Comparison of the efficacy and safety of anti-VEGF monotherapy versus anti-VEGF therapy combined with subthreshold micropulse laser therapy for diabetic macular edema

2021 ◽  
Author(s):  
Meltem Guzin Altınel ◽  
Banu Acikalin ◽  
Meryem Guler Alis ◽  
Gokhan Demir ◽  
Kemal Mert Mutibayraktaroglu ◽  
...  
Keyword(s):  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Efficacy And Safety ◽  
Micropulse Laser ◽  
Anti Vegf ◽  
Subthreshold Micropulse Laser

scholarly journals Treatment results of nondamaging retinal laser therapy in diabetic macular edema

2022 ◽  
Vol 14 ◽  
pp. 251584142110632
Author(s):  
Burcu P. Gültekin
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Intravitreal Injections ◽  
Diabetic Patients ◽  
Efficacy And Safety ◽  
Anti Vegf ◽  
Significant Difference ◽  
The Mean

Background: Subthreshold nondamaging retinal laser therapy (NRT) provides a greater safety profile than conventional laser methods, but more data is needed on the efficacy and safety of subthreshold NRT in diabetic macular edema. Purpose: To evaluate the efficacy and safety of NRT for the treatment of clinically significant macular edema (CSME) that is partially responsive or resistant to intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods: This was a retrospective case series study. Fifty eyes of 38 diabetic patients with CSME previously treated with at least 6-monthly intravitreal bevacizumab injections with/without intravitreal Ozurdex therapy were evaluated. The patients received 577-nm yellow wavelength laser therapy with PASCAL laser system (Topcon Medical Laser Systems, Santa Clara, CA, USA). Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were evaluated before and 1, 3, 6, 12 and 24 months after laser treatment. Results: Baseline mean CST was 368.06 ± 86.9 µm. The mean CST values at the 1-, 3-, 6-, 12-, and 24-month visits were 336.93 ± 79.8, 352.40 ± 113.5, 336.36 ± 109.3, 325.10 ± 104 µm, and 310.08 ± 84.7 µm, respectively. The mean CST decreased significantly at the first ( p = 0.002) and second year visits ( p < 0.001) when compared with pretreatment values. Although visual acuity was improved at the first year compared with baseline, this difference was not statistically significant ( p = 0.03). There was no significant difference in visual acuities between pretreatment and posttreatment visits. During 24-month follow-up, while 37 eyes were treated with [mean: 5.7 ± 3.4 (1–14)] intravitreal anti-VEGF injections, 3 eyes were administered single-dose intravitreal steroids. Additional intravitreal injections were not required in 10 (20%) eyes. Conclusion: NRT is effective by itself or in combination with anti-VEGF agents in diabetic macular edema that is partially responsive or resistant to previous intravitreal injections. T role in treating this disorder should be assessed in more detail with prospective controlled studies.

scholarly journals Subthreshold Micropulse Laser Modulates Retinal Neuroinflammatory Biomarkers in Diabetic Macular Edema

2021 ◽  
Vol 10 (14) ◽  
pp. 3134
Author(s):  
Luisa Frizziero ◽  
Andrea Calciati ◽  
Giulia Midena ◽  
Tommaso Torresin ◽  
Raffaele Parrozzani ◽  
...  
Keyword(s):  
Macular Edema ◽  
Laser Treatment ◽  
Diabetic Macular Edema ◽  
Metabolic Pathways ◽  
Treatment Method ◽  
Micropulse Laser ◽  
Subthreshold Micropulse Laser ◽  
Inflammatory Processes ◽  
Standardized Parameters

Subthreshold micropulse laser treatment has become a recognized option in the therapeutic approach to diabetic macular edema. However, some yet undefined elements pertaining to its mechanism of action and most effective treatment method still limit its clinical diffusion. We reviewed the current literature on subthreshold micropulse laser treatment, particularly focusing on its effects on the modulation of retinal neuroinflammation. Subthreshold micropulse laser treatment seems to determine a long-term normalization of specific retinal neuroinflammatory metabolic pathways, contributing to the restoration of retinal homeostasis and the curtailing of local inflammatory processes. Optimized and standardized parameters ensure effective and safe treatment.

Navigated Laser Therapy for Diabetic Macular Edema

2014 ◽  
Vol 07 (01) ◽  
pp. 59
Author(s):  
Marcus Kernt ◽  
Michael Ulbig ◽  
Anselm Kampik ◽  
Aljoscha S Neubauer ◽  
◽  
...  
Keyword(s):  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Treatment Success ◽  
Study Data ◽  
Panretinal Photocoagulation ◽  
Documentation Quality ◽  
Anti Vegf ◽  
Navigated Laser ◽  
Photocoagulation Treatment

