The Early Treatment Diabetic Retinopathy Study historical review and relevance to todayʼs management of diabetic macular edema (original) (raw)
Related papers
Archives of Ophthalmology, 2007
Purpose-To compare two laser photocoagulation techniques for treatment of diabetic macular edema (DME): modified-ETDRS direct/grid photocoagulation (mETDRS) and a, potentially milder, but potentially more extensive, mild macular grid (MMG) laser technique in which small mild burns are placed throughout the macula, whether or not edema is present, and microaneurysms are not treated directly. Methods-263 subjects (mean age 59 years) with previously untreated DME were randomly assigned to receive laser photocoagulation by mETDRS (N=162 eyes) or MMG (N=161 eyes) technique. Visual acuity, fundus photographs and OCT measurements were obtained at baseline and after 3.5, 8, and 12 months. Treatment was repeated if DME persisted. Main Outcome Measure-Change in OCT measures at 12-months follow up. Results-From baseline to 12 months, among eyes with baseline central subfield thickness ≥ 250 microns, central subfield thickening decreased by an average of 88 microns in the mETDRS group and decreased by 49 microns in the MMG group (adjusted mean difference: 33 microns, 95% confidence interval 5 to 61 microns, P=0.02). Weighted inner zone thickening by OCT decreased by 42 and 28 microns, respectively (adjusted mean difference: 14 microns, 95% confidence interval 1 to 27 microns, P=0.04), maximum retinal thickening (maximum of the central and four inner subfields) decreased by 66 and 39 microns, respectively (adjusted mean difference: 27 microns, 95% confidence interval 6 to 47 microns, P=0.01), and retinal volume decreased by 0.8 and 0.4 mm 3 , respectively (adjusted mean difference: 0.3 mm 3 , 95% confidence interval 0.02 to 0.53 mm 3 , P=0.03). At 12 months, the mean change in visual acuity was 0 letters in the mETDRS group and 2 letters worse in the MMG group (adjusted mean difference: 2 letters, 95% confidence interval −0.5 to 5 letters, P=0.10). Conclusions-At 12 months after treatment, the MMG technique is less effective at reducing OCT measured retinal thickening than the more extensively evaluated current mETDRS laser photocoagulation approach. However, the visual acuity outcome with both approaches is not substantially different. Given these findings a larger long-term trial of the MMG technique is not justified. Application to Clinical Practice-Modified ETDRS focal photocoagulation should continue as a standard approach for treating diabetic macular edema.
Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema
Current Diabetes Reports
Purpose of Review This review highlights indications and evidence on laser therapy in the management of diabetic retinopathy and diabetic macular edema. Particular focus is placed upon the benefits and limitations of conventional laser photocoagulation versus more modern laser photocoagulation techniques, as well as the role of laser photocoagulation in treatment of diabetic retinopathy and diabetic macular edema with the frequent utilization of pharmacologic, including anti-vascular endothelial growth factor (VEGF), therapy. Recent Findings Laser photocoagulation remains the gold-standard therapy for the effective, definitive treatment of PDR, and also is highly effective in the management of DME. However, numerous recent studies have demonstrated the clinical efficacy and improved functional and anatomic outcomes of combination therapy with pharmacologic treatment. Summary Continuing innovations in laser technology and improved understanding of laser-retinal interactions and pathophysiology demonstrate that laser therapy will continue to play a critical role in the treatment of diabetic retinopathy and diabetic macular edema for many years to come.
Focal laser photocoagulation in non-center involved diabetic macular edema
Medical hypothesis, discovery and innovation in ophthalmology, 2014
This study was performed to evaluate the functional and anatomic outcomes of focal macular laser photocoagulation in eyes with non-center involved macular edema (non-CI ME). Forty-nine eyes of 43 patients with non-CI ME were included. Focal macular laser photocoagulation was conducted on twenty-nine eyes of 25 patients, while 20 eyes of 18 patients with non-CI ME were followed without treatment and served as the control group. Data relating to best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study) and central subfield thickness (CST), inner zone thickness (IZT), outer zone thickness (OZT), and total macular volume (TMV) as determined by optical coherence tomography (OCT) were collected and compared between the groups. At 12 months, VA decreased by a mean of 0.4 letters in the treatment group and 3.3 letters in the control group (p=0.03). Gain in VA ≥5 letters was noted in 6 (21%) of the eyes in the treatment group versus 1 (5%) eye in the control group (p=0....
