July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Long-term outcomes of macular laser photocoagulation in the treatment of clinically significant diabetic macular edema (CSDME) – real world experience.
Author Affiliations & Notes
  • Jessica Best
    Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
    Academic Unit of Ophthalmology and Orthoptics, University of Sheffield, Sheffield, South Yorkshire, United Kingdom
  • Siri B Gowda
    University College London Hospital, United Kingdom
  • Edward Pritchard
    Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
  • Fahd Quhill
    Ophthalmology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
  • Footnotes
    Commercial Relationships   Jessica Best, None; Siri Gowda, None; Edward Pritchard, None; Fahd Quhill, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2606. doi:
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      Jessica Best, Siri B Gowda, Edward Pritchard, Fahd Quhill; Long-term outcomes of macular laser photocoagulation in the treatment of clinically significant diabetic macular edema (CSDME) – real world experience.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2606.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Although intravitreal anti-VEGF therapy is the first- line treatment for centre-involving DME, laser photocoagulation remains the preferred treatment for non-centre involving DME.
We performed a retrospective study to measure the efficacy of focal macular laser photocoagulation in reducing central involvement and need for intravitreal therapy (IVT) in patients with CSDME as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS).

Methods : Retrospective review of medical records for consecutive patients treated by a single surgeon with macular laser for CSDME with 3 year follow-up.

Inclusion criteria: Only cases with CSDME, no previous photocoagulation or IVT, and follow-up for at least 3 years were included.

Outcome measures: visual acuity (VA), central subfield thickness (CSFT), macular volume at baseline and 3 years; and need for IVT. Further subgroup analysis on the above outcomes was performed separating the population into two: CSFT>300μm, and CSFT<300μm at baseline.

Results were analysed using two-paired t-test and z-proportion test for statistical significance.

Results : 92 eyes of 69 patients were included in the study.
Over 3 years, there was an average loss of 1.4 letters in patients’ VA. Mean initial CSFT was significantly reduced by 38μm at 3 years, associated with significant reduction in mean macular volume by 0.57mm3. Furthermore, subgroup analysis of cases receiving macular laser only (69 eyes of 54 patients), showed similar anatomical outcomes.
Overall, 25% of eyes required IVT. Of these, those with a baseline CSFT of >300μm were significantly more likely to require IVT.

Conclusions : In our cohort, macular laser for CSDME was successful in reducing retinal thickening and preserving VA irrespective of baseline CSFT. Patients with non-centre involving DME (CSFT<300μm) had stable visual and anatomical outcomes for at least 3 years after laser. Patients with a higher baseline CSFT >300μm were more likely to require intravitreal interventions, although a substantial proportion were managed successfully with laser alone. To the author’s knowledge this is the largest European real world study showing the long-term benefit of macular laser photocoagulation for CSDME.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Table 1: Results

Table 1: Results

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