Evaluation of Navigated Laser Photocoagulation (Navilas 577+) for the Treatment of Refractory Diabetic Macular Edema

Purpose. To evaluate navigated laser photocoagulation for the treatment of refractory diabetic macular edema (DME). Methods. Retrospective study of 25 eyes (21 patients) treated with Navilas 577+ focal laser system. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (OCT) parameters were measured at baseline, 1, 3, and 6 months, and final visit. Results. The mean follow-up period was 12.8 ± 2.4 (7–16 months). All subjects had history of previous treatment which was injection of triamcinolone acetonide or antivascular endothelial growth factor (VEGF) agents. The navigated laser photocoagulation was delivered to the microaneurysms on indocyanine green angiography (ICGA) in 21 of 25 eyes (84%), fluorescein angiography (FA) guided in 3 eyes, and OCT angiography guided in 1 eye. After initial navigated laser treatment, 16 of 25 eyes (64%) were needed additional navigated laser photocoagulation, injection of triamcinolone acetonide, and/or injection of VEGF agents. Although median BCVA remained stable, the central retinal thickness and macular volume were significantly decreased over 6 months (p<0.05). All patients were treated without complications. Conclusions. Focal photocoagulation using Navilas 577+ showed to be effective in treating DME with improvement in macular edema on OCT over 6 months. Navilas 577+ was beneficial to perform navigated laser photocoagulation based on three modalities (ICGA, FA, and OCT angiography).

Download Full-text

Current Therapy of Diabetic Macular Edema Bevacizumab, Triamcinolone Acetonide, and Laser Photocoagulation

Ophthalmologica Indonesiana ◽

10.35749/journal.v45i1.172 ◽

2019 ◽

Vol 45 (1) ◽

pp. 13

Author(s):

Gladys Kusumowidagdo ◽

Randy Sarayar ◽

Kartika Rahayu ◽

Gitalisa Andayani

Keyword(s):

Macular Edema ◽

Triamcinolone Acetonide ◽

Diabetic Macular Edema ◽

Systematic Reviews ◽

Laser Photocoagulation ◽

Meta Analysis ◽

Intravitreal Bevacizumab ◽

Current Therapy ◽

Intravitreal Triamcinolone ◽

Mesh Terms

Background: Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy (DR). Current gold standard therapy of DME is macular laser photocoagulation (MPC). Growing evidences have shown benefits of intravitreal anti-VEGF agents (i.e bevacizumab) and intravitreal corticosteroids (i.e triamcinolone acetonide). Aim: To compare the visual acuity (VA) improvement of patients with DME, treated with intravitreal bevacizumab (IVB), a combination of IVB and intravitreal triamcinolone (IVB/IVT), and MPC. Method: A comprehensive PubMed® and Cochrane® databases search was conducted on May 4th, 2017 using appropriate keywords (diabetic macular edema, bevacizumab, triamcinolone, and laser photocoagulation using their MeSH terms). Studies were filtered using inclusion criterions (clinical trials, RCT, meta-analysis, systematic review, English, humans, and publication within 10 years) Results: Three studies (2 systematic reviews and 1 RCT) were found suitable. From these results, all studies showed favoring effects of IVB when compared to IVB/IVT combination and MPC in short term period (up to 6 months). However, there was no significant improvement of VA beyond this period in all groups. Conclusion: IVB appears to be superior to IVB/IVT and MPC in improving VA during 6 months follow- up period. Future systematic reviews and meta-analysis are required on the effect of IVB and MPC combination in cases of DME.

Download Full-text