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Randee C Miller, Chandan Yashraj, Rama Jager, Harit Bhatt, Veeral Sheth; Visual and Anatomic Outcomes of Combined Focal Navigated Laser Photocoagulation and Intravitreal Anti-Vascular Endothelial Growth Factor for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1762.
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To report the results of combined focal navigated laser (Navilas; OD-OS, Berlin, Germany) and intravitreal bevacizumab or ranibizumab for the treatment of diabetic macular edema (DME).
The medical records of all eyes treated with Navilas focal laser in a single practice were retrospectively reviewed. Thirty-two eyes were included in this analysis; all had a diagnosis of DME and also received at least one intravitreal injection of either bevacizumab or ranibizumab before Navilas laser treatment or within the subsequent 12 months after laser. Demographics, visual acuity, central subfield thickness (CST), macular volume and number of injections and laser treatments were recorded at baseline, 3 months, 6 months and 12 months post laser treatment.
Thirty-two eyes of 25 patients were analyzed. Twenty-five of 32 eyes had been treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to Navilas therapy with an average of 5.2 injections per eye. The mean visual acuity (VA) at time of Navilas laser (baseline) was LogMAR 0.368 (20/46 Snellen equivalent), with average CST and macular volume of 345 mm and 8.88 mm3, respectively. At 12 months post-laser, the mean VA was LogMAR 0.336 (20/43 Snellen equivalent; p=0.19), mean CST 307 mm (p<0.005) and mean macular volume 8.56 mm3 (p<0.01). Over the 12-month period following Navilas treatment, 26 eyes received at least one intravitreal anti-VEGF injection with an average of 6.1 injections per eye. Thirteen eyes underwent one repeat Navilas focal laser treatment during the study period.
Navilas focal laser in combination with intravitreal anti-VEGF injections is effective in reducing macular thickness and volume in patients with DME. Visual acuity trended towards improvement but did not reach statistical significance; this may be because the mean visual acuity at baseline was very good (20/46). Compared to the first 12 months of the RESTORE study (Ranibizumab 0.5mg + laser cohort), our eyes received slightly fewer intravitreal injections (6.1 vs. 6.8) per eye and fewer repeat laser treatments (0.4 vs 0.7) per eye. Macular volume measurement may be a helpful adjunct in assessing response to treatment, especially in eyes with central-sparing macular edema.
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