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Each subject gave written informed consent to participate in the study.Patients were older than 18 years of age, with clinically significant DME, Hb A1c less than 10%, and no history of renal failure or uncontrolled hypertension.

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All groups showed statistically significant progressive reduction of central macular thickness (CMT) throughout the study (At 1 year, the clinical performance of HD-SDM was superior to that of the m ETDRS photocoagulation technique, according to the anatomic and functional measures of improvement used in this investigation.Best corrected visual acuity (BCVA) was better than 20/400 and worse than 20/40 measured by the ETDRS protocol, retinal thickening due to DME had to be within 500 μm of the macular center and with central macular thickness (CMT) of 250 μm or more measured by optical coherence tomography (Stratus OCT 3; Carl Zeiss Meditec, Inc., Dublin, CA), and patients could not have undergone prior laser or drug treatment for DME.Patients were not eligible if they had either thickening of the epiretinal membrane or vitreomacular traction syndrome, had been treated with panretinal photocoagulation within 4 months before enrollment, or had undergone major ocular surgery (including cataract surgery) within 6 months.Patients were randomized to receive either m ETDRS focal/grid photocoagulation (42 patients), ND-SDM (39 patients), or HD-SDM (42 patients).Before treatment and 1, 3, 6, and 12 months after treatment, all patients underwent ophthalmic examinations, BCVA, color fundus photography, fluorescein angiography, and optical coherence tomography (OCT).A rationale for this treatment modality as a preferable approach is suggested, and the precise role of subthreshold micropulse laser treatment may become more defined as experience grows, guided by optimized treatment guidelines and more comprehensive trials.

(number, NCT00552435.) The Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated a significant benefit of laser photocoagulation for the treatment of clinically significant macular edema, reducing the incidence of visual loss by approximately 50% at 3 years' follow-up.Numerous clinical studies have been conducted with subthreshold laser treatments with an 810-nm diode laser using a variety of micropulse parameters, and the lack of a well-defined treatment strategy is reflected in their variable results.Another strategy is selective retinal therapy (SRT), which causes thermomechanical damage selective to the RPE, causing thermal modeling and theoretically causes re-establishment of a normal RPE monolayer.but have never been proven to be a prerequisite in the mechanism of action of laser photocoagulation.Conversely, recent understanding of the modification of gene expression mediated by the healing response of the RPE to thermal injury suggests that the useful therapeutic cellular cascade is activated, not by laser-killed RPE cells, but by the still-viable RPE cells surrounding the burned areas that are reached by the heat diffusion at sublethal thermal elevation.New strategies have been developed for laser treatments that minimize the chorioretinal damage while maintaining at least similar treatment efficacy.

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