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Sumeer Thinda, Amar P Patel, Allan A Hunter, Ala Moshiri, Lawrence S Morse; Combination therapy with subthreshold diode laser micropulse photocoagulation and intravitreal anti-vascular endothelial growth factor injections for diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6363.
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To determine the anatomical and functional outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections combined with supplemental subthreshold diode laser micropulse (SDM) photocoagulation in the treatment of diabetic macular edema (DME).
A retrospective chart review of all patients with subfoveal DME identified by spectral domain optical coherence tomography (SD-OCT) and fluorescein angiogram (FA) who had undergone SDM photocoagulation and/or anti-VEGF injections in the time period between January 2011 to November 2013 was performed. Exclusion criteria included the presence of other concomitant retinal diseases that can lead to subfoveal macular edema, a history of intravitreal steroid injections, or focal photocoagulation in the previous 2 years. Ten patients were identified. Group 1 consisted of 5 patients who had undergone both SDM photocoagulation and anti-VEGF injections. Group 2 consisted of 5 patients matched for age, gender and a diagnosis of subfoveal DME who had undergone anti-VEGF injections only. All records were reviewed for BCVA, fundus photography, FA (presence of macular ischemia and leakage), macula SD-OCT (presence and location of fluid or exudates, central macular thickness (CMT)) and the type (ranibizumab or bevacizumab) and frequency of treatments administered. Statistical analysis was performed using the paired student t-test.
Groups 1 and 2 included a total of 10 patients. The average age of Group 1 was 64 years and that of Group 2 was 61 years. Duration of follow-up ranged from 6 to 27 months (average 14.2 months) for Group 1 and 10 to 17 months (average 13.6 months) for Group 2. Average number of injections given per month was 0.35 for Group 1 and 0.86 for Group 2 (p=0.03). Average BCVA improved 0.10 logMAR in Group 1 and 0.20 logMAR in Group 2 (p=0.12). Average CMT improved 97 um in Group 1 and 140 um in Group 2 (p=0.26).
The frequency of anti-VEGF injections was significantly reduced in patients who had undergone supplemental SDM photocoagulation without a significant difference in anatomical and functional outcomes. Combination therapy with anti-VEGF injections and SDM photocoagulation may help to reduce the treatment burden for patients with subfoveal DME. This pilot study provides impetus for a larger controlled prospective study.
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