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.