Purchase this article with an account.
Daniel Lee, Ryan K Wong, James K Kempton, John J Huang; Predictive Factors for Visual Acuity Loss after Focal/Grid Photocoagulation for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1790.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Macular edema accounts for the majority of vision loss in those with diabetic retinopathy. Though focal/grid laser photocoagulation remains the standard for treatment, many studies are showing the benefit of other modalities, such as intravitreal corticosteroids or anti-vascular endothelial growth factor (VEGF) agents. With an array of treatment choices, it is at times difficult to determine which modality to use. We aim to identify prognostic factors for response to laser photocoagulation treatment of diabetic macular edema (DME).
A retrospective chart review was conducted on patients referred for DME to the West Haven Veteran’s Administration Hospital from January 2010 to January 2013. Inclusion criteria included: patients treated with focal/grid laser photocoagulation for clinically significant macular edema. Exclusion criteria included: lack of followup, previous vitrectomy, history of intraocular surgery or previous treatment for DME within the previous 4 months prior to treatment, or any concomitant ocular pathology know to also cause macular edema (epiretinal membrane, vein occlusion, tractional detachment). Data was collected on the following at baseline: visual acuity, age, renal function (eGFR), diabetic retinopathy stage, smoking status, HbA1c, blood pressure, and BMI. Endpoints were visual acuity at 4 month followup and 1 year followup.
15/56 (27%) patients and 24 eyes qualified for the study. Tables 1 and 2 demonstrate that worse renal function (eGRF) was a predictive factor for vision loss (change of 0.1 logMAR) following focal/grid laser photocoagulation at both the 4-month followup (p=.04) and the 1-year followup (p=0.02). Baseline visual acuity, age, diabetic retinopathy stage, smoking status, HbA1c, systolic blood pressure, mean arterial blood pressure, and BMI were not predictive of visual acuity worsening following treatment.
Though a larger study will need to validate our data, the results suggest a possible predictive role of renal function for treatment failure following focal/grid laser photocoagulation for DME. Though laser photocoagulation still remains the proven standard for treatment, this information could be useful in determining which patients should forgo laser photocoagulation for alternative treatments such as corticosteroids or anti-VEGF agents.
This PDF is available to Subscribers Only