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Corey Waldman, David Ellenberg, Philip Henry Scharper; THE EFFECT OF MACULAR LASER ON VITREOMACULAR ADHESION IN PATIENTS UNDERGOING TREATMENT FOR DIABETIC MACULAR EDEMA. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6349.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether macular laser (ML) adversely affects the resolution of DME by enhancing vitreomacular adhesion (VMA) in the area of treatment.
A retrospective review of all eyes with refractory DME (rDME) who had pars plana vitrectomy (PPV) (Constellation, Alcon, TX) from 2010 through 2013 was performed. Each eye had undergone previous treatment for DME, including a combination of intravitreal anti-VEGF and steroid therapy and/or macular laser (ML) (Iridex IQ 577, Iridex Corp., CA). Eyes were divided into “injection only” group and “injection + ML” groups. All eyes in the "injection + ML” group had undergone standard focal and grid laser treatment for DME. Eyes in both groups underwent PPV with intravitreal triamcinolone (iTA) used intraoperatively to identify areas of VMA. The existence and location of VMA in both groups were compared.
A total of 34 eyes in 31 patients were included in the study. Nineteen eyes were in the “injection only” group and 15 eyes in the “injection + ML” group. The mean number of injections in the “injection only” group was 2.5 as compared to 2.1 in the “injection + ML” group. The mean number of laser treatments in the “injection + ML” group was 1.2. In the “injection only” group, 15 out of 19 eyes (79%) had VMA identified intraoperatively which corresponded to the area of rDME, as compared to 13 out of 15 eyes (87%) in the “injection + ML” group.
ML has long been a mainstay of treatment for DME. However, the widespread use of anti-VEGF therapy has made the role of ML for DME increasingly less clear. The beneficial effect of a posterior vitreous detachment is recognized in eyes with DME. This study suggests a trend that ML may actually be counterproductive by enhancing vitreous attachment in the area of treatment. This persistent VMA may worsen DME through tractional and/or hypoxic mechanisms. Further prospective randomized controlled studies are needed to evaluate this trend.
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