Barely visible 10-millisecond pascal laser photocoagulation for diabetic macular edema: observations of clinical effect and burn localization.
OBJECTIVE
To investigate the morphologic features and clinical efficacy of barely visible Pascal (Optimedica Corporation) photocoagulation burns in diabetic macular edema (DME) using Fourier-domain optical coherence tomography (FD OCT) and fundus autofluorescence (AF).


METHODS
Interventional case series.


METHODS
Retrospective evaluation of 10 eyes with newly diagnosed DME that underwent barely visible Pascal photocoagulation using an array of 10-microm, 10-millisecond photocoagulation burns. FD OCT and camera-based AF was performed at baseline and at 1 hour, 2 weeks, 4 weeks, and 12 weeks after laser. Changes in retinal thickening after laser treatment were measured using retinal thickness maps within the treated sector and the central foveal subfield.


RESULTS
At 1 hour after treatment, burns were visualized partially with clinical biomicroscopy. AF demonstrated spots lacking autofluorescence that confirmed effective laser uptake within the Pascal arrays. Sequential changes in hyperreflectivity on FD OCT correlated with morphologic alterations seen on AF. Burns became increasingly hyperautofluorescent between 2 and 4 weeks. There were significant reductions in the retinal thickness within treated sectors on FD OCT at 2 weeks (26 +/- 32 microm; P = .012) and 3 months after laser (20 +/- 21 microm; P = .02) compared with baseline. Clinical biomicroscopic reduction of DME was the most common finding in 80%.


CONCLUSIONS
Barely visible 10-millisecond Pascal laser seems to produce an effect at the level of the inner and outer photoreceptor segments and apical retinal pigment epithelium, with minimal axial and lateral spread of burns. FD OCT confirmed spatial localization of AF signal changes that correlated with laser burn-tissue interactions over 3 months. The technique of lower-fluence barely visible 10-millisecond laser may reduce retinal edema within affected sectors and effectively treat DME with minimization of scar formation.
University of Manchester, Manchester Royal Eye Hospital, Manchester, United Kingdom.
Mahiul M K
MM
Muqit
Jane C B
JC
Gray
George R
GR
Marcellino
David B
DB
Henson
Lorna B
LB
Young
Niall
N
Patton
Stephen J
SJ
Charles
George S
GS
Turner
Paulo E
PE
Stanga
D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D017075:Laser Coagulation; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008269:Macular Edema / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D012160:Retina / Q000473:pathology; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology