Macular Grid Laser Photocoagulation Research Articles

Therapeutic Effects of Combination Therapy and Photobiomodulation Therapy on Retinal Regeneration.

Introduction: Many systemic and ocular diseases cause macular edema (ME). Macular edema is seen in two primary forms; the first is diffuse thickening of the macula, and the other is a macula with a distinct petaloid (cloverleaf) appearance called cystoid macular edema. Macular edema has a known role in the reduction of visual equity, and many options have been proposed for the reversal of this condition. Methods: Articles on the effects of macular laser grid photocoagulation on diabetic macular edema (DME) or cystoid macular edema published between 2000 and 2022 were collected from PubMed, Google Scholar, and Web of Science. The following keywords were used for the search: "macular laser photocoagulation", "macular edema", "cystoid macular edema", "intravitreal pharmacotherapies", and "antivascular endothelial growth factor". Two hundred nineteen articles were found in google scholar and 165 articles in PubMed, and a total of 58 articles were included in the study after applying the exclusion criteria. Results: We investigated the effects of various lasers photocoagulation such as Focal and/or grid macular laser, subthreshold micropulse laser (SMPL), as well as intravitreal pharmacotherapies with triamcinolone acetonide, and fluocinolone, and extended released intraocular implants such as Ozurdex, Retisert, Iluvien, and anti-vascular endothelial growth factors such as bevacizumab (Avastin), Eyela, and Lucentis. Corticosteroids were more effective than lasers, although some researchers have found that lasers and combined lasers and corticosteroids are more effective. In addition, some studies have shown that the frequency and concentrations of intravitreal pharmacotherapies are effective in increasing visual outcomes. Conclusion: The results of the studies showed that the combined intravitreal corticosteroids are much more effective in improving visual acuity (VA) than a single corticosteroid, and the low concentration of the drug is safer. Still, corticosteroids have side effects such as increased intraocular pressure and glaucoma. Therefore, combining the medication with a laser is much more reasonable than each alone. Also, the subthreshold photocoagulation laser (670 nm) is better at reducing the central macular thickness (CMT) and improving VA than the micro pulse yellow laser and pan-retinal photocoagulation (PRP).

What do Cochrane systematic reviews say about interventions for retinal vein occlusion

Abstract Purpose: To summarize the evidence from Cochrane systematic reviews on interventions for Central or Branch Vein Occlusion. Methods: We included and summarized the results from Cochrane systematic reviews on interventions for both types of occlusion. The initial search retrieved was 21 reviews and four of them were selected. Results: The four systematic reviews included evaluated the effects of laser techniques and intravitreal injections of Anti-Vascular Endothelial Growth Factor (anti-VEGF) and corticosteroids on Branch and Central Retinal Vein Occlusions. Conclusions: In Branch Retinal Vein Occlusion was found some benefits in the use of grid laser when comparable to no intervention but insufficient evidence about the use of early grid laser, subthreshold laser, intravitreal triamcinolone or anti-VEGF over macular grid laser photocoagulation. In Central Retinal Vein Occlusion with Macular Edema was found insufficient evidence to determine the benefits of intravitreo steroids but ranibizumab may improve clinical and visual outcomes at six and 12 months and repeated intravitreal injection of anti-VEGF agents improved visual outcomes at six months when compared to no treatment.

Retinal Vein Apoplexy: Pathogenesis, Risk Factors Hematological Disorders and Treatment

