scholarly journals Real-life outcomes of subthreshold laser therapy for diabetic macular edema

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Renato M. Passos ◽  
Fernando K. Malerbi ◽  
Marindia Rocha ◽  
Maurício Maia ◽  
Michel E. Farah
Keyword(s):  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Combined Treatment ◽  
Real Life ◽  
Case Series ◽  
Macular Thickness ◽  
Panretinal Photocoagulation ◽  
Subthreshold Laser

Abstract Background Diabetic macular edema (DME) is a major cause of visual impairment and its treatment is a public health challenge. Even though anti-angiogenic drugs are the gold-standard treatment, they are not ideal and subthreshold laser (SL) remains a viable and promising therapy in selected cases. The aim of this study was to evaluate its efficacy in a real-life setting. Methods Retrospective case series of 56 eyes of 36 patients with center-involving DME treated with SL monotherapy. Treatment was performed in a single session with the EasyRet® photocoagulator with the following parameters: 5% duty cycle, 200-ms pulse duration, 160-µm spot size and 50% power of the barely visible threshold. A high-density pattern was then applied to the whole edematous area, using multispot mode. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and around 3 months after treatment. Results Fifty-six eyes of 36 patients were included (39% women, mean age 64.8 years old); mean time between treatment day and follow-up visit was 14 ± 6 weeks. BCVA (Snellen converted to logMAR) was 0.59 ± 0.32 and 0.43 ± 0.25 at baseline and follow-up, respectively (p = 0.002). Thirty-two percent had prior panretinal photocoagulation (p = 0.011). Mean laser power was 555 ± 150 mW and number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) was seen in 96 and 41% of eyes at baseline and improved in 35 and 74% of those after treatment, respectively. Quantitative analysis of central macular thickness (CMT) change was performed in a subset of 23 eyes, 43% of which exhibited > 10% CMT reduction post-treatment. Conclusions Subthreshold laser therapy is known to have RPE function as its main target, modulating the activation of heat-shock proteins and normalizing cytokine expression. In the present study, the DME cases associated with SRF had the best anatomical response, while intraretinal edema responded poorly to laser monotherapy. BCVA and macular thickness exhibited a mild response, suggesting the need for combined treatment in most patients. Given the effect on SRF reabsorption, subthreshold laser therapy could be a viable treatment option in selected cases.

scholarly journals Conbercept and Retinal Photocoagulation in the treatment of Diabetic Macular Edema

2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Weizhe Meng ◽  
Ronghua Li ◽  
Xiufen Xie
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Diabetic Macular Edema ◽  
Laser Photocoagulation ◽  
Retinal Nerve Fibre Layer ◽  
Macular Thickness ◽  
Control Group ◽  
Panretinal Photocoagulation ◽  
Observation Group ◽  
Retinal Photocoagulation

Objective: To explore the clinical efficacy of intravitreal injection of conbercept in combination with retinal laser photocoagulation in the treatment of diabetic macular edema. Methods: Ninety patients with diabetic macular edema were selected and grouped into an observation group and a control group using random number table, 45 patients (45 eyes) each group. The control group was given retinal laser photocoagulation, while the observation group was given intravitreal injection of Conbercept on the basis of panretinal photocoagulation. The Best Corrected Visual Acuity (BCVA), thickness of retinal nerve fibre layer (RNFL) and macular thickness were measured through relevant examinations before and after treatment. The intraocular pressures of patients in the two groups were evaluated, and moreover the complications were recorded. Results: The RNFL thickness and macular thickness of the two groups had no statistically significant differences before treatment (P>0.05) and decreased significantly after treatment; the decrease amplitude of the observation group was significantly larger than that of the control group (P<0.05). The BCVA of both groups significantly increased in the 1st, 2nd and 4th week after treatment (P<0.05); the increase amplitude of BCVA of the observation group was more significant than that of the control group at different time points after treatment (P<0.05). The intraocular pressure of the observation group was not significantly different with that of the control group in the 1st, 2nd and 4th week after treatment (P>0.05). There were no severe eye complications and systemic adverse reactions in both groups in the process of follow up. Conclusion: Intravitreal injection of conbercept in combination with retinal laser photocoagulation performs better in improving the BCVA and central macular thickness of patients with diabetic macular edema compared to retinal laser photocoagulation and has high safety. doi: https://doi.org/10.12669/pjms.35.6.512 How to cite this:Meng W, Li R, Xie X. Conbercept and Retinal Photocoagulation in the treatment of Diabetic Macular Edema. Pak J Med Sci. 2019;35(6):1493-1498. doi: https://doi.org10.12669/pjms.35.6.512 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

2018 ◽  
Vol 2018 ◽  
pp. 1-16 ◽  
Author(s):  
Laurent Kodjikian ◽  
David Bellocq ◽  
Thibaud Mathis
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Observational Studies ◽  
Real Life ◽  
Pharmacological Management ◽  
Anti Vegf ◽  
Pubmed Database ◽  
Baseline Visual Acuity

