Monotherapy laser photocoagulation for diabetic macular oedema

Jorge, Eliane Chaves; Jorge, Edson Nacib; Botelho, Mayra Souza; Farat, Joyce Godoy; Virgili, Gianni; Dib, Regina El

doi:10.1002/14651858.cd010859.pub2

Cited by 37 publications

(30 citation statements)

References 62 publications

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“…[1][2][3][4][5][6] SMPL does not induce protein coagulation, and, therefore, prevents formation of retinal scars and tissue damage. 1,7 Even if SMPL has proven to be an effective treatment for diabetic macular edema (DME), in terms of visual function improvement/stabilization and macular thickness decrease, 3,4,[8][9][10][11][12][13][14][15] the exact mechanism of action is still under investigation. Retinal pigment epithelium (RPE) has been considered the main target with the consequent release of "heat shock proteins" (Hsps), in particular Hsp 70.…”

Section: Introductionmentioning

confidence: 99%

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Vujosevic

Toma

Villani

et al. 2020

Trans. Vis. Sci. Tech.

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The aim of this study was to evaluate 1-year quantitative changes in specific inflammatory parameters on optical coherence tomography (OCT) / optical coherence tomography angiography (OCTA) in diabetic macular edema (DME) treated with subthreshold micropulse laser (SMPL). Methods: Thirty-seven patients / eyes with previously treatment-naïve DME treated with SMPL were prospectively evaluated at 3, 6, and 12 months. Fifteen fellow eyes with only microaneurysms (MAS) not eligible for treatment were controls. Evaluated OCT / OCTA parameters included: central macular thickness (CMT); hyper-reflective retinal spots (HRS); disorganization of inner retinal layers (DRILs); MA in the superficial / deep capillary plexuses (SCP/DCP); cysts in the area at the SCP / DCP; and macular perfusion parameters (MATLAB, version 2017b). Results: In the treated group, mean best corrected visual acuity (BCVA) progressively increased from 69.4 ± 12.0 to 76.0 ± 9.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (P < 0.001) at 12 months; HRS decreased from baseline (80.75 ± 20.41) at 3 (73.81 ± 17.1, P = 0.002), 6 (69.16 ± 16.48, P < 0.0001), and 12 months (66.29 ± 18.53, P < 0.0001). MA decreased at 3 months in the DCP (P = 0.015), at 6 and 12 months in both plexuses (P ≤ 0.0007). BCVA, HRS, and MA remained stable in the controls during all follow-ups. DRIL was present in 18 of 37 patients at baseline and progressively decreased from 557.0 ± 238.7 to 387.1 ± 282.1 μm (P = 0.01). The area of cyst decreased both in the SCP (P = 0.03) and the DCP (P = 0.02). CMT and perfusion parameters did not change. Conclusions: SMPL reduced the number of HRS (sign of activated microglia cells in the retina), MA, DRIL extension, and the area of cysts. Further studies are needed to confirm these preliminary data on the anti-inflammatory effect of SMPL, and to explore the mechanism of action. Translational Relevance: The follow-up of OCT/OCTA noninvasive biomarkers offers a unique insight in the mechanism of laser action, suggesting an anti-inflammatory effect of SMPL.

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Section: Introductionmentioning

confidence: 99%

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Vujosevic

Toma

Villani

et al. 2020

Trans. Vis. Sci. Tech.

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“…Die Fachinformation des Dexamethason-Implantats macht darauf aufmerksam, dass die "Erfahrungen bezüglich der Wirksamkeit und Sicherheit wiederholter Verabreichungen für DMÖ" nicht über "mehr als sieben Implantate" hinausgingen [232]. Für Triamcinolon wurde beobachtet, dass die Wirkung des Steroids in der wiederholten Behandlung nachlassen kann [234] In den historischen ETDR-Studien erwies sich die Therapie mittels Laserkoagulation v. a. in der Situation eines klinisch signifikanten Makulaödems als wirksam [235], da sie eine Verringerung der Verschlechterung um mindestens 2 Zeilen gegenüber dem Spontanverlauf erreichte [36]. In den nachfolgenden Studien des DRCR.…”

Section: 1-2 Ivom-therapie Mit Steroidenunclassified

“…Vorerst sprechen die fehlenden Wirksamkeitsdaten, die Belastung der Patienten und die Wirtschaftlichkeit auch gegen eine Ausweitung der IVOM-Therapie auf die Patienten ohne foveale Beteiligung. Somit bleibt die fokale Laserkoagulation hier die sinnvolle Therapieempfehlung, insbesondere wenn die Kriterien eines klinisch signifikanten Makulaödems gegeben sind [36]. [44,200].…”

Section: Therapiewahl: Diabetisches Makulaödem Ohne Foveale Beteiligungunclassified

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

2020

Klin Monatsbl Augenheilkd

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“…[ 4 5 7 9 12 37 ] A recent Cochrane review concluded that at 1–3 years of follow-up, MLP improved the chances of DME resolution and decreased the chances of visual loss compared to the natural history. [ 38 ] Patients with persistent DME are usually retreated with MLP at 4-month intervals. On average, patients received 3–4 MLP treatments.…”

Section: Continuous Wave Macular Laser Photocoagulation Monotherapy Amentioning

confidence: 99%

Macular laser photocoagulation in the management of diabetic macular edema: Still relevant in 2020?

Zas

Cotic

et al. 2020

Taiwan J Ophthalmol

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Macular laser photocoagulation (MLP) is inferior to intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of center-involved diabetic macular edema (DME). Ultra-widefield fluorescein angiography-guided laser photocoagulation to presumed ischemic areas of the peripheral retina or MLP do not reduce the treatment burden nor improve the visual outcomes of eyes treated with anti-VEGF drugs. Destruction of retinal tissue is not necessary to induce a therapeutic response in DME. Modern lasers are capable of producing invisible laser “burns” that do not destroy the targeted tissue using micropulse subthreshold (ST) mode where the laser's duty cycle is modified or alternatively selective retinal therapy (SRT) where ultrashort pulses of continuous wave laser selectively target the RPE. The best results with micropulse ST laser are obtained in eyes with a central macular thickness ≤400 μm. Eyes need to be treated in a continuous manner with no spaces between burns in the edematous area. Micropulse ST-MLP downregulates inflammatory biomarkers produced by activated microglial cells and Müller cells. Micropulse ST-MLP may reduce the anti-VEGF injection burden in DME. In SRT, the diseased RPE is targeted and heated with the laser with the hope that the adjacent RPE migrates and proliferates into these areas to heal the diseased RPE. There is much less experience with SRT, but the results are promising and deserve further study.

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Monotherapy laser photocoagulation for diabetic macular oedema

Abstract: Monotherapy laser photocoagulation for diabetic macular oedema.

Cited by 37 publications

References 62 publications

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

Subthreshold Micropulse Laser in Diabetic Macular Edema: 1-Year Improvement in OCT/OCT-Angiography Biomarkers

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

Macular laser photocoagulation in the management of diabetic macular edema: Still relevant in 2020?

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