Retinal vein impediment (RVO) is the most common retinal vascular sickness after diabetic retinopathy. Attributable to its multifactorial nature, notwithstanding, the board of this condition remains a test. Of the two fundamental kinds of RVO, branch retinal vein impediment (BRVO) is more pervasive than central retinal vein impediment (CRVO). Most patients create the disease at an older age, and the greater parts of them have associated foundational messes (for example hypertension, hyperlipidemia and/or diabetes mellitus). There is no proof to suggest routine testing for heritable thrombophilia’s in patients with RVO. The fundamental driver of the visual debilitation is macular edema, while neovascularization of the retina and optic plate are the most genuine inconveniences prompting glassy hemorrhage, retinal separation and neovascular glaucoma. Macular grid laser photocoagulation is an effective treatment for macularedema in patients with BRVO and a visual keenness of 20/40 or less. Other treatment choices for decreasing the edema are intra vitreal steroids, against VEGF medications and vitrectomy. The recently presented intra vitreal use of steroids and against VEGF medications might end up being a superior methodology for improving visual keenness. At long last, dissipate pan retinal laserphotocoagulationcan effectively treat neovascularization and its secondary complications.

Intravitreal Bevacizumab Alone Versus Combined Bevacizumab and Macular Grid Laser Photocoagulation in Diffuse Diabetic Macular Oedema

Introduction: Diabetes Mellitus (DM) is a common disease with multiple systemic complications. Diabetic macular oedema is the main threat to vision in patients with diabetic retinopathy, which results from the increased permeability of the inner and outer blood-retinal barrier. Macular argon laser photocoagulation was the only treatment of diabetic macular oedema in the past. Now-a-days, both intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and macular grid laser photocoagulation are used in the management of diffuse and focal Diabetic Macular Oedema (DME). Aim: To assess the changes in both visual acuity and Central Macular Thickness (CMT) in patients with DME after intravitreal injection of bevacizumab only or in combination with macular grid laser treatment. Materials and Methods: A prospective longitudinal cohort study included 89 eyes of 52 patients with DME, who were categorised into two interventional groups. The first group received only intravitreal bevacizumab for the first three months, then Pro Re Nata (PRN), while the second group received intravitreal bevacizumab, similar to the first group, in addition to macular grid laser treatment two weeks after the initial injection. Participants were followed-up at 12 months, and the visual acuity, CMT, and the total number of injections were documented. Patients were followed-up but data was gathered on baseline and at the 12th month were compared. Results: In comparison to the initial presentation, a significant decrease in CMT was noticed in both groups (163.47±83.60 μm vs. 126.45±52.45 μm, respectively). Moreover, a significant improvement in visual acuity of both groups (p<0.023 and p<0.016, respectively) and significantly fewer injections being required in the second group were noticed. Conclusion: Combining intravitreal bevacizumab with macular grid laser treatment can lead to stabilisation and improvement of visual acuity with a smaller number of injections which was statistically significant.

Photocoagulation combined with ranibizumab for macular edema secondary to branch retinal vein occlusion

Objective To evaluate the clinical efficacy of macular grid photocoagulation combined with intravitreal ranibizumab injection in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Methods The data of 50 eyes of 50 patients with macular edema secondary to BRVO from Oct.2013 to Dec.2017 were analyzed retrospectively. All cases were randomly divided into two groups, each group with 25 cases. All cases received intravitreal injection of ranibizumab. The combined group received standard macular grid photocoagulation at 1 week after injection. Results The difference in BCVA and central macular thickness (CMT) were not statistically significant between the two groups before treatment (P>0.05). BCVA was significantly improved and CMT was significantly decreased in both groups at 1, 2 and 6 months after treatment, the differences were statistically significant (P 0.05). Conclusion The single intravitreal injection of ranibizumab or combined with macular grid laser photocoagulation in the treatment of retinal macular edema secondary to BRVO are effective, and the combined effect is more durable. Key words: Macular edema, secondary; Branch, retinal, vein occlusion; Photocoagulation, macular, grid; Ranibizumab

Intravitreal bevacizumab injection versus intravitreal bevacizumab injection followed by macular grid laser photocoagulation for diabetic macular edema

