How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema?

Abstract

Vascular endothelial growth factor inhibitors (anti‐VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment protocols of anti‐VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME treatment. Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approximately 20–50% of patients receiving anti‐VEGF monotherapy for centre involving DME. Further, a lower retreatment rate and a more stable reduction in retinal thickness have been demonstrated in more studies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti‐VEGF trials. Hence, this paper aimed to provide an overview of the currently available data relevant to the potential role of focal/grid laser photocoagulation in DME treatment including a thorough overview of the current most commonly used laser systems. Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valuable option as adjunctive therapy to anti‐VEGF treatment. However, more well‐designed studies on combination therapy are warranted to determine the full potential of modern retinal photocoagulation systems. In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients.

Aflibercept and navigated versus conventional laser in diabetic macular oedema: a 12‐month randomized clinical trial

“…However, estimated efficacy in our study was comparable to other trials with anti‐VEGF for DME in regard to VA improvement (Blindbaek et al. ). Furthermore, the percentages of eyes with an improvement in letter score of 10 or more and 15 or more in our study were 40 and 16, respectively.…”

Protective Role of microRNA-200a in Diabetic Retinopathy Through Downregulation of PDLIM1

“… 16 Focal laser photocoagulation is regarded as a classical treatment for DME; however, it leads to a number of serious complications. 23 Data from several clinical trials demonstrated significant beneficial effects of anti-VEGF therapy in the management of DME, while anti-VEGF resistance was associated with poor prognosis of DME management. 24 , 25 Although a variety of scientific advances have been made over the last decade, the pathogenesis of DME remains to be discovered fully.…”

Retinal arteriolar oxygen saturation predicts the need for intravitreal aflibercept in patients with diabetic macular oedema

“…However, our results are approximately at the same level as previous anti-VEGF trials for DMO in regards to improvement in VA and CRT. 27 Hence, we do not believe that the predictive value of retinal arteriolar oxygen saturation is unique to our population due to differences in response to treatment.…”

“…Also, the number of intravitreal injections between BL and month 12 in this study was fairly low as compared with the most previously conducted studies on anti-VEGF monotherapy for DMO. 27 Hence, we speculate that the difference in need for therapy between groups (A and B) may be more pronounced in other treatment regimens with more frequent intravitreal injections. However, further studies with other treatment strategies, for example, intravitreal aflibercept with and without adjunctive focal/grid laser photocoagulation or treat and extend regimens are warranted to clarify the generalisability of our results.…”