First Author: C.Azuara Azuara MEXICO
Co Author(s): J. Davila Villarreal E. Gutierrez Enriquez M. de Alba Castilla H. Trevino Rodriguez J. Ruiz Gonzalez J. Gonzalez Cortes
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To evaluate best corrected visual acuity (BCVA) and central macular thickness (CMT) in patients where we applied laser therapy in areas of retinal ischaemia guided by OCT-A in recurrent macular edema previously treated with several monotherapy antiangiogenic intravitreal injections.
Servicios Médicos Quirúrgicos de Monterrey, Monterrey, Nuevo Leon, México.
Retrospective case series of 5 patients with macular edema (ME) secondary to branch retinal vein occlusion and diabetic retinopathy. All patients received three ranibizumab loading doses followed by PRN regimen. All patients presented at least two relapsing ME episodes. Ophthalmological evaluation, macular OCT; OCT-A, and fluorescein angiography (FAG) were performed to all patients. Best corrected visual acuity, central macular thickness, non perfusion areas, number of injections, and number of laser photocoagulation sessions were measured. FAG versus OCT-A images were compared to identify ischaemic / low reflectance areas (LRA). Laser photocoagulation was performed to low reflectance areas guided by OCT-A with a 50-100µm threshold spot sparing 500µm of foveal zone. The mean follow-up after laser treatment was 9 months.
All non perfused retinal areas were better documented by OCT-A compared with FAG. After one laser treatment in the LRA, visual acuity and CMT remained stable. There were no changes in the LRA after laser treatment with no signs of vascular recanalization. After follow-up in all five patients, neither laser treatment nor anti-angiogenic intravitreal therapy were needed.
The use of new technological diagnostic tools for retinal diseases allows us to identify ischaemic areas better than the standard diagnostic studies. This new approach to retinal pathologies may establish the use of guided laser photocoagulation as a still useful alternative of complementary treatment for recurrent ME. Even if there was no vascular recanalization in non perfusion areas after laser treatment, the visual acuity and macular thickness remained stable. This will lead us to a better understanding of the mechanisms of laser therapy.