First Author: A.Filloy Rius SPAIN
Co Author(s): C. Peralvarez Conde J. Ocampo Candamil
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To describe the results and safety of optical coherence tomography guided focal laser as a consolidation treatment after intravitreal treatment for diabetic macular edema in terms of macular thickness, visual acuity and need for further treatments.
Diabetic macular edema patients treated at our retina unit who after receiving intravitreal therapy achieved foveal dryness with remaining areas of macular thickening.
Prospective case series. After intravitreal treatment (anti-VEGF or steroids) achieved foveal dryness in patients with previously fovea-involving edema, those patients with remaining areas of retinal thickening at the macula on the OCT received focal argon laser. The laser was aimed at the thickened areas at the lowest power setting needed to produce a barely visible burn (usually 50-70 mW) with burns 100μm on diameter placed at a distance of one burn apart from each other. The 500μm around the fovea and the papillomacular bundle were avoided when delivering laser. Three months after, the patients were evaluated for changes in macular thickness on OCT as well as in visual acuity. Funduscopy was performed in search for visible scars. Depending on the response at that moment, follow-up, more laser or intravitreal treatment were prescribed.
The study included 20 patients, 23 eyes and 27 different treated areas. All of them were type II diabetic patients. They were 70% male, 75% phakic and 63 years old on average. Prior to laser 18 of them received anti-VEGF, one received steroids, and one both forms of treatment. Follow-up time was 7.4 months on average (4-12). Three months after laser, 80% of the patients showed anatomical improvement on OCT. The average thickness of the treated areas decreased from 427μm (SD 65) to 381μm (SD 79) (p=0.028) while foveal thickness was stable. Visual acuity remained unchanged in most cases with a mean decrease on Snellen charts of -0.03 (p=0.59). Most of the patients showing an initial response remained stable for the following months, and no further treatment was considered necessary until a mean time of 7 months in this group of responders. The treatment most often indicated after this period of stability has been more laser (60%). Neither laser-related scars nor any other secondary effect have been noted.
OCT provided a fast and reliable information for laser delivery and follow-up. Most of patients responded well to laser without need for further treatment the following months. Rational and individualized use of focal laser combined with intravitreal therapy might play a role in decreasing the treatment burden and improving patient comfort in diabetic macular edema. A larger number of patients and longer follow-up are required to strengthen these conclusions.