Abstract
Purpose :
To evaluate the functional and morphological long-term outcome of ICGA-guided laser therapy of teleangiectatic capillaries (TC) and to assess their immediate as well as their subsequent morphological response to laser treatment.
Methods :
In this retrospective study, the presence of TCs was evaluated in patients with treatment naive or pretreated diabetic macular edema (DME). TCs, presenting as hyperfluorescent spots in late-phase ICGA (>10minutes), were targeted with laser. Customized OCT scans were used to monitor changes in the reflectivity of the TCs lumina during and immediately after laser therapy as well as during follow-up. Additionally, patients were treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) as needed.
Results :
13 eyes of 10 patients with DME were followed-up for a mean of 24 months (±8). After targeted laser therapy of only 2 TCs per eye on average mean best-corrected visual acuity (BCVA) improved from 0.25 logMar (±0.19) at baseline to 0.13 (±0.10;p=0.035) at months 12-15 and remained stable at 0.14 (±0.12;p=0.042) at each patient’s last visit. Mean central subfield thickness (CST) decreased from 406µm (±82) at baseline to 295µm (±39) at months 12-15 (p<0.001) and remained stable at 291µm (±50) at the last visit (p<0.001). The immediate darkening of the TCs lumina, observed in 11 out of 13 eyes at the first laser session was followed by shrinking of the TCs after a mean of 1.3 months, followed by their full resolution after a mean of 4 months in all of these cases. In the two eyes where no darkening of the TCs lumina was observed, re-treatment was necessary after 6 months due to persistence of the TCs and an increase of the edema. Within a mean follow-up of 2 years additional treatment with anti-VEGF was indicated in only 2 of 13 eyes (1 eye 1 injection, the other 4 injections).
Conclusions :
The darkening of the TCs lumina visible in OCT as immediate reaction to focal laser therapy resulted in successful closure of these lesions in all cases. Consequently, a statistically significant improvement in BCVA and reduction in CST could be achieved with targeted laser therapy of only two lesions per eye on average. No anti-VEGF injections were needed in the vast majority of eyes during a mean follow-up of 2 years.
This is a 2021 ARVO Annual Meeting abstract.