Effects of focal/grid laser treatment on the central visual field in diabetic macular oedema: a 2‐year follow‐up study

Introduction: Diabetes Mellitus (DM) is a common disease with multiple systemic complications. Diabetic macular oedema is the main threat to vision in patients with diabetic retinopathy, which results from the increased permeability of the inner and outer blood-retinal barrier. Macular argon laser photocoagulation was the only treatment of diabetic macular oedema in the past. Now-a-days, both intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and macular grid laser photocoagulation are used in the management of diffuse and focal Diabetic Macular Oedema (DME). Aim: To assess the changes in both visual acuity and Central Macular Thickness (CMT) in patients with DME after intravitreal injection of bevacizumab only or in combination with macular grid laser treatment. Materials and Methods: A prospective longitudinal cohort study included 89 eyes of 52 patients with DME, who were categorised into two interventional groups. The first group received only intravitreal bevacizumab for the first three months, then Pro Re Nata (PRN), while the second group received intravitreal bevacizumab, similar to the first group, in addition to macular grid laser treatment two weeks after the initial injection. Participants were followed-up at 12 months, and the visual acuity, CMT, and the total number of injections were documented. Patients were followed-up but data was gathered on baseline and at the 12th month were compared. Results: In comparison to the initial presentation, a significant decrease in CMT was noticed in both groups (163.47±83.60 μm vs. 126.45±52.45 μm, respectively). Moreover, a significant improvement in visual acuity of both groups (p<0.023 and p<0.016, respectively) and significantly fewer injections being required in the second group were noticed. Conclusion: Combining intravitreal bevacizumab with macular grid laser treatment can lead to stabilisation and improvement of visual acuity with a smaller number of injections which was statistically significant.

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The impact of compliance among patients with diabetic macular oedema treated with intravitreal aflibercept: a 48‐month follow‐up study

Acta Ophthalmologica ◽

10.1111/aos.14946 ◽

2021 ◽

Author(s):

Reinhard Angermann ◽

Markus Hofer ◽

Anna Lena Huber ◽

Teresa Rauchegger ◽

Yvonne Nowosielski ◽

...

Keyword(s):

Macular Oedema ◽

Diabetic Macular Oedema ◽

Follow Up Study ◽

Intravitreal Aflibercept ◽

The Impact

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Comparison of efficacy and safety of the combined laser treatment technology versus conventional laser photocoagulation in diabetic macular edema management

Diabetes Mellitus ◽

10.14341/dm7811 ◽

2017 ◽

Vol 20 (1) ◽

pp. 68-74

Author(s):

Aleksander Victorovich Doga ◽

Galina Fedorovna Kachalina ◽

Elena Konstantinovna Pedanova ◽

Dmitry Anatolievich Buryakov

Keyword(s):

Laser Treatment ◽

Macular Oedema ◽

Laser Photocoagulation ◽

Diabetic Macular Oedema ◽

Control Group ◽

Efficacy And Safety ◽

Treatment Technology ◽

The Mean ◽

Conventional Laser

Aim. To evaluate the efficacy and safety of the novel combined laser treatment technology compared with those of the conventional laser photocoagulation in diabetic macular oedema management. Material and methods. Fifty eyes of 44 patients with clinically significant diabetic macular oedema were enrolled. Patients of the main group (25 eyes) underwent combined laser treatment, whereas patients in the control group (25 eyes) underwent modified ETDRS (mETDRS) focal/grid photocoagulation. Results. Mean central point thickness (CPT) in the main group decreased from 411.24 126 m to 359.86 120.4 m (p 0.05), with a subsequent increase in the mean best-corrected visual acuity (BCVA) from 0.52 0.2 at baseline to 0.71 0.2 (p 0.05) at the 12-month follow-up. The mean central retinal sensitivity (RS) improved from 11.27 3.8 dB to 13.24 3.2 dB (p 0.05). In the control group, our results showed similar improvement in BCVA and CPT values at the 12-month follow-up (from 0.59 0.12 to 0.72 0.23 and from 424.17 68.12 m to 387.51 93.45 m, respectively, p 0.05). The RS value, on the contrary, decreased from 12.32 0.90 dB to 10.14 0.71 dB (p 0.05). Conclusions. The combined laser technology is a safe treatment technique that allows to minimise the extent of laser-induced chorioretinal complex damage due to the contribution of subthreshold micropulse laser photocoagulation. The efficacy of this novel technology is comparable with that of the mETDRS technique in the resolution of macular oedema and BCVA increase. This technology also provides an advantage of RS improvement and the possibility of safe and repetitive treatment sessions.