Background: Diabetic macular edema is the commonest cause of visual impairment in diabetic patients. The aim of the study is to evaluate the effectiveness of repeated intravitreal bevacizumab injections alone versus injection with sequential macular grid laser photocoagulation in patients with diabetic macular edema. Methods: This study included 128 eyes of 64 patients with bilateral diabetic macular edema, randomly assigned into two groups. First group was treated with monthly intravitreal bevacizumab injections (IVB group). Second group was treated with 3 monthly IVB injections, followed by macular grid photocoagulation (MGP) 4 weeks later (combined group). All patients received a complete ophthalmic examination including measurement of best corrected visual acuity (BCVA) and measurement of central macular thickness (CMT) by optical coherence tomography at baseline and 3 weeks after each injection. Results: At the end of the follow-up period there was a statistically significant difference between the mean BCVA and the CMT compared to baseline in both groups. In the IVB group at the end of study, the mean BCVA was 0.46±0.11 LogMAR compared to 0.79±0.16 LogMAR preoperatively, and the mean CMT was 248.49±13.40µm compared to 497.25±27.97µm preoperatively. In the combined group the mean BCVA was 0.41±0.12 LogMAR compared to 0.89±0.12 LogMAR preoperatively, and the mean CMT was 239.47±13.53µm compared to 510.86±37.64µm preoperatively. The mean number of injections was significantly lower in combined group. Conclusion: Intravitreal injection of bevacizumab is effective in controlling DME. Performing MGP 4 weeks after the third injection decreased the number of IVB injections needed during the study duration.

Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study.

The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated. Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2μm ± 138.4μm and 538.9μm ± 156.9μm in BEV (P < 0.1697). At 38weeks, CRT decreased in both groups significantly, 98.2μm in the BEV + GRID (P = 0.02) and 141.7μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3-6) with no significant difference between groups. Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.

Evaluation of intravitreal bevacizumab as monotherapy and in combination with macular grid laser photocoagulation in diffuse diabetic macular edema.

BACKGROUND AND OBJECTIVE:The objective of the study was to compare the efficacy of intravitreal bevacizumab (IVB) as monotherapy versus combination with modified macular grid (MMG) laser photocoagulation in the primary treatment of diffuse diabetic macular edema (DDME).MATERIALS AND METHODS:A prospective randomized trial was carried out in sixty eyes with DDME after Institutional Ethical clearance. Group A received three doses of IVB at a 1-month interval. Group B received MMG in addition to IVB. Complete examination including best-corrected visual acuity (BCVA) (Snellen's), central macular thickness (CMT) using spectral domain-optical coherence tomography was carried out at 0, 1, 4, 8, 12, and 24 weeks.RESULTS:mean CMT at baseline, 12 and 24 weeks in Group A was 401 (±76), 280 (±49), and 307 (±46) and in Group B, 405 (±73), 237 (±33), and 242 (±45), respectively. Group B had significantly greater reductions (P < 0.001) from 12 weeks onward. BCVA and contrast sensitivity showed improvements with no significant difference.CONCLUSION:Combined therapy has more advantage in primary DDME by reducing CMT on longer follow-up.

Clinical effect of Conbercept intravitreal injection combined with macular grid laser photocoagulation on the treatment of diabetic macular edema

Clinical effect of Conbercept intravitreal injection combined with macular grid laser photocoagulation on the treatment of diabetic macular edema

Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology

To evaluate the available evidence on the ocular safety and efficacy of current therapeutic alternatives for the management of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Literature searches were last conducted on January 31, 2017, in PubMed with no date restrictions and limited to articles published in English, and in the Cochrane Database without language limitations. The searches yielded 321 citations, of which 109 were reviewed in full text and 27 were deemed appropriate for inclusion in this assessment. The panel methodologist assigned ratings to the selected studies according to the level of evidence. Level I evidence was identified in 10 articles that addressed anti-vascular endothelial growth factor (VEGF) pharmacotherapies for ME, including intravitreal bevacizumab (5), aflibercept (2), and ranibizumab (4). Level I evidence was identified in 6 studies that examined intravitreal corticosteroids, including triamcinolone (4) and the dexamethasone implant (2). Level I evidence also was available for the role of macular grid laser photocoagulation (7) and scatter peripheral laser surgery (1). The inclusion of level II and level III studies was limited given the preponderance of level I studies. The number of studies on combination therapy is limited. Current level I evidence suggests that intravitreal pharmacotherapy with anti-VEGF agents is effective and safe for ME secondary to BRVO. Prolonged delay in treatment is associated with less improvement in visual acuity (VA). Level I evidence also indicates that intravitreal corticosteroids are effective and safe for the management of ME associated with BRVO; however, corticosteroids are associated with increased potential ocular side effects (e.g., elevated intraocular pressure, cataracts). Laser photocoagulation remains a safe and effective therapy, but VA results lag behind the results for anti-VEGF therapies.

Efficacy of intravitreal triamcinolone acetonide with thermal combination therapy versus intravitreal triamcinolone acetonide monotherapy on diffuse diabetic macular edema

Purpose The aim of this study was to compare the efficacy of intravitreal triamcinolone acetonide (IVTA) monotherapy with IVTA plus macular grid laser photocoagulation combination therapy on the treatment of diffuse diabetic macular edema.Patients and methods Fifty eyes of 38 patients exhibiting diffuse diabetic macular edema were evaluated in this prospective comparative study. The patients were divided into two groups: IVTA monotherapy group and combination therapy group (IVTA plus grid laser). The main outcome measures of the study were best-corrected visual acuity (VA) scored in logMAR and the central macular thickness (CMT) as estimated at 3 and 6 months after treatment. The study further assessed the potential complications associated with IVTA injection.Results The baseline logMAR VA and CMT were 0.46±0.22 and 445.2±123.91 µm for the IVTA monotherapy group and 0.57±0.27 and 456.91 ±134.32 µm for the combination therapy group, respectively. The post-treatment logMAR VA at 3 and 6 months were 0.24±0.12 and 0.28±0.09 for the IVTA monotherapy group and 0.22±0.13 and 0.18±0.16 for the combination therapy group, respectively. The CMT values at 3 and 6 months were 305.5±115.30 and 310.8±86.8 µm for the IVTA monotherapy group and 280.9±43.9 and 254.2±45.95 for the combination therapy group. Improvement in VA and CMT after treatment was statistically significant in both groups. Approximately 10% of patients developed cataract after 5 months of intravitreal injection. The mean pretreatment intraocular pressure and the mean post-treatment intraocular pressure were 15.49±2.47 and 14.56±2.26 and 14.92±2.80 and 13.55±2.02 mmHg in both the IVTA monotherapy and combination therapy groups, respectively.Conclusion Macular grid laser photocoagulation after IVTA effectively maintains the VA and macular thickness of the patients included in this study during the first 6 months of treatment.

Update on the Use of Anti-VEGF Intravitreal Therapies for Retinal Vein Occlusions.

The use of anti-vascular endothelial growth factor (VEGF) therapy in ophthalmology has profoundly changed our management and treatment of conditions such as cystoid macular edema, diabetic macular edema, choroidal neovascularization, and other proliferative retinopathies. Although initially used for the treatment of choroidal neovascularization in neovascular age-related macular degeneration, their application has spread rapidly for other indications as their outcomes have often outperformed previously existing treatments. Retinal vein occlusion (RVO) continues to be one of the leading causes of vision loss secondary to macular edema, in addition to macular ischemia and neovascularization in more severe cases. Before the availability of anti-VEGF therapy, the use of macular grid laser and panretinal photocoagulation was the mainstay of treatment of macular edema and neovascularization, respectively, in patients with RVOs. Two landmarks studies established the guidelines of these treatments for nearly a quarter century. Since the availability of anti-VEGF agents, there has been a paradigm shift in the treatment of RVO. Most importantly, there has also been a significant improvement in visual outcomes in these patients. The goal of this article is to provide a review of the pertinent clinical studies that have investigated the use of anti-VEGF in patients with retinal vein occlusions.

