The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review

Abstract

Background and Objectives: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with, the first-line treatment, anti-vascular endothelial growth factor (VEGF). Materials and Methods: A comprehensive literature search to identify studies that evaluated the efficacy of laser photocoagulation therapy in the management of DME was performed. The relevant findings of the efficacy of focal/grid laser therapy from data in randomized, controlled trials were synthesized, and the potential of new laser technologies, such as navigated laser systems, pattern scan lasers, and subthreshold lasers, was explored. The usefulness of multimodal imaging-guided laser therapy was also evaluated, with a focus on the potential contribution to anti-VEGF therapy. Results: Focal laser photocoagulation targeting microaneurysms remains an effective therapeutic approach to chronic refractory edema, despite the widespread use of anti-VEGF therapy. To achieve the best possible treatment outcomes, precise identification of microaneurysms is essential. This requires the use of multimodal imaging-guided, highly accurate, minimally invasive coagulation techniques. Subthreshold laser therapy can also reduce the frequency of anti-VEGF injections and minimize treatment burden. Conclusions: Further studies are needed to determine the optimal timing and settings for laser photocoagulation therapy and the potential of new laser technologies in the management of DME. Nevertheless, laser photocoagulation therapy plays an important role in the management of DME, in conjunction with anti-VEGF therapy.

Use of Ranibizumab for evaluating focal laser combination therapy for refractory diabetic macular edema patients: an exploratory study on the RELAND trials

“…This study focused on the focal laser combination and anti-VEGF therapies. However, alternative treatment options for anti-VEGF-resistant DME do exist, such as steroid injection 14 , 15 , vitrectomy 16 , 17 , and grid laser therapy 18 – 20 . Further research should consider other options for treating anti-VEGF-resistant DME to provide a more balanced and informative perspective on DME management.…”

Role of the Vitreous in Retinal Pathology: A Narrative Review

“…Laser photocoagulation still plays an important role in the treatment of DR as an adjuvant treatment [ 35 ]. If the anti-VEGF treatment and laser are combined, the number of injections could be reduced [ 36 ].…”

Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema

“…3,4 LP is considered the gold standard for DME and the only treatment that has been shown to be effective in eliminating retinal neovascularization. 5 However, in some patients, retinal neovascularization may still progress even after laser treatment, and the overall outcome may fall short of clinical expectations. 5,6 Study has found that vascular endothelial growth factor (VEGF) can stimulate angiogenesis, increase its permeability, and accelerate the progress of DME.…”

“…9,10 Several studies have suggested the superiority of combining laser treatment with anti-VEGF therapy in patients with DME. 5,11 However, most studies only compared the combined therapy with LP alone or ranibizumab alone, and few studies compared all three simultaneously. In recent years, our hospital has adopted the combination of ranibizumab and laser therapy for treating patients with DME.…”

“… 5 However, in some patients, retinal neovascularization may still progress even after laser treatment, and the overall outcome may fall short of clinical expectations. 5 , 6 Study has found that vascular endothelial growth factor (VEGF) can stimulate angiogenesis, increase its permeability, and accelerate the progress of DME. 7 Therefore, anti-VEGF drugs have emerged as potential agents to improve the therapeutic effect of DME.…”