Role of Systemic Control Prior to Laser Photocoagulation in Diabetic Macular Edema

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.

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Experimental Treatments for Diabetic Macular Edema

US Ophthalmic Review ◽

10.17925/usor.2011.04.02.125 ◽

2011 ◽

Vol 04 (02) ◽

pp. 125

Author(s):

Homayoun Tabandeh ◽

David Boyer ◽

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Keyword(s):

Clinical Trials ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Laser Photocoagulation ◽

Large Scale ◽

Case Series ◽

Treatment Modalities ◽

Systemic Control ◽

Experimental Treatments ◽

Endothelial Growth Factor

Diabetic macular edema (DME) is the most common reason for the loss of reading vision in diabetes patients. Systemic control of blood sugar, blood pressure, and lipids is an important aspect of the management of DME. In these patients, macular laser photocoagulation has been shown to reduce the incidence of moderate visual loss by 50 %. Significant visual improvement occurs in a small minority. Other treatment modalities, such as intravitreal steroids and anti-vascular endothelial growth factor (VEGF) drugs, have become increasingly popular. Case series and small clinical studies are suggestive of a beneficial effect, while large-scale clinical trials are ongoing. Currently, it appears that macular laser photocoagulation remains the gold standard for the treatment of DME. Intravitreal steroids and anti-VEGF agents are useful adjuncts that may improve visual outcomes. Current treatments and ongoing clinical trials are discussed.

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The role of structural changes in OCT in patients with diabetic macular edema

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2020-4-283-284 ◽

2020 ◽

pp. 283-284

Author(s):

S.G. Sergushev ◽

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Structural Changes

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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.

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