Focal Photocoagulation as an Adjunctive Therapy to Reduce the Burden of Intravitreal Injections in Macula Edema Patients, the LyoMAC2 Study

Abstract

Aim:To assess the efficacy of focal photocoagulation of capillary macroaneurysms (CMA) to reduce the burden of intravitreal injections (IVI) in patients with macular edema (ME). Materials and Methods: Retrospective multicenter study in patients with diabetic ME or ME secondary to retinal vein occlusion (ME-RVO). CMA associated with ME were selectively photocoagulated. Patients were followed for one year after photocoagulation. Results: 93 eyes of 76 patients were included in this study. At 6 months after the laser (n = 93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 2.52 to 1.52 at 6 months, p < 0.001). The mean BCVA remained stable (0.32 and 0.31 logMAR at baseline and 6 months, p = 0.95). At 12 months (n = 81/93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 4.44 to 2.95 at 12 months, p < 0.001), while the mean BCVA remained stable (0.32 and 0.30 logMAR at baseline and 12 months, p = 0.16). Conclusion: Focal laser photocoagulation of CMA seems to be effective and safe for reducing the burden of IVI in patients with ME. Their screening during the follow-up should be considered closely.

Fluocinolone Acetonide Implant Injected 1 Month after Dexamethasone Implant for Diabetic Macular Oedema: the ILUVI1MOIS Study

“…Another study of chronic macular oedema (secondary to diabetes and vein occlusion) has found that 66.3% of patients had macular TELCAPS [ 28 ]. Furthermore, treating these TELCAPS allowed for the reduction of the interval between intravitreal injections [ 29 ].…”

Progress in the Treatment of DME

“…Net Protocol I study showed no significant difference in 5-year visual prognosis between the 6-month delayed combined laser group and the early combined laser group, but delayed laser treatment reduced macular damage, eliminated the need for grid-pattern photocoagulation in about 56% of patients, and provided a better visual prognosis in patients with poor baseline VA (<20/50) with delayed laser treatment [15]. The LyoMAC2 study noted that focal photocoagulation of capillary macroaneurysm (CMA) was effective in reducing the number of injections in patients with chronic DME, at 12 months after laser treatment, the number of anti-VEGF treatments was reduced by nearly 50%, and the number of DEX-I treatments was reduced by 25% [82]. Laser therapy still has an irreplaceable role in the treatment of DME, and further studies are needed to explore the optimal timing of laser photocoagulation to provide better anatomical and functional improvement and to reduce the number of injections.…”

The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review

“…Paques et al identified the relatively large ICGA-positive area as telangiectatic capillaries (defined by a diameter larger than 150 µm on late-phase ICGA) [ 75 , 77 ]. Telangiectatic capillaries may be associated with chronic refractory macular edema [ 78 , 79 , 80 ], and focal direct laser photocoagulation of telangiectatic capillaries seems to be effective and safe for reducing the burden of anti-VEGF drugs in patients with refractory ME [ 81 ].…”

“…The types and settings of current laser are summarized in Figure 6 . Focal/grid laser photocoagulation is crucial in treating non-center-involved, clinically significant DME [ 6 , 22 , 81 ]. For center-involved DME, anti-VEGF therapy has become the gold standard treatment.…”