Abstract
Purpose :
To evaluate the value of LASER “rescue” in selected patients with MacTel by reporting functional and anatomic outcomes.
Methods :
Retrospective and descriptive study. Nine eyes of nine patients with MacTel included. Best corrected visual acuity (BCVA) was evaluated and central retinal thickness (CRT) was measured by optical coherence tomography at baseline (before laser rescue) and during the follow-up.
Results :
Four patients underwent LASER rescue. Mean time between first visit and first LASER treatment was 3.71 years. The mean number of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) before LASER was 16.75. Mean CRT was 467,5 µm and mean BCVA was 63 letters (L) before rescue treatment. Of the four patients, one showed sllght improvement of CRT and BCVA values, one worsened and two had no changes at first month post-LASER (Mean CRT 472,25 µm and BCVA 61L). Anti-VEGF treatment was resumed 3M post-LASER in all but one patient. A mean of 3.25 injections were given within 6 months. Mean CRT improved to 398,75 µm and mean BCVA was 61,25 letters at 6M. Mean baseline and final BCVA was lower (67 versus 70 L at baseline,p=0,53, and 60L versus 73L, p=0,09, at last follow-up visit) and the mean CRT was higher (438,75 vs 392,6 µm, p=0,59, at baseline; 413,25 vs 333 µm, p=0,3, at last follow-up) in patients that were rescued with laser.
Conclusions :
Mean CRT and mean BCVA after rescue showed no statistical significant changes. Eyes that were rescued were worse cases, as they had a higher mean CRT, lower mean BCVA and longer follow-up time (59,7 M vs 29.4 M) than those that were not treated with LASER. These baseline differences, rather than rescue per se, might be a possible cause for the differences found. However, after resuming anti-VEGF treatment, BCVA did not return to the baseline levels, prior to the LASER treatment.
MacTel remains an elusive disease, usually resistant to treatment. The role of LASER remains controversial. In our sample, focal LASER treatment was largely ineffective. The use of anti-VEGF seems effective in slowing down the disease progress, postponing the photoreceptor cell death and irreversible visual loss, while very often uncapable of drying the macula. Larger studies are needed to validate the findings of this exploratory work.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.