How does macular grid laser photocoagulation compare with intravitreal drugs for the treatment of branch retinal vein occlusion?

How does macular grid laser photocoagulation compare with intravitreal drugs for the treatment of branch retinal vein occlusion?

Comparison of therapeutic effect of micro-pulse laser and conventional laser on diabetic macular edema

Objective To compare the therapeutic effect of micro-pulse laser, single-spot laser and pattern scan laser for diabetic macular edema(DME). Methods Total of 120 eyes of 60 patients who were confirmed as preproliferative diabetic retinopathy or IV phase proliferative diabetic retinopathy complicated with clinically significant macular edema were included. These patients were randomized divided into the micro-pulse group with 40 eyes of 20 patients, the single-spot laser group with 40 eyes of 20 patients and the pattern scan laser group with 40 eyes of 20 patients.The patients in micro-pulse group underwent micro-pulse laser therapy in macular region , the single-spot laser group underwent macular laser grid photocoagulation therapy by single-spot laser, the pattern scan laser group underwent macular laser grid photocoagulation therapy by pattern scan laser.The BCVA, central macular thickness(CMT) and mean sensitivity(MS) of all patients were examined before and after the treatment. The changes in BCVA, CMT and MS at 6 months after treatment were observed and compared among the groups. Results At 6 months after the treatment, the BCVA of micro-pulse group increased more significantly compared to that before treatment(P 0.05). At 6 months after the treatment, the CMT of micro-pulse group, single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P 0.05). At 6 months after the treatment, the MS of micro-pulse group increased significantly compared to that before treatment(P<0.05), the MS of single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P<0.05), the MS of the three groups showed statistical difference (P<0.05). Conclusion Micro-pulse laser, single-spot laser and pattern scan laser therapies on DME can effectively reduce CMT and alleviate macular edema, micro-pulse laser therapy on DME also increase BCVA and MS, and improve visual function.Single-spot laser and pattern scan laser therapies can not improve visual function. Key words: Macular edema, diabetic; Micro-pulse laser; Laser coagulation; Effect, therapeutic

Comparison of Anti-VEGF, Steroid, and Combination Therapy in the Treatment of Retinal Vein Occlusion

