Subthreshold micropulse laser in BRVO
Reviewed by Saruban Pasu

The purpose of this retrospective, consecutive, single-centre, non-randomised, and case-control study was to verify the therapeutic effects and safety of oedema (from branch retinal vein occlusion (BRVO)) recurrence suppression effect using 577-nm subthreshold micropulse laser photocoagulation (SMLP) in combination with intravitreal ranibizumab (IVR). Forty-six eyes of 46 patients with treatment-naïve BRVO-cystoid macular oedema (CME) were enrolled. Twenty-two patients were in the IVR + SMLP group with 24 patients in an IVR only group. The IVR was given as prn after the first injection and the laser was delivered one month after the first IVR. No differences were observed between two groups in age, sex, visual acuity, corneal topography (CRT), duration of symptom from onset, location of vein occlusion, and occlusion type (major or macular). CRT and best corrected visual acuity (BCVA) improved significantly at all time points in both groups. BCVA at six months in the IVR + SMLP group and IVR groups was 0.11±0.15 (range in Snellen equivalents: 20/50-20/16) and 0.23±0.38 (range in Snellen equivalents: 20/400–20/16), respectively, and was not significantly different between the two groups. Twenty of 22 eyes (90.9%) maintained BCVA >20/40 at six months in IVR + SMLP group and 19 of 24 eyes (79.2%) maintained in IVR monotherapy group. The number of IVR injections was 1.9±0.8 in the IVR + SMLP group and 2.3±0.9 in the IVR group; there was a significant difference between the two groups. The authors concluded that the combination therapy of IVR and 577nm SMLP can treat macular oedema secondary to BRVO effectively and safely, by decreasing the frequency of IVR while maintaining good visual acuity.

Combination therapy of intravitreal ranibizumab and subthreshold micropulse photocoagulation for macular edema secondary to branch retinal vein occlusion.
Terashim H, Hasebe H, Okamoto F, et al.
RETINA
2019;39(7):1377-84.