Título

MULTIMODAL ANALYSIS OF SUBTHRESHOLD LASER EFFECTS IN PATIENTS WITH DIABETIC MACULAR EDEMA

Objetivo

The aim of the present study was to describe the findings of the images acquired through the Adaptive Optics system regarding the arrangement and density of photoreceptors in patients with diabetic macular edema, before and after receiving subthreshold laser therapy, as well as to correlate the structural findings with the functional aspects, evaluated through the microperimetry.

Relato do Caso

Case1:A 69-year-old white female patient with nonproliferative diabetic retinopathy, with macular edema in the left eye. The BCVA was 20/30 and the anterior segment presented no significant findings.A region of 293x293 micra (1x1 dg) of the treated area was analyzed as a representative sample pre and post-treatment in terms of cell density, intercellular spacing and number of neighboring cells via AO detect (software) generating colored graphics.There was an increase in cell density in the region studied, as well as reduction in intercellular spacing and improvement in the pattern of distribution of neighboring cells (Voronoi) when the results were compared before and after 3 months of treatment.Using the MAIA microperimeter (CenterVue SpA), through a grid strategy, we analyzed the mean sensitivity of the studied region. Sensitivity thresholds improved after 3 months of treatment. The mean threshold was 17.1, 17.8 and 19.4 dB, pre-treatment and after 1 and 3 months, respectively. Case 2:White patient, male, 69 years, mild non-proliferative diabetic retinopathy. BCVA 20/30 in the left eye.The analysis of an area of 293 μm x 293 μm also showed higher cell density, reduction of intercellular spacing and higher frequency of cells with 6 neighboring cells (Voronoi index) after micropulse laser treatment.

Conclusão

The improvement of the mosaic pattern of the cones and the slight increase in the sensitivity thresholds may be secondary to the reduction of macular edema. Multimodal analysis of subthreshold therapy in diabetic macular edema suggests that there is no damage to the photoreceptors strucuture and function after treatment.