Macular grid laser photocoagulation was the standard therapy for RVO (retinal vein occlusion) for many years, but several newer studies have come along in the last 6 years that introduced new injectable agents like anti-vascular endothelial growth factor (anti-VEGF) and corticosteroids. The BRAVO, CRUISE, Galileo and Copernicus studies looked at anti-VEGF as treatment, and the Ozurdex/Geneva study and SCORE involved corticosteroids.The Ozurdex/Geneva study compared intravitreally injected dexamethasone implant with a sham in both CRVO and BRVO patients. Patients received either 2 injections of 700-μg dexamethasone intravitreal implant (Ozurdex, Allergan) 6 months apart or 1 sham injection and then 1 implant injection 6 months later. The data showed that sustained-release dexamethasone (Ozurdex, Allergan) was effective in treating macular edema in BRVO and CRVO, and patients had a mean improvement in BCVA (best corrected visual acuity) of about 10 letters. When patients were reinjected, they achieved the same improvement in visual acuity in the second 6 months. The SCORE study investigated a special preparation of triamcinolone (Trivaris, Allergan). Patients were injected with the agent every 4 months. The results showed that for CRVO, triamcinolone was superior to observation, and for BRVO, laser was better than triamcinolone. The BRAVO and CRUISE studies observed how well intravitreal injections of ranibizumab worked to treat BRVO and CRVO, respectively. The BRAVO data showed a gain of 18.3 letters in BCVA with a 0.5-mg injection, 16.6 letters with a 0.3-mg injection, and 7.3 letters in the sham group. The CRUISE study showed similar 6-month results, with patients gaining 14.9 letters in the 0.5-mg group, 12.7 letters in the 0.3-mg group, and 0.8 letters in the sham group. The Galileo and Copernicus studies evaluated monthly aflibercept for the treatment of macular edema in patients with CRVO. In both studies, patients received monthly injections for 6 months with the agent or with a sham injection. In Copernicus, all patients were switched to as needed dosing at 6 months, while in Galileo only patients initially treated with the agent were retreated on an as-needed basis. At 1 year, the mean change in vision was + 16.2 letters in the aflibercept group in Copernicus and + 16.9 letters in the Galileo group, versus + 3.8 letters in both sham groups. A recent emerging idea is to treat RVO with both intravitreal sustained-release dexamethasone and anti-VEGF agents (combination therapy) which has been shown to improve visual acuity and prolong the time between injections (reinjection interval). In our study, patients with both CRVO and BROV received anti-VEGF injections (either bevacizumab, ranibizumab, or aflibercept) followed by 0.7-mg dexamethasone intravitreal implant (Ozurdex) 2 weeks later. Patients were evaluated every 2-4 weeks until the next anti-VEGF injection. The mean BCVA increased from 9.4 to 16.8 letters during the course of the initial study (by 6 months), and the mean peak improvement in BCVA across all re-treatment cycles was 12.5 letters for BRVO and 20.1 letters for CRVO (a longer term evaluation). This study showed that the addition of dexamethasone intravitreal implant 2 weeks following anti-VEGF therapy provides improvements in BCVA and macular thickness in patients with RVO and increases the percentage of patients whose macula was essentially fluid-free compared with anti-VEGF therapy alone.

The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema

PurposeTo assess the safety and efficiency of combined phacoemulsification (PHACO) surgery and intravitreal triamcinolone (IVTA) injection with or without macular grid laser photocoagulation in patients with cataract and diabetic macular edema. Material and methodsThis prospective study included 41 eyes of 36 diabetic patients with cataract and coexisting clinically significant macular edema (CSME). After PHACO and IVTA injection eyes were divided into two groups: the laser and IVTA group (Group 1) and only IVTA group (Group 2). Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. Paired sample t-test was used to compare data in the groups and C square test for qualitative variables. ResultsPostoperative BCVA was significantly higher than the initial BCVA during the follow-up period in both groups (p<0.01). The BCVA 6months after surgery was significantly higher in group 1 than in group 2 (p<0.01). There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (p>0.05). There was no statistically significant difference between both groups in mean CMT preoperatively and 2nd week, 2nd month and 3rd month after surgery (p>0.05). The mean CMT 6months after surgery was statistically significantly lower in group 1 than in group 2 (p<0.01). ConclusionsPHACO surgery combined with IVTA injection improves BCVA and provides a decrease in CMT in diabetic patients with CSME. Additional macular grid laser photocoagulation after surgery helps to preserve this improvement in BCVA and decrease in CMT.

Macular grid laser photocoagulation for branch retinal vein occlusion.