Navigated laser therapy introduces computerized assistance systems to retinal laser photocoagulation treatment. The Navilas system offers high precision and safety and provides additional advantages regarding standardization of planning, execution, documentation, quality assurance, and better overall treatment comfort for the patient as main benefits over conventional laser. Navigated laser therapy is being used with good success in the treatment of diabetic macular edema (DME), retinal vein occlusions (RVO), and fast-pattern navigated panretinal photocoagulation in proliferative diabetic retinopathy (PDR). In center-involving DME, a combination of anti-vascular endothelial growth factor (VEGF) and macular laser may provide advantages over anti- VEGF monotherapy. In terms of navigated laser therapy, recent study data from our clinic and other institutions indicate that combined initial anti-VEGF and navigated macular laser therapy allows treatment success to be achieved and maintained with a significantly reduced number of interventions.

scholarly journals Role of focal laser retinal photocoagulation in treatment of diabetic macular edema

2021 ◽  
Vol 38 (2) ◽  
pp. 56-69
Author(s):  
I. V. Ionkina ◽  
A. G. Grinev ◽  
O. M. Zherebtsova
Keyword(s):  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Laser Photocoagulation ◽  
Current Evidence ◽  
Adjunct Therapy ◽  
Anti Vegf ◽  
Laser Systems ◽  
Retinal Photocoagulation

Vascular endothelial growth factor (anti-VEGF) inhibitors in action have demonstrated efficacy and safety in the treatment of diabetic macular edema (DME), and have changed both the goal and prospects for treatment of this disease. Consequently, the role of focal laser retinal photocoagulation in the treatment of DME has been actively debated. However, technical advances in new laser systems, treatment protocols for anti-VEGF drug research, and the functional impact of modern focal photocoagulation are necessary to assess the role of laser coagulation in the treatment of DME. A wide range of clinical studies of laser therapy was necessary as an additional treatment for 20 to 50 % of patients receiving monotherapy with anti-VEGF drugs in patients with diabetic macular edema. In addition, a lower frequency of repeated treatment and a more stable reduction in retinal thickness have been demonstrated in other studies. However, the lack of information about the laser systems used, their technical characteristics, and application protocols often make it difficult to compare directly the results of anti-VEGF tests. Therefore, the aim of our work was to analyze the currently available data related to the potential role of focal laser photocoagulation in the treatment of DME, including a detailed review of the most commonly used laser systems. The results obtained with sub-threshold diode micro-pulse laser photocoagulation may be a valuable option as an adjunct therapy to treatment with angiogenesis inhibitors. Current evidence suggests that focal laser therapy should still exist as an adjunct therapy for many patients.

scholarly journals Macular function and structure in patients with center-involved diabetic macular edema before and after micropulse laser therapy

Klinika Oczna ◽  
2021 ◽  
Vol 123 (2) ◽  
pp. 90-95
Author(s):  
Barbara Nowacka ◽  
Katarzyna Mozolewska-Piotrowska ◽  
Wojciech Lubiński ◽  
Anna Machalińska ◽  
Aleksandra Grabowicz
Keyword(s):  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Macular Function ◽  
Micropulse Laser ◽  
Before And After

scholarly journals Anatomical and functional outcomes of subthreshold micropulse laser versus intravitreal ranibizumab injection in treatment of diabetic macular edema

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Amr Abdelrahman ◽  
Wagiha Massoud ◽  
Ahmed Mohamed Kamal Elshafei ◽  
Mahmoud Genidy ◽  
Raafat Mohyeldeen Abdelrahman Abdallah
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Diabetic Macular Edema ◽  
Functional Outcomes ◽  
Implicit Time ◽  
Therapeutic Effects ◽  
Micropulse Laser ◽  
Subthreshold Micropulse Laser ◽  
Group 2 ◽  
Group 1

Abstract Background To compare the therapeutic effects of subthreshold micropulse laser (SML) versus intravitreal injection of ranibizumab in treatment of diabetic macular edema (DME) both anatomically using optical coherence tomography (OCT) and functionally using best corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG). Methods his study was an interventional prospective randomized comparative study. The study included 120 eyes classified into 3 groups: Group 1 included 40 eyes of 28 patients treated by SML laser, group 2 included 40 eyes of 32 patients treated by intravitreal injection of ranibizumab, and group 3 (control group for mfERG) included 40 eyes of 20 patients with diabetes mellitus (DM) of more than 10 year duration with no signs of diabetic retinopathy (DR). BCVA measurements, OCT and mfERG were done for the cases before and after interference and were followed up for 6 months Results By the end of the follow up period, BCVA significantly improved by 31% in group 1 vs 93% in group 2 with a statistically highly significant difference between the two groups (p value < 0.001). There was also a significant decrease in central subfield thickness in both groups with more reduction in group 2 compared with group 1 (p value < 0.001). There was a significant improvement in P1 amplitude of mf-ERG in group 2 (p value < 0.002) with no significant improvement in group 1. There was a significant decrease in P1 implicit time in group 2 (p value < 0.001) while there was no significant decrease in group1. Conclusions Intravitreal injection of ranibizumab is a superior treatment modality for DME compared with SML regarding both anatomical and functional outcomes. Trial registration: This study has been approved by the local ethical committee of faculty of medicine of Minia University and retrospectively registered at the clinical trial gov. with Identifier: NCT04332133.

Sign in / Sign up

Export Citation Format

Share Document