Minimally invasive laser treatment combined with intravitreal injection of anti-vascular endothelial growth factor for diabetic macular oedema

Abstract

The purpose of this study was to investigate the effect of the combination of minimally invasive laser treatment to the intravitreal injection of anti-vascular endothelial growth factor (VEGF) for diabetic macular oedema (DME). This study was retrospective longitudinal study of thirty-four eyes of 31 patients with DME. Either once or several times of intravitreal anti-VEGF injection was followed by the single minimally invasive laser within a month. The mean best corrected visual acuity (VA) and the central macular thickness (CMT) were measured before treatment, 1, 3, 6 and 12 months after the first anti-VEGF injection. The mean logMAR VA had improved from 0.52 ± 0.34 at baseline to 0.44 ± 0.32 (p = 0.003), 0.40 ± 0.34 (p = 0.006), 0.43 ± 0.33 (p = 0.063), and 0.41 ± 0.34 (p = 0.009), at 1, 3, 6, and 12 months after treatment, respectively. The mean CMT decreased significantly by 1 month and maintained over 12 months (491.1 ± 133.9 µm at baseline, 396.6 ± 116.8 µm (p = 0.001), 385.2 ± 156.2 µm (p = 0.002), 336.5 ± 86.3 µm (p = 0.000), and 354.8 ± 120.4 µm (p = 0.000) at 1, 3, 6, and 12 months, respectively). The average number of the anti-VEGF injection in 1 year was 3.6 ± 2.1 in all patients. The combined intravitreal anti-VEGF and minimally invasive laser therapy improves the VA, alleviates DME, and may decrease the required number of anti-VEGF injections.

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

“…Nevertheless, they were analyzed because they documented the results of combined therapy. Two trials compared the outcome of combination treatment versus SDM alone [15,16], and two studies presented the effects of combination treatment in specific cases of ME [17,18]. A description of these four studies is provided in Table 2.…”

“…Although the results suggested the occurrence of significant morphological and functional improvements, the trial did not include a control group, so it was not possible to assess how the addition of SDM to intravitreal dexamethasone affected the final outcome. A study by Inagaki et al, which considered SDM and anti-VEGF therapy in DME is a case series, [18] observed a moderate BCVA improvement (by 0.11 logMAR), with a relatively low number of injections required to achieve this effect during one year of follow-up (mean: 3.6 ± 2.1 injections).…”

“…In BRVO, an additive strong anti-inflammatory effect of intravitreal steroids provided significant improvements that were clearly superior to SDM only [15]. The remaining two studies reported an effect of SDM added to either intravitreal steroid or anti-VEGF therapy in the treatment of DME [17,18]. The lack of a control groups in these reports makes their interpretation rather risky and, despite favorable morphological and functional outcomes, the benefit of adding SDM to the treatment regimen is impossible to evaluate.…”

Investigations on Retinal Pigment Epithelial Damage at Laser Irradiation in the Lower Microsecond Time Regime

“…There is increasing clinical evidence for the effectiveness of these laser treatments. [14][15][16][17][18][19][35][36][37][38] Thus, a laser system that enables one to choose the treatment modality properly according to the purpose, selective RPE destruction, mild hyperthermia, or classical photocoagulation with desired strength is very useful. Moreover, it would be also highly valuable to have a method that can monitor and display the tissue response during treatment sensitively.…”

Efficacy of combining intravitreal injections of ranibizumab with micropulse diode laser versus intravitreal injections of ranibizumab alone in diabetic macular edema (ReCaLL): a single center, randomised, controlled, non-inferiority clinical trial

“…Inagaki et al showed recently, that combining anti-VEGF injections and minimally invasive laser treatment in DME results in good anatomical and functional improvement at 12 months [ 20 ]. While the visual gain in the study of Inagaki et al was slightly worse (5.9 ETDRS letters), than in previous prospective studies for anti-VEGF therapy alone (6.6–10.3 EDTRS letters in REVEAl, RESTORE and RESOLVE), the mean number of injections was as low as 3.6 12 months after treatment.…”