Branch retinal vein occlusion (BRVO) is the second most common cause of retinal vascular abnormality after diabetic retinopathy. Persistent macular oedema develops in 60% of eyes with a BRVO. Untreated, only 14% of eyes with chronic macular oedema will have a visual acuity (VA) of 20/40 or better. Macular grid laser photocoagulation is used for chronic non-ischaemic macular oedema following BRVO and has been the mainstay of treatment for over 20 years. New treatments are available and a systematic review is necessary to ensure that the most up-to-date evidence is considered objectively.To examine the effects of macular grid laser photocoagulation in the treatment of macular oedema following BRVO.We searched CENTRAL, Ovid MEDLINE, EMBASE, Web of Science Conference Proceedings Citation Index, the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 21 August 2014.We included randomised controlled trials (RCTs) comparing macular grid laser photocoagulation treatment to another treatment, sham treatment or no treatment.We used standard methodological procedures expected by Cochrane.We included five studies conducted in Europe and North America. Four separate trials compared grid laser to no treatment, sham treatment, intravitreal bevacizumab and intravitreal triamcinolone. One further trial compared subthreshold to threshold laser. Two of these trials were judged to be at high risk of bias in one or more domains.In one trial of grid laser versus observation, people receiving grid laser were more likely to gain visual acuity (VA) (10 or more ETDRS letters) at 36 months (RR 1.75, 95% confidence interval (CI) 1.08 to 2.84, 78 participants, moderate-quality evidence). The effect of grid laser on loss of VA (10 or more letters) was uncertain as the results were imprecise (RR 0.68, 95% CI 0.23 to 2.04, 78 participants, moderate-quality evidence). On average, people receiving grid laser had better improvement in VA (mean difference (MD) 0.11 logMAR, 95% CI 0.05 to 0.17, high-quality evidence). In a trial of early and delayed grid laser treatment versus sham laser (n = 108, data available for 99 participants), no participant gained or lost VA (15 or more ETDRS letters). At 12 months, there was no evidence for a difference in change in VA (from baseline) between early grid laser and sham laser (MD -0.03 logMAR, 95% confidence interval (CI) -0.07 to 0.01, 68 participants, low-quality evidence) or between delayed grid laser and sham laser (MD 0.00, 95% CI -0.04 to 0.04, 66 participants, low-quality evidence).The relative effects of subthreshold and threshold laser were uncertain. In one trial, the RR for gain of VA (15 or more letters) at 12 months was 1.68 (95% CI 0.57 to 4.95, 36 participants, moderate-quality evidence); the RR for loss of VA (15 or more letters) was 0.56 (95% CI 0.06 to 5.63, moderate-quality evidence); and at 24 months the change in VA from baseline was MD 0.07 (95% CI -0.10 to 0.24, moderate-quality evidence).The relative effects of macular grid laser and intravitreal bevacizumab were uncertain. In one trial, the RR for gain of 15 or more letters at 12 months was 0.67 (95% CI 0.39 to 1.14, 30 participants, low-quality evidence). Loss of 15 or more letters was not reported. Change in VA at 12 months was MD 0.11 logMAR (95% CI -0.36 to 0.14, low-quality evidence).The relative effects of grid laser and 1mg triamcinolone were uncertain at 12 months. RR for gain of VA (15 or more letters) was 1.13 (95% CI 0.75 to 1.71, 1 RCT, 242 participants, moderate-quality evidence); RR for loss of VA (15 or more letters) was 1.20 (95% CI 0.63 to 2.27, moderate-quality evidence); MD for change in VA was -0.03 letters (95% CI -0.12 to 0.06, moderate-quality evidence). Similar results were seen for the comparison with 4mg triamcinolone. Beyond 12 months, the visual outcomes were in favour of grid laser at 24 months and 36 months with people in the macular grid group gaining more VA.Four studies reported on adverse effects. Laser photocoagulation appeared to be well tolerated in the studies. One participant (out of 71) suffered a perforation of Bruch's membrane, but this did not affect visual acuity.Moderate-quality evidence from one RCT supports the use of grid laser photocoagulation to treat macular oedema following BRVO. There was insufficient evidence to support the use of early grid laser or subthreshold laser. There was insufficient evidence to show a benefit of intravitreal triamcinolone or anti-vascular endothelial growth factor (VEGF) over macular grid laser photocoagulation in BRVO. With recent interest in the use of intravitreal anti-VEGF or steroid therapy, assessment of treatment efficacy (change in visual acuity and foveal or central macular thickness using optical coherence tomography (OCT)) and the number of treatments needed for maintenance and long-term safety will be important for future studies.

