Table 3.
Studies on efficacy of MPLT in DME treatment.
| Article | Design | Evaluated on | Results |
|---|---|---|---|
| Nakamura et al., 2010 [38] |
Prospective 810 nm MPLT 200 μm/200 ms/15% DC titrated to 2× CWL power, without papillomacular bundle |
28 eyes diffuse DME FU = 3 |
Significant improvement in BCVA; significant reduction in CRT (from 481 ± 110 to 388 ± 127 μm). Central retinal sensitivity did not improve significantly. |
| Ohkoshi et al., 2010 [53] |
Prospective 810 nm MPLT 200 μm/200–300 ms/15% DC titrated to 2× CWL power |
43 eyes CS-DME < 600 μm FU = 3 |
BCVA did not change significantly. Significant reduction in CRT (from 341.8 ± 119.0 to 289.5 ± 122.8 μm). |
| Takatsuna et al., 2011 [52] |
Retrospective 810 nm MPLT 200 μm/100 ms/15% DC titrated to 2× CWL power |
56 eyes DME FU = 12 |
BCVA did not change significantly. Significant reduction in CRT (from 504.3 ± 105.8 to 320.4 ± 134.9 μm). |
| Luttrull et al., 2014 [14] |
Retrospective 810 nm MPLT 125–200 μm/300 ms/5% DC fixed 780 mW or 950 mW |
39 eyes CI-DME, V > 20/40 FU = 12 |
Significant improvement in BCVA (logMAR from 0.19 ± 0.11 to 0.16 ± 0.09); significant reduction in CRT for eyes with CRT < 300 μm (from 248.3 ± 27.8 to 229.4 ± 34.3 μm). No evidence of MPLT injury to RPE. |
| Kwon et al., 2014 [51] |
Retrospective 577 nm MPLT 100 μm/20 ms/15% DC titrated to immediately below CWL power 3 × 3 pattern, 1.5 widths |
14 eyes DME > 260 μm FU = 8 |
Significant improvement of BCVA (logMAR from 0.51 ± 0.42 to 0.40 ± 0.35). Nonsignificant decrease in CRT. No laser scars detected in color photographs, FAF, IR, and FA. |
| Mansouri et al., 2014 [50] |
Retrospective 810 nm MPLT CRT ≤ 400 μm vs. CRT > 400 μm 125 μm/300 ms/5% DC fixed 950 mW |
63 eyes DME FU = 12 |
Significant reduction in CRT and gain in BCVA in patients with CRT ≤ 400 μm, stable CRT and BCVA in patients with CRT > 400 μm. No adverse effect from MPLT. |
| Nicolò et al., 2014 [49] |
Retrospective 577 nm MPLT Naïve vs. previously treated DME 200 μm/200 ms/5% DC fixed 200 mW |
22 eyes DME FU = 6 |
Significant improvement in BCVA (logMAR from 0.39 ± 0.19 to 0.27 ± 0.17) and CRT (from 350.9 ± 74.7 to 311.2 ± 49.43 μm) only in naïve patients. No evidence of RPE damage in FAF. |
| Inagaki et al., 2015 [18] |
Prospective 810 nm MPLT + 561 nm focal laser of microaneurysms vs. 577 nm MPLT + 577 nm focal laser of microaneurysms 200 μm/200 ms/15% DC titrated to 2× CWL power, up to 500 μm from fovea |
53 eyes CS-DME FU = 12 |
Similar significant reduction in CRT on both groups. Stable BCVA in both groups. Retreatment rate higher in 810 nm group (16.7% vs. 3.4%). Mean power lower in 577 nm group (204.1 vs. 954.1 mW). |
| Abouhussein et al., 2016 [48] |
Prospective 577 nm MPLT previously treated 200 μm/200 ms/5% DC fixed 400 mW |
20 eyes CI-DME ≤ 400 μm FU = 6 |
Significant improvement in BCVA (logMAR from 0.42 ± 0.15 to 0.3 ± 0.26), significant reduction in CRT (from 354.3 ± 32.96 to 310.7 ± 52.62 μm). No evidence of retinal scars in fundus photography or FA. |
| Latalska et al., 2017 [47] |
Prospective 577 nm MPLT Rural vs. urban patients 100 μm/20 ms/5% DC titrated to 2× CWL power |
75 eyes Diffuse DME FU = 6 |
More significant treatment effects in rural patients. Significant improvement of reading visual acuity and decrease in CRT in both groups. BVCA remained stable. No retinal damage. |
| Değirmenci et al., 2018 [54] |
Retrospective 577 nm MPLT 160 μm/200 ms/5% DC titrated to 0.5× visible MPLT power |
9 eyes non-FI-DME FU = 3 |
Significant decrease in mean retinal thickness (from 470.6 to 416 μm). Nonsignificant improvement of BCVA. No evidence of laser scars in FAF. |
| Vesela et al., 2018 [46] |
Retrospective 577 nm MLPT 160 μm/200 ms/5% DC titrated to 0.3–0.5× CWL power |
63 eyes DME FU = 12 |
Significant decrease in CRT (from 442 to 379 μm). Stabilization of BCVA. |
| Citirik et al., 2019 [56] |
