Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Distéfano, Laura; García-Arumí, José; Martínez-Castillo, Vicente; Boixadera, Anna

doi:10.1155/2017/2407037

Cited by 28 publications

(23 citation statements)

References 36 publications

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“…Although anti-VEGF therapy has increasingly become the mainstay of therapy for DR, laser therapy still plays an important role as an adjuvant treatment or rescue therapy. The utility of focal laser as an adjuvant treatment dramatically reduced the frequency of anti-VEGF injections when compared with anti-VEGF treatment alone in DME patients [ 64 ] ( Table 3 ).…”

Section: Current and Novel Treatment Strategies In Drmentioning

confidence: 99%

Diabetic Retinopathy: Pathophysiology and Treatments

Wang

2018

IJMS

877

784

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Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM). It has long been recognized as a microvascular disease. The diagnosis of DR relies on the detection of microvascular lesions. The treatment of DR remains challenging. The advent of anti-vascular endothelial growth factor (VEGF) therapy demonstrated remarkable clinical benefits in DR patients; however, the majority of patients failed to achieve clinically-significant visual improvement. Therefore, there is an urgent need for the development of new treatments. Laboratory and clinical evidence showed that in addition to microvascular changes, inflammation and retinal neurodegeneration may contribute to diabetic retinal damage in the early stages of DR. Further investigation of the underlying molecular mechanisms may provide targets for the development of new early interventions. Here, we present a review of the current understanding and new insights into pathophysiology in DR, as well as clinical treatments for DR patients. Recent laboratory findings and related clinical trials are also reviewed.

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Section: Current and Novel Treatment Strategies In Drmentioning

confidence: 99%

Diabetic Retinopathy: Pathophysiology and Treatments

Wang

2018

IJMS

877

784

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“…Intravitreal injection of Triamcinolone (in pseudophakic patients only) or anti-VEGF, in particular, have shown to be an alternative to focal or grid laser in the treatment of CSME involving the center of the macula, as these drugs have shown to effective in reducing macular edema and anti-VEGF prevent retinal neovascularization. Also, studies have shown that the combination of laser therapy (focal or grid laser) and intravitreal injection of triamcinolone or anti-VEGF to be very effective in the treatment of CSME than laser therapy alone [8][9][10]. The currently available anti-VEGF are Ranibizumab, Bevacizumab (Avastin), and Pegaptanib.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Visual Outcomes between Panretinal Photocoagulation and Panretinal Photocoagulation Plus Intravitreal Bevacizumab in Proliferative Diabetic Retinopathy Patients Treated at Northen Zonal Hospital

Darabe

Makupa

2020

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Introduction: Diabetic retinopathy is one of the rigorous microvascular complications of diabetes mellitus is the significant cause of visual impairment and consequently blindness affecting about 36% of the diabetic population. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are two prime manifestations of DR that are responsible for visual morbidity. The basis of the treatment in PDR is Laser photocoagulation as accomplished by Diabetic retinopathy treatment study (DRS) and early treatment diabetic retinopathy study (ETDRS) for the last two decades. The dawn of intravitreal anti-VEGF agents has revolutionized the management of diabetic eye disease for more than the last decade. The aim of the study is to compare the visual outcomes of diabetic retinopathy patients between pan-retinal photocoagulation and pan-retinal photocoagulation plus intravitreal Bevacizumab. Methodology: A hospital-based cross-section study using medical record information for all DR patients treated by PRP and IVB at the KCMC eye. Data were analyzed using SPSS version 20. Results: A number of 204 patients were included in the study. The mean age was 59.26 (SD=9.6) years; 75.4% were male. Most of the patients 71.1% are from Arusha and Kilimanjaro. Among all, 51% had PRP alone and the duration of Diabetes was 5-10 years in the majority. The mean VA for PRP alone was 0.89 (SD=0.89) before treatment while it was 1 (SD=0.99) in PRP plus Bevacizumab. At 3 months after treatment VA for PRP alone was 0.947 (SD=0.93) and 0.96 (SD=1.01) for PRP plus Bevacizumab. The mean difference was not statistically significant. VA improved by 49% and it deteriorated by 27.7%. The majority had early proliferated DR 49.7%, 42.8% high risk proliferated DR and advanced proliferated DR was 7.5%. The complications were found in 5.6% and they included: vitreous hemorrhage (4.6%) and retinal detachment (1%) in PRP plus Bevacizumab and none in PRP alone. Conclusion: With respect to this study there is no significant difference in visual outcome for PRP alone and PRP plus injection Bevacizumab, though PRP plus Bevacizumab in treatment of DR had better visual outcome over PRP alone. PRP plus injection Bevacizumab is associated with a higher and early rate of regression of active NVs than PRP alone in patients with PDR. Further studies will be needed to determine whether IVB plus PRP is a satisfactory treatment for the prevention of vision-threatening complications such as vitreous hemorrhage and tractional retinal detachment.

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“…Considering that in addition to the general disease burden, IVT is a crucial factor of diabetic patients´ quality of life, [ 12 , 20 ] it is reasonable that the value and additional effect of macular laser treatment, either focal or grid, has continuously been investigated until now and controversies still exist. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

“…Conventional MLT monotherapy has been largely replaced by intravitreal injection therapy and several studies tried to evaluate the effect of laser treatment in combination with intravitreal injection therapy. [ 15 ] None of these trials demonstrated a significant effect on visual acuity or a significant reduction of intravitreal injections by adding conventional laser treatment however. [ 8 , 10 ]…”

Section: Introductionmentioning

confidence: 99%

3-year-data of combined navigated laser photocoagulation (Navilas) and intravitreal ranibizumab compared to ranibizumab monotherapy in DME patients

et al. 2018

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PurposeThe prospective, comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema has shown advantage of a combination therapy compared to ranibizumab monotherapy at year 1 with significantly reduced injections. The purpose of this retrospective study was to determine the long-term visual gains and need of injections in a 3 year-follow-up period.MethodsRetrospective analysis of patients of the original study in the long-term follow-up from month 12 to 36. BCVA measurements following the original 1 year study were taken using logMAR charts. Injections were provided with standard of care using PRN, based on change in BCVA and CRT using SD-OCT scans. Main outcome measures were change in BCVA and mean number of injections from 12 to 36 months.ResultsBCVA was stable in both groups from 12 through 36 months, showing a change of 0.16 ± 0.1 log MAR. Following the initial reduction in required injections at month 12, combination therapy patients continued to require 1.3 times fewer injections over the next 24 months (2.91 ± 2.3 vs 3.85±3.7 injections for monotherapy).ConclusionsCombination of navigated laser and ranibizumab achieved BCVA gains equivalent to anti-VEGF monotherapy. These results could be maintained through month 36. Required injections were 2.0 injections lower in year 1 and further 1.3 times fewer in year 2 and 3 in the combination group compared to monotherapy. Adding navigated laser photocoagulation to intravitreal anti-VEGF therapy may still represent a superior therapeutic approach to DME patients.

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Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

Cited by 28 publications

References 36 publications

Diabetic Retinopathy: Pathophysiology and Treatments

Diabetic Retinopathy: Pathophysiology and Treatments

Comparison of Visual Outcomes between Panretinal Photocoagulation and Panretinal Photocoagulation Plus Intravitreal Bevacizumab in Proliferative Diabetic Retinopathy Patients Treated at Northen Zonal Hospital

3-year-data of combined navigated laser photocoagulation (Navilas) and intravitreal ranibizumab compared to ranibizumab monotherapy in DME patients

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