Objectives of the Study. Summary of observational studies concerning the pharmacological management of diabetic macular edema (DME). Methods. A literature review was conducted using the PubMed database on 1 February 2018 to identify studies evaluating the efficacy of anti-VEGF and dexamethasone (DEX) implants for DME. Studies with more than 10 patients and follow-up of more than 6 months were selected. Analyses were carried out on the overall population and on subgroups defined according to baseline visual acuity (BVA) and the patients’ naïve or non-naïve status. Results. Thirty-two studies evaluating the efficacy of anti-VEGF and 31 studies evaluating the efficacy of DEX-implants were retained, concerning 6,842 and 1,703 eyes, respectively. A mean gain of +4.7 letters for a mean of 5.8 injections (mean follow-up: 15.6 months) and +9.6 letters for a mean of 1.6 injections (10.3 months) was found in the anti-VEGF and DEX-implant studies, respectively. Final VA appears to be similar for both treatment (62 letters for anti-VEGF, 61.2 letters for DEX-implant), and BVA appears lower for DEX-implant, which may partially explain the greater visual gain. The DEX-implant studies show greater gains in VA compared to the anti-VEGF studies, especially for higher BVA. Indeed, mean gains for the subgroups of patients with BVA<50 letters, 50<BVA<60 letters, and BVA>60 letters are +4.3, +5.8, and +3.1 letters, respectively, in the anti-VEGF studies and +10.5, +9.3, and +8.8 letters, respectively, in the DEX-implant studies. Regarding the patient’s initial status, only naïve status appears to confer the best functional response in DEX-implant studies. Conclusion. Observational studies investigating DEX-implant report clinically similar final VA when compared to anti-VEGF, but superior visual gains in real-life practice. This latter difference could be due to the better BVA, but also to the fact that less injections were administered in the anti-VEGF observational studies than in the interventional studies.

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 Treatment of diabetic macular edema and proliferative diabetic retinopathy with anti-vascular endothelial growth factor agents under the reimbursement policy of the Taiwan National Health Insurance Bureau: Aflibercept or ranibizumab?

2021 ◽  
Author(s):  
Ming-Chieh Hsieh ◽  
Chieh-Yin Cheng ◽  
Kun-Hsien Li ◽  
Chih-Chun Chuang ◽  
Jian-Sheng Wu ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Case Series ◽  
Incidence Rates ◽  
Panretinal Photocoagulation ◽  
Reimbursement Policy ◽  
Micropulse Laser ◽  
The Mean

Abstract The purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.59 ± 6.54. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR -0.38, 95% CI -6.97~-1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.

scholarly journals Treatment Efficacy and Compliance in Patients with Diabetic Macular Edema Treated with Ranibizumab in a Real-Life Setting

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Anne-Laurence Best ◽  
Franck Fajnkuchen ◽  
Sylvia Nghiem-Buffet ◽  
Typhaine Grenet ◽  
Gabriel Quentel ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Real Life ◽  
Treatment Compliance ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Real Life Setting ◽  
The Mean

Purpose. To assess real-life efficacy of ranibizumab and treatment compliance of patients with vision loss secondary to diabetic macular edema (DME). Methods. A retrospective study was conducted in DME patients treated with ranibizumab. Patients were monitored every 4 weeks for visual acuity (VA) and central retinal thickness (CRT) by SD-OCT. All patients received a loading dose of 3 monthly injections followed by retreatments on an as-needed basis. The primary endpoint was the change in VA at M12. Patient compliance to the follow-up and the correlation between the injection number and VA were also investigated. Compliance was compared to that of neovascular age-related macular degeneration (nAMD) patients. Results. Seventy-two eyes of 55 consecutive DME patients were included. At baseline, the mean VA was 56.5 letters and CRT was 470 μm. At M12, the mean VA was 63.4 letters (p<0.0001), 31.1% of patients had a VA > 70 letters, the mean VA change was +6.9 letters, and the mean CRT was 361.9 μm (p=0.0001) after a mean number of 5.33 intravitreal injections. In patients who received ≥7 injections, the VA gain and final VA were significantly higher than in patients who received <7 injections. At M12, 25.45% of DME patients were lost to follow-up versus 16.8% of nAMD patients (n=55). Discussion/Conclusion. Our study confirms the real-life efficacy of ranibizumab in DME at M12 and the need for a large number of injections to achieve better visual outcomes. We also showed a trend to a lower compliance in diabetic versus nAMD patients.

scholarly journals DIABETIC MACULAR EDEMA;

