Abstract
Diabetic macular edema (DME) is the leading cause of blindness in the diabetic population. The diabetes Control and Complications Trial reported that 27% of patients affected by type 1 diabetes develop DME within 9 years of onset. Other studies have shown that in patients with type 2 diabetes, the prevalence increased from 3% to 28% within 5 years of diagnosis to twenty years after the onset. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal therapies for DME (e.g., corticosteroids, and anti-VEGF drugs), laser photocoagulation remains the current gold standard and the only treatment with proven efficacy in a wide range of clinical trials for this condition. Despite being the standard technique for comparison and evaluation of the emerging treatments, we have generally poor understanding of the ETDRS recommendations, and we often forget about the results of laser in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME with an extensive review of the ETDRS results and discuss the laser techniques. Furthermore, we will describe the new developments in laser systems and review the current indications and results. Finally, we will discuss the results of laser treatments versus the current pharmacological therapies. We conclude by trying to provide a general overview that which laser treatment must be indicated and what types of lasers are currently recommended.
Highlights
Diabetes is a chronic disease that typically causes changes in the small vessels of the whole body, changes that are referred to as diabetic microangiopathy
Studies have compared the effectiveness of new drugs with that of the laser effect; in all studies a control group submitted to laser photocoagulation has been the gold standard
It is interesting that Karacolu [59], who carried out a study at one-year follow-up, reports no improvement in visual acuity (VA) in his series against other studies that report a percentage between 8.3% to 25% of improvement after two or three years follow up
Summary
Diabetes is a chronic disease that typically causes changes in the small vessels of the whole body, changes that are referred to as diabetic microangiopathy. Despite the fact that ETDRS study has been the gold standard in the classification and treatment of diabetic retinopathy and macular edema, it seems that DME photocoagulation laser treatment has been replaced by the new intravitreal drugs. This study does not provide data to suggest that a larger long-term trial of the MMG technique is likely to show substantial clinical benefit over the current mETDRS approach This recent technique uses a subthreshold laser micropulse, using an 810 nanometre diode laser; the desired effect is to reduce the laser damage to ocular tissue; its application in the macular area is very promising in order to treat DME with the less retinal damage. One important finding of the ETDRS was that the effect of DME laser photocoagulation increases over time in eyes with CSME, visual acuity increases by about 1% in the first year, 6% at 24 months and 10% at 36 months
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