Visual outcome of laser treatment in diabetic macular edema: Study from an Urban Diabetes Care Center (original) (raw)
Related papers
Green or Yellow Laser Treatment for Diabetic Macular Edema
Retina, 2013
Purpose: Explore differences in green compared with yellow focal/grid laser treatment on functional and anatomic endpoints in eyes with diabetic macular edema. Methods: Data from two randomized clinical trials were evaluated for differences in visual acuity (VA) and optical coherence tomography (OCT) parameters, eyes were assigned to sham injection+prompt laser, ranibizumab+prompt laser, or prompt laser only; among subgroups of eyes treated exclusively and electively with either green or yellow laser. Results: In the sham injection+prompt laser group, the mean VA letter score change for eyes receiving green and yellow laser treatment, respectively, was +2.4±14 and +5.1±13 at the 52-week visit (P = 0.06), and +2.4±15 and +6.0±13 at the 104-week visit (P = 0.13), with no corresponding evidence of differences in OCT thickness. When comparing wavelength groups in the ranibizumab +prompt laser and prompt-laser only groups, meaningful differences in VA and OCT thickness were not detected at 1 or 2 years. Conclusion: A trend towards improved vision outcome with yellow laser observed in one trial was not corroborated by anatomic outcomes or by the other trial. Without random assignment to different wavelengths controlling for bias and confounding, it is not possible to determine whether one wavelength is better than the other.
The effect on the macular function of laser photocoagulation for diabetic macular edema
Graefe's Archive for Clinical and Experimental Ophthalmology, 1992
The benefit of focal and grid-laser photocoagulation in reducing the risk of visual loss from diabetic macular edema has been established. In order to investigate the effect of this treatment on macular function, 30 diabetics with macular edema and 1.0 visual acuity were tested before and after laser treatment at intervals of I week, and 1 and 3 months, respectively. The test was carried out by means of nyctometry, contrast sensitivity, hue discrimination and critical flicker frequency of blue cones. All patients had abnormal results in macular tests before treatment. During the follow-up, visual acuity remained stable and the macular tests did not statistically modify, except for nyctometry, which deteriorated at the 1-week follow-up (P--0.02) and then increased to the basal values, and contrast sensitivity [improved at the last control ( P = 0.006)]. Clinical regression of macular edema was observed, but macular function tests never normalized. Patients with diabetic macular edema and good visual acuity should be monitored with many functional methods, and laser treatment should be performed before macular function deteriorates irreversibly.
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.
Visual outcome after laser treatment for diabetic retinopathy
Practical Diabetes International, 2002
Aims To identify factors that predict visual outcome after laser treatment for sight threatening diabetic retinopathy (STDR) in routine care. Patients and Methods We studied consecutive patients from a single diabetes centre who had laser photocoagulation by a single operator (LBY) which was commenced between 1991 and 1996. Follow-up data were obtained until the start of 1998. Potential predictors investigated were age, sex, duration and type of diabetes, HbA 1C , systolic and diastolic blood pressures, lipids, initial visual acuity (VA), urine albumin/creatinine ratio (UACR), serum creatinine and presence of macrovascular disease (MVD). Results Complete data were available for 137 (91.3%) of the 150 patients (median age 59 years, 35% female, 258 treated eyes). 140 eyes (54.3%) had maculopathy alone, 57 (22.1%) proliferative retinopathy alone and 61 (23.6%) had mixed retinopathy. Final VA (3-48 months post photocoagulation) was better than or equal to 6/12 in 81.4% maculopathy, 82.5% proliferative and 54.1% mixed eyes. Initial VA was the strongest predictor of final VA . 70% of maculopathy eyes, 61.4% of proliferative eyes and 42.6% of mixed eyes were unchanged or improved. Deterioration was additionally predicted by: maculopathy -increasing age & female sex; proliferative retinopathy -high UACR & concurrent MVD; mixed disease -type 2 DM. Conclusions In a routine care environment laser treatment of STDR can maintain very good vision. Initiating treatment before visual acuity drops is the most important factor in preventing blindness.
The open ophthalmology journal, 2013
To report one year outcomes of focal Navigated Retina Laser Therapy (NAVILAS) for diabetic macular edema (DME). Retrospective cohort series of 7 diabetic patients treated with NAVILAS focal laser. Statistical analysis included descriptive and continuous variables (Best-corrected logMAR Visual Acuity and time-domain optical coherence tomography (OCT) parameters) which were compared using a non-parametric procedure, the Friedman tests for repeated measures. A p-value of less than 0.05 was considered to denote statistical significance. diabetic patients (4 male; 3 female) with an average age of 60.8 years (range 48-85 years) were included. All treated eyes were phakic; patients had an average hemoglobin A1C of 9.1 (range 7.8-11.7) at baseline and 8.0 (range 7.4-8.4) at 12 months. Six of the 7 patients had intravitreal bevacizumab injections prior to focal laser treatment with 1 patient having had more than 1 prior injection (total 3). At 12 months, median logMAR improved from 0.695 (± ...
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.
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...
