First Author: L.El Matri FRANCE
Co Author(s): Y. Falfoul Z. Chebbi M. Kortli A. Hassairi K. Matri A. Chebil
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Our aim was to investigate the effect of micropulse laser (MP) in the treatment of diabetic macular edema (DME) refractory to anti-VEGF therapy.
Hedi Rais institute of ophthalmology of Tunis
Fifteen eyes from 9 patients with clinically significant DME were included in the study. All eyes received anti-VEGF therapy without significant improvement in visual acuity and macular thikness. We performed macular MP laser treatment. We began with the laser set in traditional settings. We placed a test spot in a non-edematous area of the retina and we increased the power up moving to a new area each time, until we note a thermal reaction (white burn). In the second step, we switch the laser to the micropulse setting and perform MP over the area of edema with a high-density grid treatment. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured before treatment and 3, 6 and 12 months after intervention, and the results were compared.
Our patients were aged from 48 to 75 years (mean: 56.5 years). Mean anti-VEGF injections were 9. After three months of MP laser treatment, BCVA improved from 0.717 +/- 0.3 logMAR to 0.54+/-0.4 (p=0.01). CMT was 548.7 um, and improved to 501.3 um (p<10-3) at 3 months after treatment, to 376,2 um at 6 months (p<10-3) and to 275um at 12 months (p=0,03). All patients reported subjective improvement. We did not observe changes or scars related to laser MP treatment on both colour fundus and fundus autofluorescence imaging. No adverse events were observed during follow-up.
In this study, MP laser seems to be a long term effective laser to treat DME particularly in refractory cases. Moreover, the attractive safety profile of MP treatment allows clinicians to offer earlier treatment to prevent tissue damage and the development of visual disability.