Prospective 577 nm MPLT CRT 250–300 μm vs. 301–400 μm vs. > 400 μm vs. healthy control 160 μm/200 ms/5% DC titrated to 0.5× visible MPLT power |
80 eyes recurrent DME after injection FU = 6 |
Significant reduction in CRT (from 276.0 ± 22.44 to 238.57 ± 25.87 μm) and gain in BCVA (logMAR from 0.52 ± 0.05 to 0.38 ± 0.04) only in patients with pretreatment CRT ≤ 300 μm. |
| Vujosevic et al., 2020 [44,45] |
Prospective 577 nm MLPT vs. control 100 μm/200 ms/5% DC fixed 250 mW, 7 × 7 pattern |
52 eyes naïve DME ≤ 400 μm FU = 12 |
Significant increase in BCVA (ETDRS score from 69.4 ± 12.0 to 76.0 ± 9.1). Significantly decrease in hyper-reflective retinal spots, microaneurysms, DRIL. CRT did not change. Stable parameters in control group. No need for rescue treatment. No changes in FAF. |
| Donati et al., 2021 [16] |
Retrospective 577 nm MPLT fixed vs. variable treatment regimen 100 μm/200 ms/5% DC fixed 450 mW or titrated to 4× CWL power |
39 eyes DME < 400 μm FU = 12 |
Equally significant decrease in CRT in both groups. No significant improvement in BCVA in both groups. |
| Frizziero et al., 2021 [57] |
Retrospective 577 nm MPLT 100 μm/200 ms/5% DC/fixed 250 mW |
134 eyes naïve CI-DME CRT ≤ 400 μm FU = 12 |
Significant improvement in BCVA (EDTRS score from 77.3 ± 4.5 to 79.4 ± 4.4). No significant CRT reduction. No adverse effects in FAF and OCT. |
| Kikushima et al., 2021 [19] |
Retrospective 577 nm vs. 670 nm MPLT 200 μm/200 ms/10% DC titrated to immediately below CWL power |
43 eyes DME FU = 1 |
Both lasers maintained BCVA. CRT equally significantly decreased in both groups. No changes in FAF. |
| Nowacka et al., 2021 [58] |
Prospective 577 nm MPLT 5% DC, titrated, not exceeding 350 mW |
21 eyes CI-DME CRT < 400 μm FU = 6 |
No significant change in BCVA, CRT, bioelectrical function of cones, and bipolar cells in mfERG. |
| Passos et al., 2021 [42] |
Retrospective 577 nm MPLT 160 μm/200 ms/5% DC titrated to 0.5× CWL power |
56 eyes CI-DME FU = 3 |
Significant improvement in BCVA (logMAR from 0.59 ± 0.32 to 0.43 ± 0.25). Different OCT instruments disabled CRT analysis. |
| Ueda et al., 2021 [40] |
Prospective 577 nm MPLT Evaluation of the dynamics of retinal healing process 100 μm/200 ms/5% DC titrated to 0.5× CWL power, 7 × 7 pattern |
11 eyes DME FU = 6 |
Decrease in RPE entropy after MPLT on polarization-sensitive OCT. No visible signs in color photography, FAF, and OCT. No significant changes in BCVA and CRT. |
| Valera-Cornejo et al., 2021 [41] |
Prospective 577 nm MPLT naïve vs. previously treated DME 100–150 μm/200 ms/5% DC titrated to 0.5× CWL power, 8 × 8 pattern |
33 eyes CI-DME < 700 μm FU = 3 |
No significant changes in BCVA for both groups. Significant reduction in CRT (from 420 ± 121 to 390 ± 130 μm) in naïve group. No adverse events in color photographs and FAF. |
| Işık et al., 2022 [39] |
Retrospective 577 nm MPLT MPLT vs. healthy control 160 μm/200 ms/5% DC titrated to 0.5× visible MPLT power |
40 eyes CI-DME FU = 3 |
Significant increase in BCVA; significant decrease in CRT. Area of central RPE measured in EDI-OCT was smaller in patients requiring retreatment. |
| Marashi et al., 2022 [59] |
Retrospective 532 nm focal threshold laser of microaneurysms + 532 nm grid MPLT 125 μm/200 ms/5% DC titrated to 0.5× CWL power |
12 eyes DME CRT > 300 μm FU = 6 |
Significant reduction in CRT (from 336.58 ± 86.36 to 264.33 ± 61.41 μm). Stable BCVA. Minimal scar formation. Four eyes required anti-VEGF injection. |
MPLT, micropulse laser treatment; CWL, continuous-wave laser; DME, diabetic macular edema; FU, follow-up (in months); BCVA, best corrected visual acuity; CRT, central retinal thickness; CS, clinically significant; CI, center involved; RPE, retinal pigment epithelium; FAF, fundus autofluorescence; IR, infrared; FA, fluoresceine angiography; DRIL, disorganization of inner retinal layers; mfERG, multifocal electroretinography; EDI, enhanced-depth imaging.