International Journal of Ophthalmology, 2012
AIMTo find out the outcome of laser photocoagulation in clinically significant macular edema (CSME) by optical coherence tomography (OCT)METHODSIt was a prospective, non-controlled, case series study enrolling 81 eyes of 64 patients with CSME between August 2008 and January 2010. All patients received modified grid photocoagulation with frequency doubled Nd: YAG laser. Each patient was evaluated in terms of best-corrected visual acuity (BCVA) and regression or progression of maculopathy after laser therapy at 1, 3 and 6 months. Spearman's correlation test was used to show the correlation between BCVA and total macular volume (TMV). Analysis of variance (ANOVA) was used to compare among groups and independent t-test was used to compare in each group.RESULTSThere is high correlation between BCVA and TMV (P≤0.001). BCVA improved in 50.6 %, remained static in 39.5% and deteriorated in 9.9% patients after 6 month of treatment. The Baseline TMV (mean and SD) were 9.26±1.83, 10.4±2.38), 11.5±3.05), 8.89±0.75 and 9.47±1.98mm3 for different OCT patterns, ST (sponge like thickening), CMO (cystoid macular edema), SFD (subfoveal detachment), VMIA (Vitreo macular interface abnormality) and average TMV respectively (P=0.04). After 6 months of laser treatment, the mean TMV decreased from 9.47±1.98mm3 to 8.77±1.31mm3 (P=0.01). In ST there was significant decrease in TMV, P=0.01, Further within these groups at 6 months, they were significantly different, P=0.01.CONCLUSIONOCT showed the different morphological variant of CSME while the response of treatment is different. TMV decreased the most and hence showed the improvement in vision after 6 months of laser treatment. In the era of Anti vascular endothelial growth factors (VEGFs), efficacy of laser seems to be in shadow but it is still first line of treatment in developing nation like Nepal where antiVEGFs may not be easily available and affordable.
QUANTITATIVE AND QUALITATIVE ASSESSMENT OF DIABETIC RETINOPATHY AFTER LASER TREATMENT
Aim: To investigate the visual and tomographic changes in patients undergoing pan retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) with or without clinically significant macular edema (CSME). Methods: This was a prospective, interventional clinical trial including 78 eyes of 78 patients suffering from diabetic retinopathy (DR). All patients were divided into three groups based on the severity of diabetic retinopathy and presence of clinically significant macular edema (CSME). Laser was administered as per the ETDRS standards. Visual acuity (VA), Central macular thickness (CMT), HbA1c and other parameters recorded pre and post laser. Results: Mean BCVA decreases from 0.24 to 0.33 at one month (p<0.001) and improved to 0.27 (p>0.05) after 4 months in group 1. In group 2 mean BCVA improved from 0.57 to 0.44 at one month (p<0.001) and further improved to 0.39 at four months (p<0.001). In group 3 it deteriorated from 0.63 to 0.67 (p>0.05) but improved to 0.61 at four months (p>0.05). Mean CMT in group one increased from 235μ to 277μ (p<0.001) but decreased to 253μ (p>0.05). From group 2 mean CMT decreased from 379μ to 325μ at one month (p<0.001) and further decreased to 318μ at four months (p<0.001). In group 3 also mean CMT increased from 374 μ to 382μ at one month (p>0.05) and then decreased to 373μ (p>0.05). Conclusion: Laser photocoagulation still remains the gold standard treatment modality in cases of proliferative diabetic retinopathy (PDR) and in treatment of CSME.
Clinical Ophthalmology, 2013
The purpose of this study was to evaluate and compare clinical outcomes and retreatment rates using navigated macular laser versus conventional laser for the treatment of diabetic macular edema (DME). Methods: In this prospective, interventional pilot study, 46 eyes from 46 consecutive patients with DME were allocated to receive macular laser photocoagulation using navigated laser. Best corrected visual acuity and retreatment rate were evaluated for up to 12 months after treatment. The control group was drawn based on chart review of 119 patients treated by conventional laser at the same institutions during the same time period. Propensity score matching was performed with Stata, based on the nearest-neighbor method. Results: Propensity score matching for age, gender, baseline visual acuity, and number of laser spots yielded 28 matched patients for the control group. Visual acuity after navigated macular laser improved from a mean 0.48 ± 0.37 logMAR by a mean +2.9 letters after 3 months, while the control group showed a mean −4.0 letters (P = 0.03). After 6 months, navigated laser maintained a mean visual gain of +3.3 letters, and the conventional laser group showed a slower mean increase to +1.9 letters versus baseline. Using Kaplan-Meier analysis, the laser retreatment rate showed separation of the survival curves after 2 months, with fewer retreatments in the navigated group than in the conventional laser group during the first 8 months (18% versus 31%, respectively, P = 0.02). Conclusion: The short-term results of this pilot study suggest that navigated macular photocoagulation is an effective technique and could be considered as a valid alternative to conventional slit-lamp laser for DME when focal laser photocoagulation is indicated. The observed lower retreatment rates with navigated retinal laser therapy in the first 8 months suggest a more durable treatment effect.