Subthreshold micropulse laser for retinal pigment epithelium detachment: subtype-stratified outcomes and predictors of treatment response.

Background: Pigment epithelium detachment (PED) arising from various macular diseases can significantly impair visual function. Although subthreshold micropulse laser treatment (SMLT) shows promise for PED, comparative data across subtypes and factors influencing outcomes remain limited. Methods: We included patients with visually significant macular PED who underwent SMLT between January 2017 and April 2023. Visual acuity and PED dimensions were recorded at baseline and follow-up. PEDs were classified as serous (sPED), drusenoid (dPED), or polypoidal (pPED) using fluorescein fundus angiography/indocyanine green angiography and optical coherence tomography. Within-group changes were assessed using paired Results: Forty-two patients (42 eyes; mean age 60.90 years; 59.5% male patients) were included: 27 with sPED, 10 with dPED, and 5 with pPED. Patients with sPED were significantly younger (mean 53.00 years) than those with dPED (77.20) and those with pPED (71.00; Conclusion: SMLT was associated with modest visual and anatomic improvements, with statistically significant PED area reduction observed only in sPED eyes; the absence of a control arm limits causal inference. Baseline BCVA was the strongest predictor of outcomes. Larger controlled studies are needed to establish the efficacy of SMLT across PED subtypes.