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A Journal on Ophthalmology
Minerva Oftalmologica 2004 September-December;46(3-4):163-8
New laser strategies in retinal diseases
Bandello F., Pirracchio A., Roman Pognuz D., Frattolillo A., Lanzetta P.
The purpose of laser photocoagulation is to create a thermal therapeutical damage which causes biological reactions and, ultimately, beneficial effects. The whitening of the retina is the ophthalmoscopic sign of laser application and of the thermal damage. The major site of laser absorption is the retinal pigment epithelium (RPE) which is the site of production of factors that are responsible for beneficial effects. Unfortunately the photoreceptors are involved in the damage process. To avoid this side effect and to stimulate only the RPE, new selective laser strategies are being developed. Laser light coagulation is obtained with conventional continuous wave lasers with lowest energy needed to reach the biological effect. Subthreshold photocoagulation is obtained using very short laser exposure times (microsecond) and the energy is delivered using a series of repetitive low energy pulses with a specific pulse repetition or number of pulse per second (pps). At the time of the laser session, t he impacts are barely visible in the laser light coagulation and invisible in subthreshold photocoagulation. The goal of both strategies is to stimulate the RPE without damaging the photoreceptors and avoid the side effects due to the high energy employed in the classic laser phothocoagulation.