Pakistan Journal of Medical Sciences, 2016
Objective: To determine the visual outcome of laser treatment in clinically significant macular edema. Methods: This interventional and qausi experimental study was carried out at Diabetic Association of Pakistan (DAP) during January 2011 and December 2012. Approval was taken from Research Ethical Committee of Isra Postgraduate Institute of Ophthalmology. Records of 925 eyes of 464 patients with "Clinical Significant macular edema" (CSME), treated with laser photocoagulation were analyzed. Bestcorrected visual acuity (BCVA) at the time of presentation and at the last follow up, minimum of one year and maximum of 45 months was recorded and compared. SPSS version 20.0 was used to analyze the data. Results: Diabetic retinopathy was found in 20.3% (1777) of 8742 diabetic attending DAP Hospital" amongst whom 39.6% (705) had Sight threatening diabetic retinopathy. Laser was advised in 96.4% (680) individuals, accepted by 70.5% (480) individuals. Amongst 960 eyes of 480 patients who accepted laser, 925 eyes had clinically significant macular edema and 35 eyes had PDR who are not included in this study. Amongst 925 eyes with CSME, Grid laser was done in 913 eyes (99%) and focal laser was done in 12 eyes (1%). After a follow up of 12 to 45 months, it was found that best corrected visual acuity had declined in 2.4% (22) eyes, stabilized in 67% (619) eyes and improved in 30.7% (284) eyes. One line improvement on Snellen's chart was fond in 21.3% (197) eyes, 2 lines in 8% (74) eyes, 3 lines in 1.2% (12) eyes and 4 lines in one (0.1%) eye with p-value of 0.000. Conclusion: Laser therapy is an effective treatment in stabilizing/improving the vision in diabetic macular edema particularly at those centers where only Argon Laser is available and OCF, FFA facilities do not exist.
Retina, 2009
Purpose-To report visual acuity and anatomic changes from baseline to 12 months after modified ETDRS style (focal/grid) photocoagulation in eyes with non-center involved (non-CI) clinically significant macular edema (CSME). Methods-Visual acuity, optical coherence tomography, fluorescein angiography, and fundus photography data were analyzed from eyes with non-CI CSME treated with modified ETDRS style (focal/grid) photocoagulation in a Diabetic Retinopathy Clinical Research Network trial. Results-Among the 22 eyes (of 22 patients) with 12 month follow-up, median visual acuity letter score remained within one letter of baseline over 12 months. The median central subfield retinal thickness decreased by 10μm, median total macular volume decreased by 0.2mm 3 , and median fluorescein leakage area within the grid decreased by 0.7 disc areas. Conclusions-We are unaware of any other systematic evaluation of eyes with non-CI CSME since the ETDRS. Focal/grid laser in these non-CI eyes was associated with relatively stable visual acuity and retinal thickness measurements, and decreased fluorescein leakage area at 1 year. One year visual acuity results are consistent with those published by the ETDRS, despite the intervening significant differences in the management of diabetes. Although this was a small study without a concurrent control group, the ETDRS recommendation to consider focal/grid laser in eyes with non-CI CSME still seems appropriate.
Navigated Laser Photocoagulation of Chronic Diabetic Macular Edema
Journal of Clinical & Experimental Ophthalmology, 2015
Objective: This paper deals with a retrospective evaluation of the effect of navigated photocoagulation of chronic DME with the NAVILAS device. Methods: The cohort comprised 18 eyes with clinically significant DME. The age range was 41-82 years (median 68) and the monitoring time in all eyes lasted for 12 months. The following examination techniques were employed: best corrected visual acuity (BCVA) tested on ETDRS charts, biomicroscopic examination of the fundus in artificial mydriasis, colour photography, fluorescent angiography (FAG), and optical coherence tomography (OCT, spectral domain Cirrus, C. Zeiss). The values of BCVA and OCT were statistically tested by means of a non-parametric pair test (Wilcoxon). The performed therapy included 1 focal laser treatment of the macula, 9 grid photocoagulations of the macula, and 8 direct photocoagulations of leaking microaneurysms. Laser treatment was done using navigated photocoagulation by NAVILAS device. Results: The initial BCVA ranged between 0.1 and 0.8 (average 0.5); at the end of the monitoring period the range of BCVA was 0.1 to 1.0 (average 0.5). No statistically significant difference was found between the preoperative and post-operative values of BCVA. The average value of the thickness of the macula in the central field on OCT was 360 µm prior to the intervention and 322 µm at the end of the monitoring time. This difference was statistically significant (p=0.015 Wilcoxon). After laser treatment with a NAVILAS device there was an anatomical improvement in DME. The sight functions (BCVA) remained stabilized. Conclusion: Navigated photocoagulation of the macula for DME showed in the present cohort of patients a favourable and functional benefit of the used method.
Current status in diabetic macular edema treatments
World journal of diabetes, 2013
Diabetes is a serious chronic condition, which increase the risk of cardiovascular diseases, kidney failure and nerve damage leading to amputation. Furthermore the ocular complications include diabetic macular edema, is the leading cause of blindness among adults in the industrialized countries. Today, blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy. The treatment should include an optimized control of glycemia, arterial tension, lipids and renal status. The photocoagulation laser is currently restricted to focal macular edema in some countries, but due the high cost of intravitreal drugs, the use of laser treatment for focal and diffuse diabetic macular edema (DME), can be valid as gold standard in many countries. The intravitreal anti vascular endothelial growth factor drugs (ranibizumab and bevacizumab), are indicated in the treatment of all types of DME, but the correct protocol for administration should b...