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Central visual field impairment during and following cystoid macular oedema

British Journal of Ophthalmology ◽

10.1136/bjo.2007.124016 ◽

2007 ◽

Vol 92 (1) ◽

pp. 84-88 ◽

Cited By ~ 26

Author(s):

C G Kiss ◽

T Barisani-Asenbauer ◽

C Simader ◽

S Maca ◽

U Schmidt-Erfurth

Keyword(s):

Visual Field ◽

Macular Oedema ◽

Cystoid Macular Oedema ◽

Central Visual Field ◽

Visual Field Impairment

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Hyperreflective cystoid spaces in diabetic macular oedema: prevalence and clinical implications

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317191 ◽

2020 ◽

pp. bjophthalmol-2020-317191

Author(s):

Aude Couturier ◽

Valerie Mane ◽

Carlo Alessandro Lavia ◽

Ramin Tadayoni

Keyword(s):

Macular Oedema ◽

Optical Coherence Tomography Angiography ◽

Diabetic Macular Oedema ◽

Functional Improvement ◽

Vascular Endothelial ◽

Hard Exudates ◽

Corrected Visual Acuity ◽

The Mean ◽

Endothelial Growth Factor

AimsTo analyse the prevalence and evolution of hyper-reflective cystoid spaces with decorrelation signal detected using optical coherence tomography angiography (OCTA) in diabetic macular oedema (DMO).MethodsA retrospective study of consecutive eyes with DMO imaged using OCTA over a 1-year period was conducted. All eyes with hyper-reflective cystoid spaces at baseline and at least 3 months of follow-up were included in a longitudinal analysis.ResultsThe prevalence of hyperreflective cystoid spaces with decorrelation signal was of 37% (61/165) in DMO eyes. Hyperreflective foci within hyperreflective cystoid spaces were observed in 85% of eyes. The longitudinal study included 33 eyes (10 observed and 23 treated with intravitreal anti-vascular endothelial growth factor), with a median follow-up of 15 months. The hyperreflective cystoid spaces resolved in 85% of eyes. The mean best-corrected visual acuity remained stable during the follow-up, even in the eyes achieving a resolution of the hyperreflective cystoid spaces. Hard exudates appeared in the area of resolved hyperreflective cystoid spaces in 33% of eyes.ConclusionHyperreflective cystoid spaces detected by OCTA affected more than one-third of the DMO eyes. Their disappearance was not associated with any functional improvement and led to the formation of new hard exudate deposits in about one-third of the eyes.

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Two-year outcomes of intravitreal ziv-aflibercept

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311591 ◽

2018 ◽

Vol 102 (10) ◽

pp. 1387-1390 ◽

Cited By ~ 17

Author(s):

Ahmad M Mansour ◽

Mohammed Ashraf ◽

Abdulrazzak Charbaji ◽

Muhammad H Younis ◽

Ahmed A Souka ◽

...

Keyword(s):

Macular Oedema ◽

Paired Comparison ◽

Central Retinal Artery Occlusion ◽

Diabetic Macular Oedema ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Rank Test ◽

Macular Diseases ◽

Signed Rank Test

AimTo assess the two-year outcome of intravitreal ziv-aflibercept (IVZ) in eyes with macular diseases.MethodsConsecutive subjects with various macular diseases that received six or more of 0.05 mL IVZ (1.25 mg) injections with at least 1 year follow-up were included. Outcome measures were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution) and central macular thickness (CMT) on spectral domain optical coherence tomography. Paired comparison was done using Wilcoxon signed-rank test calculator.Results107 eyes of 91 subjects received IVZ and were followed with mean±SD follow-up interval of 1.48±0.44 months following treat and extend or pro-re-nata protocol. The distribution included neovascular macular degeneration (42 eyes), diabetic macular oedema (32 eyes) and macular oedema secondary to retinal vein occlusion (11 eyes). Fifty eyes were naive, while 57 eyes were previously treated. Combining all disease categories, CMT decreased significantly by 133.0±153.0 µm at the 24-month follow-up (P<0.001) with BCVA gain of 0.35±0.37 at the 24-month follow-up (P<0.001) with mean number of injections of 8.5 at month 12, 2.4 between 12 and 18 month and 1.7 between 18 and 24 month. Ocular and systemic adverse effects included one episode of transient uveitis and one instance of central retinal artery occlusion after 1121 injections.ConclusionsIVZ appears safe and efficacious in the therapy of macular diseases through 2 years.

