Anti-VEGF therapy and wild field FA guide laser coagulation in the treatment of DME

Session Details

Session Title: Free Paper Session 19: Vascular Diseases & Diabetic Retinopathy V

Session Date/Time: Saturday 09/09/2017 | 16:30-18:00

Paper Time: 17:12

Venue: Room 120

First Author: : S.Suk UKRAINE

Co Author(s): :    S. Rykov   L. Denisuk   S. Mogilevskiy   O. Venediktova                    

Abstract Details

Purpose:

To increase the effectiveness of treatment of diabetic macular edema (DME) by combined use of laser coagulation of ischaemia of peripheral retina with intravitreal injection of anti-VEGF drugs in pre-proliferative diabetic retinopathy.

Setting:

Centre of eye microsurgery, P.L. Shupik National Medical Academy of Postgraduate Education Authors.

Methods:

The study involved 65 patients (115 eyes) aged 51 to 78 years who had pre-proliferative diabetic retinopathy and diffuse DME. The duration of the diabetes mellitus was 10 to 15 years. All patients except the standard fluoresceine angiography (FA) within 55 degrees conducted a wild field FA 150 degrees with the definition of the zones of capillary nonperfusion of the peripheral parts of the retina. In the control group (30 patients - 53 eyes), treatment with DMO was carried out by intravitreal injections of three loading dose of Aflibercept 2 mg monthly, and then, if necessary, additional injections until complete regression of DME. In the study group (35 patients - 62 eyes), combined treatment of DME was carried out using intravitreal administration of three loading doses of Aflibercept 2 mg in combination with the aim laser coagulation of peripheral ischaemic zones, determined from the data of the wide-field FAH. The average visual acuity is 32 letters on the ETDRS table in the control group and 30 letters in the study group. The average thickness of the retina is 378 +/- 9 microns and 384 +/- 11 microns, respectively, according to optical coherence tomography. The observation period is 18 months.

Results:

After 18 months, the average visual acuity in the study group was 43 letters and 40 letters in the control group, the average thickness of the retina of the macular area was 264 and 258 microns, respectively. The average number of intravenous injections of Aflibercept was 3.3 in the study group and 7.7 in the control group. Complete regress of exudative changes was observed in 48 eyes (77.4%) in the study group and 42 in the eyes (79%) in the control group.

Conclusions:

Combined use of laser coagulation of ischaemia of peripheral retina in pre-proliferative pulmonary embolism in combination with intravenous administration of Aflibercept allows for faster and more stable regression of DME, a reduction in the number of intravitreal injections of anti-VEGF drugs, and a reduction in the overall invasiveness of treatment, as well as the economic aspect.

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