Targeted Retinal Photocoagulation for Diabetic Macular Edema with Peripheral Retinal Nonperfusion

Abstract

In this 3-year randomized trial of 40 eyes with DME, there was no evidence that combination therapy with ranibizumab and TRP improved visual outcomes or reduced treatment burden compared with ranibizumab alone.

Intravitreal injection of conbercept combined with retinal photocoagulation on macular edema secondary to branch retinal vein occlusion

“…Laser photocoagulation is a conventional treatment means for BRVO, its mechanism is that due to the destruction of photoreceptor cells and retinal pigment epithelial cells, the oxygen content in the inner retina relatively increases, the contraction of arterioles is caused, and the pressure of capillary network and vein relatively declines, thereby reducing vascular leakage and alleviating ME (16). However, it is difficult to perform laser photocoagulation in the case of severe ME and retinal edema, and great bleeding, and it has been confirmed that the affected eyes often suffer from visual field defect and decline in contrast sensitivity after laser photocoagulation, affecting the recovery of visual function (17). Therefore, some scholars have proposed that combining laser photocoagulation and anti-VEGF drugs can not only improve the efficacy on ME, but also facilitate the recovery of visual function of patients, which has high clinical application value.…”

<p>The Evolving Treatment of Diabetic Retinopathy</p>

“…91,92 Analogous attempts to lessen the burden of anti-VEGF injections in the setting of DME by integrating peripheral PRP have met with mixed results. [93][94][95] Recent data from protocol V of the DRCR Network examining timing of therapy initiation in patients with center-involved DME and good VA demonstrated that focal macular laser fared equally well as anti-VEGF (aflibercept) therapy at 2 years. [96][97][98] In addition, the same protocol validated a "watchful wait" approach to managing patients with mild DME.…”

“…106 targeted PRP in conjunction with intravitreal ranibizumab for DME, have demonstrated no significant reduction in the frequency of PRN injections. 93,94 Combination therapy with intravitreal corticosteroids has likewise yielded mixed results in terms of both VA stabilization or improvement and reduction in overall treatment burden. [175][176][177][178] Further studies to explore potential benefits of combination treatment are planned, perhaps involving widefield imaging-guided peripheral laser to ischemic retina and subthreshold technique.…”

Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems

“…Über den Wert einer gezielten panretinalen Behandlung im Bereich peripherer Ischämieareale in Zusammenhang mit der DMÖ-Therapie ist lange kontrovers diskutiert worden [145]. Die Daten der DAVE-Studie konnten allerdings keinen positiven Effekt einer solchen gezielten additiven peripheren Laserkoagulation der Ischämieareale belegen.…”

“…Allerdings sind dabei einschränkend eine hohe Variabilität und somit Unsicherheit in der Beurteilung entsprechender Parameter wie beispielsweise des ischämischen Index (Verhältnis perfundierter vs. non-perfundierter Areale) zu beachten[144]. Umgekehrt scheint das Ausmaß der peripheren Ischämie allerdings keine übergeordnete Rolle für die Prognose und Injektionsfrequenz einer IVOM-Therapie des diabetischen Makulaödems zu spielen; Studien konnten bislang keinen positiven Einfluss einer gezielten Laserbehandlung peripherer ischämischer Netzhautareale auf die DMÖ-Behandlung nachweisen[145]. ▪ Die Dauer eines Ödems kann von Bedeutung für die Prognose sein, was in verschiedenen Therapiestudien zum Ausdruck kam.…”