Pascal grid modified laser (GML) treatment including subthreshold strategy (SS) in the treatment of severe diffuse cystoid macular edema (SDCME) in non proliferant diabetic retinopathy (NPDR)

Poster Details

First Author: G.Pacelli ITALY

Co Author(s):    G. Macri'   C. Pisano   L. Baraggia   A. Nucera   S. Daniela   V. Belloli              

Abstract Details


Long term retrospective study assessing the efficacy of Pascal GML associated with SS in reducing central macular thickness (CMT) improving visual function in SDCME (CMT>400 microns) in NPDR without intravitreal injection. Assessing utility of angioOCT in retreating decisions.


Ss. Trinità Hospital Borgomanero ophthalmic department


28 eyes of 22 patients affected by SDCME. Mean FU: 25 months. GML was performed with Pascal Photocoagulator: focal laser of micro-aneurysms and a mild GML (mean spot 60µm; mean power 130 mw; 20 ms). SS was performed during follow up in 15 out of 28 eyes (100 micron spot and a mean power of 275 mw, 10 ms; SLS: 30% of the tirtrate power value). Re-treatments criteria guided by OCT, fluorescein angiography (FA) and angio-OCT. To assess the influence of metabolic control, patients entered 2 groups (cut-off Hba1c:7.50%). Group 1 (G1) >7.5%: 14 eyes; Group 2 (G2) <7.5%: 14 eyes. Each patient was evaluated with best corrected visual acuity (BCVA), SD-OCT, FA and in some recent cases with angio-OCT.


BCVA improved in 88% of patients. Mean percentual improvement of BCVA: 59% (G1 41%; G2 54%). Mean BCVA (LogMAR): Initial 0.45 ; final: 0.26. CMT improved in almost all patients (mean basal CMT:537 µm; final CMT:319 µm). Observing BCVA and CMT, we stress the importance of glico-metabolic control.


Despite the enthusiasm for intra-vitreal steroids and anti-VEGF treatments of SDCME, laser treatment remains an actual modality of care with proven longstanding efficacy. PL is a valid instrument to perform GML; minimizing laser scar it allows an optimal management of CSDME. Angio-OCT helps to identify leaking microaneurysm and is a valid alternative to FA to guide treatment.

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