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J. Roider, S. H. M. Liew, H. Elsner, C. Klatt, R. Brinkmann, B. Hussain, H. Laqua, J. Marshall, P. Hamilton, R. Birngruber; Selective RPE Treatment (SRT) for Diabetic Macular Oedema - 6 Months Results of a Prospective, Multicentered Trial. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4027.
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To evaluate the effectiveness of selective Retina Treatment (SRT) targeting only the RPE for diabetic macula oedema (DME)
Sixty-three eyes of 52 patients with focal DME were recruited from 3 centres and followed in a multicentered, prospective pilot study. Laser treatment for DME was performed using a SRT laser in all patients. The SRT laser is a Q-switched frequency doubled Nd:YLF Laser (527 nm), generating pulses of 1.7 µs with a repetition rate of 100 Hz. For SRT, 30 pulses are applied onto a retinal spot diameter of J. Toµ200 µm. The single pulse energy used for each patient varied from 100-250 ensure RPE treatment without damaging the photoreceptors, the useful pulse energy range was determined prior to treatment by the evaluation of laser test spots using fundus fluorescein angiography (FFA) or ICG angiography and online optoacoustic measurement, a novel way to detect selective RPE lesions . Patients were assessed at 3 and 6 months following laser treatment. The primary outcome measures were logMAR visual acuity, reduction of hard exudates, leakage on fluorescein angiography and retinal thickness measured by OCT.
: None of the laser lesions were visible during or after treatment. At 6 months OCT showed in 35 % of patients a statistically significant reduction of central retinal thickness by a mean of 47 µm. Hard exsudates were reduced by 32 % and stable in 58 %. Analysis of fluorescein angiography leackage was less or stable in 58 %. Visual acuity improved by more than 1 line or remained stable (+/-1 line) in 92.5% (49eyes) at 3 months following laser treatment. At 6 months, 89.1% had improved or stable vision. No adverse events or side effects related to laser treatment occurred during the 6 months study period. The optoacoustic data for RPE damage detection was in correlation to angiographic leakage and thus proved as a reliable tool to detect the selective RPE effects.
. Eighty nine percent. of patients achieved stabilized or improved visual acuity at 6 months. Due to the lack of side effects SRT technique might be helpful in treatment of diabetic edema at earlier stages before clinically significant edema is present.
Ethical Comittee University of Kiel
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