina and vitreous
JID - 101677897
PMC - PMC9161489
OTO - NOTNLM
OT  - Diabetic macular edema
OT  - Macular grid and focal laser
OT  - Short-pulse laser
OT  - Subthreshold laser
COIS- The authors declare that they have no competing interests.
EDAT- 2022/06/03 06:00
MHDA- 2022/06/03 06:01
PMCR- 2022/06/02
CRDT- 2022/06/02 23:44
PHST- 2021/06/28 00:00 [received]
PHST- 2022/05/01 00:00 [accepted]
PHST- 2022/06/02 23:44 [entrez]
PHST- 2022/06/03 06:00 [pubmed]
PHST- 2022/06/03 06:01 [medline]
PHST- 2022/06/02 00:00 [pmc-release]
AID - 10.1186/s40942-022-00381-5 [pii]
AID - 381 [pii]
AID - 10.1186/s40942-022-00381-5 [doi]
PST - epublish
SO  - Int J Retina Vitreous. 2022 Jun 2;8(1):32. doi: 10.1186/s40942-022-00381-5.