115
EW RETINA
October 2014
Contact information
Mansour: smansour@virginiaretina.com
using the IQ 577 laser at 400 mW,
with a 5% duty cycle and a 200-ms
duration. I used a 200-micron spot
and an Area Centralis lens (Volk
Optical, Mentor, Ohio) to deliver
83 spots to the fovea. When he re-
turned for follow-up 1 month later,
the edema had resolved (Figure 2).
Areas CW laser doesn't work
There are a variety of situations
where we have concluded that CW
laser is not the most effective treat-
ment. The previously mentioned
VIBRANT study showed minimal
benefit of standard grid CW laser for
macular edema related to BRVO.
4
The swelling from CW laser set up
that treatment to fail. However,
the emergence of MPLT changes
the understanding of the treatment
mechanism sufficiently that it merits
revisiting many of these situations.
Now that pharmaceutical treatment
can be used, there may be a role
for MPLT to enhance that effect.
MicroPulse photo-stimulates cells
without damage, enhancing RPE
function and endothelial cells in
the retinal vasculature,
5
and that
certainly is an area worth studying
further. EW
References
1. Early Treatment Diabetic Retinopathy Study
Research Group: Focal photocoagulation
treatment of diabetic macular edema. ETDRS
Report Number 19. Arch Ophthalmol 113:
1144–1155, 1995.
2. Lavinsky D, Cardillo JA, Melo LA Jr, Dare
A, Fareh ME, Belfort R Jr. Randomized clinical
trial evaluating mETDRS versus normal or
high-density micropulse photocoagulation for
diabetic macular edema. Invest Ophthalmol
Vis Sci. 2011 Jun 17;52(7):4314–23.
3. Luttrull JK, Dorin G. Subthreshold Diode
Micropulse Laser Photocoagulation (SDM)
as Invisible Retinal Phototherapy for Diabetic
Macular Edema: A Review. Curr Diabetes Rev.
2012 July; 8(4): 274–284.
4. www.asrs.org/education/clinical-
updates/142/vibrant-study-yields-positive-
results-for-eylea-in-treating-macular-edema-
following-brvo
5. Ogata N, Tombran-Tink J, Jo N, Mrazek D,
Matsumura M. Upregulation of pigment epi-
thelium-derived factor after laser photocoagu-
lation. Am J Ophthalmol. 2001;132:427–429.
Dr. Mansour is clinical professor,
Department of Ophthalmology,
George Washington University in
Washington, D.C., and medical
director of the Virginia Retina Center,
with 3 locations in Northern Virginia.
He has financial interests with Iridex.
