For quite some time I've followed the literature on MicroPulse Laser Therapy, which has shown it to be tissuesparing to the point of allowing treatment through the fovea. This year, I started using it in my practice in patients with diabetic macular edema (DME) and patients with central serous retinopathy. Many of my MicroPulse patients are early in their treatment course for DME (I've avoided treating eyes with chronic disease). In approximately 50% of these cases, I'm seeing a treatment effect and have been pleased with the early outcomes. In the case I describe here, the patient had an incomplete response to an initial subthreshold conventional laser treatment, but has not required further treatment since one application of MicroPulse.

PATIENT PRESENTATION AND INITIAL TREATMENT

This 64-year-old male diabetic patient first required treatment for DME in his right eye at his Oct. 9, 2013 visit. On that day, slit lamp examination revealed clinically significant macular edema involving the center of the fovea. (Figure 1) Central retinal thickness (CRT) as measured by spectral-domain OCT was 413 Ám, and visual acuity was 20/40. I performed a modified focal/grid laser treatment, using a conventional green laser at subthreshold settings.

TREATMENT WITH MICROPULSE LASER THERAPY

The patient returned for follow-up on Feb. 12, 2014. The green laser subthreshold treatment he received in his right eye at his previous visit resulted in a decrease in CRT, from 413 Ám to 336 Ám, and accompanying improvement on the OCT topographic map. (Figure 2) However, the macular edema had not resolved completely. To address the remaining edema, I performed MicroPulse with the IRIDEX IQ 577Ö (yellow) laser. (Table 1) Rather than titrate the treatment settings by performing a test application with "I also used the TxCell Scanning Laser Delivery System, which improves the consistency of highdensity spot placement and saves time compared with single-spot delivery."

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