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Combination of anti-VEGF injections and navigated laser photocoagulation for diabetic macular edema (DME): twelve month results

Session Details

Session Title: Vascular Diseases III

Session Date/Time: Sunday 29/09/2013 | 08:00-10:00

Paper Time: 09:52

Venue: Hall 3 (Level 0)

First Author: M.Kernt GERMANY

Co Author(s):    W. Freeman   R. Liegl   I. Kozak   M. Ulbig     

Abstract Details


To evaluate the number of anti-VEGF injections needed in DME patients using a protocol that incorporates navigated laser. Anti-VEGF monotherapy will be used as control arm.


Pilot data collection at 2 centers, Ludwig-Maximilians University, Dept. of Ophthalmology, Munich, Germany and University of California San Diego, Jacobs Retina Center, CA, U.S.A


A consecutive series of 99 eyes with DME were included in the study and divided into 4 groups: Group 1. Three initial ranibizumab injections (n=27); Group 2. Three initial monthly ranibizumab injections followed by navigated laser therapy, (n=15), Group 3. Monthly ranibizumab injections until central retinal thickness (CRT) was reduced to 450µm or less (Spectralis OCT) followed by navigated laser therapy (n=34), Group 4. Three to five initial bevacizumab injections followed by navigated laser (n=23). After, anti-VEGF injections were reinitiated if DME recurred. All subjects were followed monthly for 12months. Best corrected visual acuity and central foveal thickness measured by OCT was evaluated at each visit.


At 12 months, all groups showed significant visual improvement compared to baseline (group 1: +6.3 ±6.77; group 2: +7.1 ±8.22; group 3: +7.4 ±7.53 and group 4: +10.6± 15 letters, p=0.0001). After the initial loading dose consisting of 3 monthly anti-VEGF injections, anti-VEGF monotherapy group 1 needed an average of 5.2 ± 3.2 injections at 12 months, while for eyes that received navigated laser (group 2, 3 and 4) the required number of injections range from 0.5 ± 0.8 to 0.8 ± 1.3 injections (p<0.001) at 12 months.


Anti-VEGF in combination with navigated laser showed similar visual improvements compared to anti-VEGF monotherapy with significantly fewer injections at 12 months. This data suggests that navigated laser helped to reduce the recurrence of edema and the required number of anti-VEGF injections.

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