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Giulio Barteselli, Su-Na Lee, Igor Kozak, Jay Chhablani, Sharif El-Emam, William Freeman; Navigated Laser Photocoagulation to Reduce Frequency of Bevacizumab Injections (ivB) for Diabetic Macular Edema: 1-Year Results. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2379. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate frequency of ivB in DME patients in a combined treatment protocol with grid/focal navigated laser photocoagulation, and to characterize microaneurysm closure after treatment.
57 eyes with DME of 45 consecutive patients were enrolled. At baseline, patients underwent BCVA measurement, fluorescein angiography and SD-OCT. Eyes with CRT≥ 400 µm (group 1) received 3 monthly ivB followed by grid/focal navigated laser treatment with Navilas photocoagulator (OD-OS, Germany). Eyes with CRT< 400 µm (group 2) received navigated laser treatment only. During 12-month follow-up, in cases with an increase in CRT ≥20% from baseline with a loss of ≥5 letters, group 1 was allowed to receive further ivB, while group 2 received laser treatment. In cases exceeding 400 µm in CRT, eyes were allowed to shift from group 2 to group 1. Leaking microaneurysms were analyzed and followed for 12 months to assess their closure after laser treatment.
27 eyes were enrolled in group 1 and 30 eyes in group 2. In group 1, BCVA improved of 13.3 letters at 12 months from baseline (p=0.01) with an average of 3.7 ivB. In group 2, a non-significant improvement of 2.1 letters was achieved. Overall, BCVA improved of 7.6 letters (p<0.01), with an average of 1.9 ivB. In 12 months, 33% of the eyes of group 1 required additional ivB. In group 2, 4 eyes (13%) required additional laser treatment and 4 eyes shifted to group 1 and received 3 ivB. In group 1, CRT improved from 436 to 342 µm (p<0.001), while in group 2 CRT was stable after 12 months. Overall, CRT improved from 347 to 319 µm (p<0.001). Closure rate of 123 treated microaneurysms was 69.9% at 3 months, and increased to 82.9% at 12 months (p<0.001). Half of closed microaneurysms left hyper-reflective spots on SD-OCT, while half of them disappeared at 3 months. Microaneurysm closure was positively associated with smaller diameter (p<0.001), and heterogeneous lumen reflectivity (p<0.03).
Combined therapy with ivB and navigated laser photocoagulation limited the frequency of ivB required in eyes with DME. Visual results and retreatment rates after 12 months compared favorably with results obtained in randomized clinical trial. Treated microaneurysms resulted in hyper-reflective spots on SD-OCT or disappeared after 3 months. Closure rate was higher in cases of small microaneurysms and heterogeneous lumen reflectivity.
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