Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema

Moisseiev, Elad; Abbassi, Sam; Thinda, Sumeer; Yoon, Joseph; Yiu, Glenn; Morse, Lawrence S.

doi:10.5301/ejo.5001000

Cited by 68 publications

(62 citation statements)

References 29 publications

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“…Additionally, a recent study retrospectively included 38 eyes with DME to either subthreshold diode micropulse photocoagulation or 3 loading doses of intravitreal injections with ranibizumab. Comparable results in regards to VA were found in both groups but with a significantly lower need for intravitreal ranibizumab in the laser group during 12 months follow-up (Moisseiev et al 2017).…”

Section: Subthreshold Diode Micropulse Laser Photocoagulationmentioning

confidence: 64%

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How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema?

Blindbæk

Grauslund

2018

Acta Ophthalmologica

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Vascular endothelial growth factor inhibitors (anti‐VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment protocols of anti‐VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME treatment. Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approximately 20–50% of patients receiving anti‐VEGF monotherapy for centre involving DME. Further, a lower retreatment rate and a more stable reduction in retinal thickness have been demonstrated in more studies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti‐VEGF trials. Hence, this paper aimed to provide an overview of the currently available data relevant to the potential role of focal/grid laser photocoagulation in DME treatment including a thorough overview of the current most commonly used laser systems. Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valuable option as adjunctive therapy to anti‐VEGF treatment. However, more well‐designed studies on combination therapy are warranted to determine the full potential of modern retinal photocoagulation systems. In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients.

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Section: Subthreshold Diode Micropulse Laser Photocoagulationmentioning

confidence: 64%

“…Comparable results in regards to VA were found in both groups but with a significantly lower need for intravitreal ranibizumab in the laser group during 12 months follow‐up (Moisseiev et al. ).…”

Section: Laser Systemsmentioning

confidence: 89%

How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema?

Blindbæk

Grauslund

2018

Acta Ophthalmologica

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“…The use of a subthreshold laser for the treatment of DME patients is known to lead to better results in terms of effectiveness and safety than conventional laser photocoagulation [13]. It might also decrease the injection burden in these patients [14]. In our study, a yellow subthreshold laser applied with a fovea-sparing technique with 1/3 power titration was shown to be a safe and effective treatment for CI-DME in patients presenting with good VA.…”

Section: Discussionmentioning

confidence: 57%

Subthreshold yellow laser for fovea-involving diabetic macular edema in a series of patients with good vision: effectiveness and safety of a fovea-sparing technique

2020

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Purpose: Patients with center-involved diabetic macular edema (CI-DME) with good visual acuity (VA) represent a controversial clinical scenario in which a subthreshold laser might be a reasonable approach. We report a case series of patients with CI-DME with VA better than 20/32 who were treated with a subthreshold 577 nm (yellow) laser. Methods: The area of retinal thickening on OCT was treated with confluent laser spots at individually titrated power. The fovea was spared from treatment. Effectiveness and safety were evaluated through OCT and autofluorescence (AF) as well as BCVA. Results: A total of 23 eyes from 19 patients were treated. VA ranged from 20/20 to 20/30. The follow-up period ranged from 6 to 18 months. Edema in OCT resolved completely at the end of follow-up in 56.5% (13/23) of the cases. Central retinal thickness was reduced at 12 weeks and at the end of follow-up, with a mean reduction of 16.9 μm and 22 μm, respectively (paired t-test p = 0.001 and 0.0003). VA remained stable. The laser was invisible (OCT, AF, Fundoscopy) in 91,3% (21/23) of eyes. Conclusions: A fovea-sparing yellow subthreshold laser was safe and effective for treating CI-DME patients with good VA in this case series. This technique is of interest to prevent the progression of mild edema and might avoid or reduce the use of more invasive and expensive therapies. Excluding the fovea from the treated area does not seem to affect the results, which is of interest to novel laser practitioners.

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“…A recent retrospective study of Moiseiev et al could also show a significant reduction in the burden of anti-VEGF injections when combining with MPL for DME treatment [ 22 ]. Kanar et al demonstrated in a randomized clinical trial, that combining intravitreal aflibercept injections with subthreshold micropulse yellow laser for DME treatment results in fewer intravitreal injections and similar anatomic and functional outcome [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background To evaluate if a combination therapy with micropulse diode laser (MPL) shows non-inferiority on visual acuity (BCVA) within 12 months in comparison to standard therapy, i.e. intravitreal injection of ranibizumab alone. Setting Institutional. Prospective randomized single-center trial . Methods Patients with diabetic macular edema (DME) received three intravitreal injections of 0.5 mg ranibizumab during the upload phase and were then randomised 1:1 to receive either the same dosage of ranibizumab (0.5 mg) injections pro re nata alone (IVOM-Group; n = 9), or with two additional treatments with micropulse diode laser (IVOM+Laser-Group; n = 10). The primary endpoint was change in BCVA after 12 months. Secondary endpoints were change in central macular thickness and overall number of ranibizumab injections. Results BCVA increased significantly in both groups (IVOM: + 5.86, p < 0.001; IVOM+Laser: + 9.30; p < 0.001) with corresponding decrease in central macular thickness (IVOM: − 105 μm, p < 0.01; IVOM+Laser: − 125 μm; p < 0.01). Patients with additional laser treatment had better visual improvement (group comparison p = 0.075) and needed fewer ranibizumab injections (cumulative proportion of injections 9.68 versus 7.46 in IVOM-Group and IVOM+Laser-Group, respectively). Conclusion Non-inferiority of combination therapy in comparison to standard therapy alone could be demonstrated. Patients with additional laser therapy needed fewer ranibizumab injections. Trial registration Registered 10 February 2014 on ClinicalTrials.gov; NCT02059772 .

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Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema

Abstract: Micropulse laser is a safe and effective treatment for DME, which may achieve comparable improvement in VA along with a significant reduction in the burden of anti-VEGF injections. We suggest a treatment approach for its inclusion in the early stages of DME.

Cited by 68 publications

References 29 publications

How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema?

How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular edema?

Subthreshold yellow laser for fovea-involving diabetic macular edema in a series of patients with good vision: effectiveness and safety of a fovea-sparing technique

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

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