The Effect of Photocoagulation in Ischemic Areas to Prevent Recurrence of Diabetic Macular Edema After Intravitreal Bevacizumab Injection

Abstract

Targeted retinal photocoagulation for NPAs was effective to maintain the reduced CRT after grid/focal PC and IVB for patients with DME. These results suggest that retinal ischemia is associated with the pathogenesis of recurrence of DME after IVB. ( www.umin.ac.jp/ctr number, UMIN000007566.).

Effect of leaking capillaries and microaneurysms in the perifoveal capillary network on resolution of macular edema by anti-vascular endothelial growth factor treatment

“…Grid laser photocoagulation to the capillary nonperfusion areas in the macula were delivered to halt local VEGF overproduction that induces leakage. Scatter laser photocoagulation of capillary nonperfusion areas in the mid to peripheral retina was also performed since VEGF overproduction in these regions has been implicated in ME pathogenesis [17][18][19]. However, the required number of additional IVR injections to manage ME increased significantly once leaking MAs became apparent in the PCN.…”

Effect of Leaking Foveal Microaneurysms on the Treatment of Center-Involving Diabetic Macular Edema: A Pilot Study

“…We considered that short-pulse grid laser photocoagulation for capillary nonperfusion in the macula successfully modulated overproduced VEGF, thus resolving foveal edema in a manner similar to panretinal photocoagulation to decreased neovascularization in the retina and iris by suppressing VEGF overproduction [12, 22, 23]. MA formation in the foveal capillaries was earlier evoked by high intraocular VEGF in an animal model [24].…”

“…Several smaller clinical trials described an injection reduction in India [10], Japan [11, 12], Italy [13, 14], and Spain [15], but these were refuted by larger multicenter trials [1-5, 9, 16-18]. However, we have observed 3 possible conditions that may make focal/grid laser treatment effective: (1) prompt focal/grid laser after intravitreal injection of anti-VEGF agents [9, 18], (2) long follow-up [9, 18], and (3) focal but not diffuse DME [19].…”

Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging

“…Identifying the presence and extent of ischemia across the entire retina may permit more accurate assessment and effective management, particularly in staging anti-vascular endothelial growth factor (VEGF) treatments with photocoagulation (see Figures 2 and 3). 19 Indeed, the value of UWF imaging in linking the extent of peripheral ischemia to the presence or potential development of diabetic macular edema (DME) and worsening disease, has been evaluated in several studies. Peripheral Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging ischemia, detected on UWF FA, has been strongly correlated with DME in treatment-naïve patients.…”