Abstract
Purpose :
Intravitreal injections of anti-vascular endothelial growth factor (VEGF) and steroid agents are the mainstay of diabetic macular edema treatment (DME). However, frequent injections can be a significant burden on patients. Nondamaging focal retinal laser therapy utilizes less energy than conventional focal laser to induce heat shock protein upregulation and thereby rejuvenate RPE cells, without permanent scarring of RPE or overlying photoreceptors. The purpose of this study was to assess the effects of nondamaging focal retinal laser therapy in patients with DME and its impact on number of intravitreal injections needed by these patients.
Methods :
A retrospective analysis of nine eyes of seven patients with diabetic macular edema treated with the Topcon Pascal 532nm Endpoint Management (Synthesis Photocoagulator, Topcon, United States) was conducted. Demographic data, visual acuity (VA), laser treatment specifications, as well as anti-VEGF injection burden before and after treatment were collected. Paired t-tests were performed to analyze the effect of nondamaging focal laser on VA and injection burden before and after treatment.
Results :
All patients had type 2 diabetes: five had proliferative diabetic retinopathy, one had severe non-proliferative diabetic retinopathy (NPDR) and one had mild NPDR. Mean age was 66.71± 20.18 years. All patients were treated with 30% of threshold laser with landmarks off and laser spot size of 200 micrometers, pulse duration of 15 milliseconds, and spacing of 0.25 Φ apart. Mean number of spots was 671.33±135.45. Mean number of intravitreal injections in the six month period prior to laser treatment was 4.55 ± 2.19 injections compared to 2.33 ± 1.58 injections in the six months following laser treatment (p=0.01). Mean VA before treatment was 0.48±0.30 and after treatment was 0.54±0.27 (p=0.12).
Conclusions :
Nondamaging focal retinal laser therapy led to a statistically and clinically significant decrease in the number of intravitreal injections required in the six month period immediately following treatment. There was no significant change in VA. Longer follow-up is needed to assess the durability of this effect. Reduction in the number of anti-VEGF injections offers tangible benefits as frequent intravitreal injections impart a considerable burden to patients, their families, and our healthcare system.
This is a 2020 ARVO Annual Meeting abstract.