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Jose Cardillo, Alessandro Dare, Renato Peroni, Rodrigo Jorge; Rescue Laser Photo Stimulation for Diabetic Macular Edema Unresponsive to Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5762. doi: https://doi.org/.
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Although, ranibizumab monthly improve vision and macular edema in patients with DME, a 30 to 50% of the patients may still require adjunctive and complementary therapy. The purpose of this investigation is to evaluate the safety and efficacy of sub-lethal continuous wave laser for the treatment of diabetic macular edema (DME) unresponsive to previously anti-VEGF therapy.
Twenty patients with DME that did not presented improvement after 6 monthly injection of Ranibizumab, understood as a reduction of at least 10% of central macular thickness compared to the baseline visit and an increase of ≥ 5 letters in visual acuity, were assigned to receive rescue laser therapy. In brief, yellow diode laser (577 nm) clinically adjusted to show barely visible photocoagulation lesions at 20 ms exposure time. The mean retinal sensitivity within the central 10 degrees measured with a fundus-related microperimeter, MP1, ETDRS-best corrected visual acuity (BCVA), optical coherence tomography-determined central macular thickness (CMT), and fluorescein angiography (FA) were performed before, 1, 3 and 6 months after a single treatment.
Central macular thickness decreased by an average of 198μm. At 6 months main change in visual acuity was 4 letters better. Mean macular sensitivity improved (P<0.005) at 3 and 6 months. Laser lesions were not clinically observed, but detected on the early phase of the FA examination.
In parallel with new pharmacologic agents for the treatment of DME, developments in new laser technologies, exploiting optimized parameters and treatment guidelines will be the key to progress DME treatment approaches for an ultimate anatomical and functional restoration
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