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Subthreshold 577 nm laser photocoagulation vesus conventional 532 nm laser photocoagulation for diabetic macular oedema

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v3i3.226 ◽

2021 ◽

Vol 3 (3) ◽

pp. 123-140

Author(s):

Linda Sui-Lin Ong ◽

Tajunisah Mohd Iqbal ◽

Kenneth Choong-Sian Fong

Keyword(s):

Diode Laser ◽

Macular Oedema ◽

Laser Photocoagulation ◽

Retinal Thickness ◽

Diabetic Macular Oedema ◽

Macular Thickness ◽

Clinically Significant ◽

Clinically Significant Macular Oedema ◽

532 Nm

Purpose: To evaluate the visual and anatomic outcomes of the subthreshold micropulse 577 nm yellow diode laser (MYL) and to compare its efficacy with the conventional green 532 nm diode laser (CGL) in Asian eyes with diabetic macular oedema (DME).Study design: Prospective randomized controlled clinical trialMethods: Sixty-seven eyes of 43 patients with clinically significant macular oedema (CSME) were randomized to receive either MYL (n = 37) or CGL (n = 30) at baseline and were followed up for 12 months. Titration in the MYL group was performed with 15% duty cycle, 300 ms duration, and double the threshold power, while the modified Early Treatment of Diabetic Retinopathy Study (mETDRS) protocol was used for the CGL arm with the power titrated to a barely visible burn. Parameters noted included best-corrected visual acuity (BCVA) (logMAR), central subfoveal thickness (CST), macular volume (MV), and average macular thickness (AMT) using optical coherence tomography, and presence of visible laser scars on colour fundus photographs and fundus autofluorescence, at baseline and at 12 months.Results: At 12 months follow-up, BCVA improved by 4.7 and 8.8 letters, respectively, for the MYL and CGL treatment arms (p < 0.05). There was a significant reduction in all retinal thickness parameters (CST, MV, and AMT) when compared to baseline in both laser treatment arms at 12 months. There was no significant difference in either BCVA or retinal thickness parameters between the two treatment arms at 1, 3, 6, 9, or 12-month follow-up. Laser scars were observed in 26.7% of patients in the MYL group compared to 75% of patients in the CGL group (p = 0.029).Conclusions: MYL is an effective, safe, and patient-friendly treatment option for clinically significant macular oedema, with improvement in BCVA, reduction in macular thickness, and less scarring after treatment at 12 months.

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Evaluation of 0.2 µg/day fluocinolone acetonide (ILUVIEN) implant in a cohort of previously treated patients with diabetic macular oedema (DMO): a 36-month follow-up clinical case series

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000484 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000484

Author(s):

Muna Ahmed ◽

Christine Putri ◽

Hibba Quhill ◽

Fahd Quhill

Keyword(s):

Clinical Practice ◽

Real World ◽

Macular Oedema ◽

Case Series ◽

Diabetic Macular Oedema ◽

Fluocinolone Acetonide ◽

Previously Treated Patients ◽

Previously Treated ◽

The Mean

ObjectiveTo assess the real-world effectiveness and safety of single injection of a fluocinolone acetonide (FAc) implant in previously treated patients with recurrent diabetic macular oedema (DMO) over a 36-month follow-up period.Methods and AnalysisThis is a retrospective study conducted at a single ophthalmology department at the Royal Hallamshire Hospital, Sheffield, UK. Data were collected using electronic medical records to identify all patients treated with a FAc implant for DMO between March 2014 and November 2014, followed with a 36-month clinic follow-up. Outcomes measured included mean change in best-recorded visual acuity (BRVA) and central macular thickness (CMT) over the period of 36 months, treatment burden pre-implant and post-implant, and functional and anatomical responder rates.ResultsTwenty-six eyes (n=22 patients) were treated with single intravitreal FAc implant followed with 36 months of follow-up. At 24 and 36 months, 86.4% and 75.0% of patients maintained or gained vision post-FAc implant in routine clinical practice. The mean BRVA increased from 41.8 to 54.6 letters at month 24 and 45.8 letters at month 36, with 50.0% and 33.3% of patients achieving a ≥15 letter improvement at months 24 and 36, respectively. The mean CMT reduced from 600.8 µm at baseline to 351.0 µm and 392.5 µm at months 24 and 36, respectively. Overall, a mean of one treatment every 13.33 months post-FAc implant (vs 3.24 months pre-FAc implant) was reported. Eleven eyes had an increased intraocular pressure of ≥10 mm Hg and 12 eyes had an increase to ≥25 mm Hg from baseline.ConclusionThese results further support the effectiveness and safety of FAc implant in previously treated patients with persistent or recurrent DMO in a real-world clinical practice.

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Long‐term follow‐up of antivascular endothelial growth factor treatment for diabetic macular oedema: a four‐year real‐world study

Acta Ophthalmologica ◽

10.1111/aos.14290 ◽

2019 ◽

Vol 98 (4) ◽

pp. 360-367

Author(s):

Elisabet Granstam ◽

Andreas Rosenblad ◽

Aseel Modher Raghib ◽

Therese Granström ◽

Jan W. Eriksson ◽

...

Keyword(s):

Growth Factor ◽

Real World ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Antivascular Endothelial Growth Factor ◽

Long Term Follow Up ◽

Endothelial Growth Factor ◽

Growth Factor Treatment

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