Fig. 4

Patient with chronic and recurrent DME that required anti-VEGF therapy. A CST map overlying near-IR image revealing diffuse CI-DME. B Late phase of fluorescein angiography showing cystoid hyperfluorescent leaking (dashed red rectangle). C Baseline SD-OCT showing hyporreflective inner retinal cysts and atrophic outer retinal lesions located temporally to the fovea from previous ETDRS laser therapy (yellow arrowheads). The CST measured 424 µm. Illustrative IVR (intravitreal ranibizumab) injection combined with SWiT laser therapy (SPD, green arrows and EpM, light purple stars). Baseline BCVA (Snellen) was 20/50. D Five months after SWiT laser therapy with CST map showing an absence of DME. E Late phase of fluorescein angiography without leaking (dashed red rectangle) and presence of tiny hypofluorescent dots spread widely on the macular area, as a result of the SPD laser array (green arrowheads). Also, representative invisible EpM laser targets (light purple stars). F SD-OCT image of a five-month resolved macular edema showing hyperreflective dots in the outer retina due to photothermal cell activation from the SPD laser pattern (green asterisks) and subthreshold anatomical representative EpM targets (pink asterisks). The atrophic outer retinal lesions located temporally to the fovea from previous ETDRS laser therapy were maintained (yellow asterisks). Interestingly, the CST decreased to 294 µm. G Eighteen months later, the SD-OCT still showed a stable CST of 287 µm, and correlated visual acuity improvement (Snellen BCVA of 20/25) was obtained since the 5-month follow-up visit