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S.R. Vora, C.L. Hagedorn, N. Khan, M. Aslan, J.P. Concato, R.A. Adelman; Is Repeat Macular Laser Photocoagulation Effective in the Management of Diabetic Macular Edema? . Invest. Ophthalmol. Vis. Sci. 2005;46(13):396.
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Purpose: To evaluate functional and fundoscopic outcomes among patients receiving multiple treatments with macular laser photocoagulation for clinically significant diabetic macular edema. Methods: A retrospective medical record review was conducted of 43 patients who had multiple macular laser treatments for diabetic macular edema from September, 1988 to May, 2004 at the Yale Eye Center. Patients with at least two laser treatments were included; exclusion criteria were retinal complications (other than edema), panretinal photocoagulation, or follow–up of less than six months after the most recent treatment. As part of routine follow–up for diabetic macular edema, visual acuity and fundoscopic findings (by fundus exam, fluorescein angiography, and fundus photos) were assessed before a given laser treatment, at 3 months, 6 months, 1 year, and 1+ year afterwards; the 6 month (or closest available) exam was used in current analyses. Comparisons of treatment outcomes were done with change in each eye as the unit of analysis, using t–tests (for Snellen visual acuities as a continuous variable) and Chi–square or Fisher exact tests (for fundoscopic changes), as appropriate. Results: The study included 63 eyes from 43 patients. For the first laser treatment, 42 of the 56 eyes (75%) with at least 6 months follow–up showed fundoscopic improvement in edema at 6 months, 9 (16%) were stable, and 5 (9%) showed worsening. There was no statistically significant difference between the proportion of eyes that worsened after treatment 1 versus the proportion of eyes that worsened after subsequent treatments: 8/59 (14%) eyes showed worsening after the second treatment (p=0.57); 3/34 (9%) eyes showed worsening after the third treatment (p=0.99); 5/23 (22%) eyes showed worsening after treatments 4–7 (p=0.99). Similarly, the changes in Snellen visual acuities were quantitatively similar with no statistically significant difference: t–value= –0.62 (p=0.54) for treatment 2 vs. 1; t–value=0.35 (p=0.72) for treatment 3 vs. 1; and t–value=–1.18 (p=0.24) for treatments 4–7 vs. 1. Conclusions: This study found that follow–up macular laser treatments for diabetic macular edema had similar outcomes compared to the first macular laser treatment. The majority of eyes that receive re–treatment after initial laser therapy will respond with an improvement in macular edema.
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