2018 ◽  
Vol 21 (04) ◽  
pp. 810-815
Author(s):  
Fuad Ahmad Khan Niaz ◽  
Bilal Humayun Mirza ◽  
Manal Niazi ◽  
Muhammad Afzal Khan Niaz
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outcome Measure ◽  
Case Series ◽  
Intravitreal Bevacizumab ◽  
Diabetic Patients ◽  
Main Outcome Measure ◽  
Clinically Significant Macular Edema ◽  
Clinically Significant

. OBJECTIVE: To evaluate the effect of Intravitreal Bevacuzimab on Best CorrectedVisual Acuity in patients with clinically significant diabetic macular edema. MATERIAL ANDMETHODS: A prospective uncontrolled interventional case series in which 42 eyes of 31consecutive diabetic patients with clinically significant macular edema and no significantcomorbid ocular association presenting in the outpatients department of Holy Family Hospitaland EYE SURGERY clinic, Rawalpindi Pakistan and opting for the treatment from 1st September2013 to 31st January 2014 were given an intravitreal injection of Bevacizumab. BCVA wasdocumented prior to and four weeks after the injection. Main outcome measure was changes inBCVA. RESULTS: Out of the 31 patients included in the study 14(45.16%) were male and 17(54.83%) female. Average age was 56.1 ± 7.6. All 31 patients (42 eyes) came for follow up andtheir BCVA recorded. 41 (97.61%) eyes showed an improvement of one or more line on Snellen'schart at 4 weeks. 14 (33.33%) eyes showed an improvement of one line, 19 (45.23%) eyes animprovement of two lines, 6 (14.28%) eyes three lines and just 2 (4.76%) eyes had animprovement of four lines on Snellen's chart at 4 weeks. Only 1(2.38%) eye remained same withno worsening. On logMAR conversion scale for Snellen's letters the BCVA improved from 0.76 ±0.27 to 0.47 ± 0.27 (p< 0.001). No significant complications were observed in any of the eyes.CONCLUSION: The use of intravitreal Bevacizumab (1.25mg/0.05ml) is a safe and effective moeof treatment for clinically significant diabetic macular edema.

scholarly journals Changes in Central Macular Thickness following Single Session Multispot Panretinal Photocoagulation

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Nawat Watanachai ◽  
Janejit Choovuthayakorn ◽  
Direk Patikulsila ◽  
Nimitr Ittipunkul
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Macular Thickness ◽  
Panretinal Photocoagulation ◽  
Central Macular Thickness ◽  
Newly Diagnosed ◽  
Single Session ◽  
Corrected Visual Acuity

Purpose. To determine changes in central subfield (CSF) macular thickness and best corrected visual acuity (BCVA) following single session, multispot panretinal photocoagulation (PRP).Methods. Forty eyes of 33 patients with newly diagnosed proliferative diabetic retinopathy were treated with single session, 20-millisecond, multispot PRP. Changes in central macular thickness and BCVA at 4- and 12-week follow-up were compared to baseline measurements.Results. Each eye received a mean (SD) of 2,750 (686.7) laser spots. At 4-week follow-up, there was a statistically significant 24.0 μm increase in mean CSF thickness (P=0.001), with a 17.4 μm increase from baseline at 12-week follow-up (P=0.002). Mean logMAR BCVA increased by 0.05 logMAR units (P=0.03) at 4-week follow-up. At 12-week follow-up, BCVA had almost returned to normal with only an increase of 0.02 logMAR units compared to baseline (P=0.39). Macular edema occurred in 2 eyes (5%) at 12-week follow-up.Conclusions. Macular thickening occurs following single session, 20-millisecond, multispot PRP, with a corresponding, mild change in BCVA. However, the incidence of macular edema appears to be low in these patients. Single session, 20-millisecond, multispot PRP appears to be a safe treatment for patients with proliferative diabetic retinopathy.

Subthreshold Laser Therapy for Diabetic Macular Edema: Metabolic and Safety Issues

2013 ◽  
Vol 20 (26) ◽  
pp. 3267-3271 ◽  
Author(s):  
Stela Vujosevic ◽  
Ferdinando Martini ◽  
Enrica Convento ◽  
Evelyn Longhin ◽  
Olympia Kotsafti ◽  
...  
Keyword(s):  
Macular Edema ◽  
Laser Therapy ◽  
Diabetic Macular Edema ◽  
Safety Issues ◽  
Subthreshold Laser

scholarly journals Diabetic macular edema and proliferative diabetic retinopathy treated with anti-vascular endothelial growth factor under the reimbursement policy in Taiwan

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Ming-Chieh Hsieh ◽  
Chieh-Yin Cheng ◽  
Kun-Hsien Li ◽  
Chih-Chun Chuang ◽  
Jian-Sheng Wu ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Case Series ◽  
Incidence Rates ◽  
Panretinal Photocoagulation ◽  
Reimbursement Policy ◽  
Micropulse Laser ◽  
The Mean

AbstractThe purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.74 ± 5.44. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR − 0.38, 95% CI − 6.97 ~ − 1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.

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