Abstract
BACKGROUND AND OBJECTIVE: Subthreshold micropulse laser (SML) treatment at 577 nm has been proposed as a safe and efficacious therapy for diabetic macular edema (DME). The study objective was to evaluate the integrity of individual cone photoreceptors after SML treatment using high-resolution retinal imaging. PATIENTS AND METHODS: An observational cohort study of four subjects with DME treated using SML was followed over time. Cone inner and outer segment lengths and total retinal thicknesses (TRT) were measured as the edema resolved. The primary outcome was the detection of any laser-induced photoreceptor damage / change following the SML treatment using adaptive optics imaging. RESULTS: Individual cones observed pre-treatment remained visible, whereas cones that were initially obscured by the DME became more discernable after the treatment. TRT showed statistically significant thinning in half of the subjects. One subject showed no significant change, whereas another showed a statistically significant increase in TRT despite the treatment. No subject was found to have photoreceptor damage following treatment. CONCLUSIONS: SML at 577 nm did not result in measurable structural damage to the underlying photoreceptor layer, supporting previous work that SML is a safe alternative for treating DME. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:946-954.].