Abstract
In this retrospective study the morphological response of teleangiectatic capillaries (TCs) to focal laser treatment and the functional and morphological outcome after Indocyanine green angiography (ICGA)-guided laser therapy was evaluated. TCs in eyes with diabetic macular edema (DME) were treated with laser therapy. The immediate and subsequent reaction of the TCs lumina to direct photocoagulation was monitored with customized OCT single scans. Additionally, patients were treated with intravitreal anti-VEGF as needed. 12 eyes of 9 patients with treatment naive (6 eyes) and pretreated (6 eyes) DME were followed-up for a mean of 24 months (± 8.1SD). Best-corrected visual acuity improved from 0.25 logMar (± 0.2SD) to 0.12 (± 0.10SD; p = 0.06) at each patient’s last visit. During laser treatment a darkening of the TCs lumina was achieved in 91.3% of lesions. All these lesions fully resolved, whereas TCs, which showed no darkening of their lumen in OCT persisted and required re-treatment with laser. Additional anti-VEGF injections were indicated in only one eye (8.3%). The darkening of the TCs lumina visible in OCT might provide an image-biomarker that indicates successful coagulation of aneurysmatic lesions. Consequently, a significant functional and morphological improvement with need for anti-VEGF treatment in only one eye, was achieved.Information concerning the registration of the trial: date of registration: 11th of december, 2019. Trial registration number: 107/2019.
Highlights
In this retrospective study the morphological response of teleangiectatic capillaries (TCs) to focal laser treatment and the functional and morphological outcome after Indocyanine green angiography (ICGA)-guided laser therapy was evaluated
Prior to ICGA-guided laser photocoagulation 6 of the 12 eyes were pretreated with anti-vascular endothelial growth factor (VEGF). 4 of the 6 pretreated eyes had fluorescein angiography (FA)-based focal/grid laser photocoagulation prior to anti-VEGF therapy and the other 2 pretreated eyes received anti-VEGF only. 6 eyes were treatment naive
Our results show the potential of ICGA-guided focal laser therapy in selected patients with pretreated as well as treatment naive center-involving diabetic macular edema (DME)
Summary
In this retrospective study the morphological response of teleangiectatic capillaries (TCs) to focal laser treatment and the functional and morphological outcome after Indocyanine green angiography (ICGA)-guided laser therapy was evaluated. TCs in eyes with diabetic macular edema (DME) were treated with laser therapy. During laser treatment a darkening of the TCs lumina was achieved in 91.3% of lesions. A significant functional and morphological improvement with need for anti-VEGF treatment in only one eye, was achieved. For many years fluorescein angiography (FA)-based focal/grid macular laser has been the go-to treatment for patients with DME3,4. Since the introduction of intravitreal anti-vascular endothelial growth factor (VEGF) therapy, macular laser has lost its role as a primary treatment in patients with center-involving DME. Data from randomized clinical trials examining fluorescein angiography-based central laser therapy (e.g. modified ETDRS laser treatment) in addition to intravitreal anti-VEGF showed no statistically significant benefit compared with intravitreal anti-VEGF monotherapy for visual acuity outcomes[5,6,7,8]. With the introduction of OCT imaging non-invasive visualization of intra- and subretinal fluid became possible, thereby greatly impacting the diagnosis of diabetic macular edema and other retinal d isease[10,11,12,13,14,15,16,17,18,19]
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