Intravitreal Aflibercept for Macular Edema Following Branch Retinal Vein Occlusion: The 24-Week Results of the VIBRANT Study

To compare the efficacy and safety of intravitreal aflibercept injection (IAI) with macular grid laser photocoagulation for the treatment of macular edema after branch retinal vein occlusion (BRVO). The VIBRANT study was a double-masked, active-controlled, randomized, phase III trial. Treatment-naïve eyes with macular edema after BRVO were included in the study if the occlusion occurred within 12 months and best-corrected visual acuity (BCVA) was between ≤73 and ≥24 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (20/40-20/320 Snellen equivalent). Eyes (1 eye per patient) received either IAI 2 mg every 4 weeks (n=91) from baseline to week 20 or grid laser (n=92) at baseline with a single grid laser rescue treatment, if needed, from weeks 12 through 20. The primary outcome measure was the proportion of eyes that gained ≥15 ETDRS letters from baseline BCVA at week 24. Secondary end points included mean change from baseline BCVA and central retinal thickness (CRT) at week 24. The proportion of eyes that gained ≥15 ETDRS letters from baseline at week 24 was 52.7% in the IAI group compared with 26.7% in the laser group (P=0.0003). The mean improvement from baseline BCVA at week 24 was 17.0 ETDRS letters in the IAI group and 6.9 ETDRS letters in the laser group (P<0.0001). The mean reduction in CRT from baseline at week 24 was 280.5 μm in the IAI group and 128.0 μm in the laser group (P<0.0001). Traumatic cataract in an IAI patient was the only ocular serious adverse event (SAE) that occurred. There were no cases of intraocular inflammation or endophthalmitis. The incidence of nonocular SAEs was 8.8% in the IAI group and 9.8% in the laser group. One Anti-Platelet Trialists' Collaboration-defined event of nonfatal stroke (1.1%) and 1 death (1.1%) due to pneumonia occurred during the 24 weeks of the study, both in patients in the laser group. Monthly IAI provided significantly greater visual benefit and reduction in CRT at 24 weeks than grid laser photocoagulation in eyes with macular edema after BRVO.

Intravitreal aflibercept for macular oedema due to branch retinal vein occlusion

AbstractPurpose To evaluate the efficacy and safety of intravitreal aflibercept (IVT‐AFL) injection compared with macular grid laser photocoagulation for the treatment of macular oedema secondary to Branch Retinal Vein Occlusion (BRVO).Methods VIBRANT was a double‐masked, Phase 3 trial with a duration of 52 weeks in which patients with macular oedema secondary to BRVO were randomised 1:1 to receive IVT‐AFL 2 mg every 4 weeks or grid laser from baseline to Week 20. The primary efficacy endpoint was the proportion of eyes that gained ≥15 letters in best‐corrected visual acuity (BCVA) from baseline at Week 24.Results The proportion of eyes that gained ≥15 letters from baseline to Week 24 was 52.7% and 26.7% (P&lt;0.001) in the IVT‐AFL and laser groups, respectively. The mean improvement in BCVA from baseline to Week 24 was 17.0 and 6.9 letters (P&lt;0.0001), respectively. The most common ocular adverse events (AEs) in the IVT‐AFL and laser group were subconjunctival haemorrhage (19.8%) and eye pain (5.4%), respectively. There were no cases of intraocular inflammation in either treatment group. One death due to pneumonia and one Anti‐Platelet Trialists' Collaboration (APTC)‐defined event of nonfatal stroke occurred during the first 24 weeks of study, both in the laser group. Week 52 data will be presented.Conclusion In this study, monthly IVT‐AFL provided statistically significant and clinically meaningful visual benefits which were superior to macular grid laser photocoagulation in eyes with macular oedema due to BRVO over 24 weeks. Compared to IVT‐AFL’s known profile no new safety signals were observed. Commercial interest

Short-term effect of a single intravitreal injection of bevacizumab (Avastin) alone, triamcinolone alone, or in combination, followed by macular grid laser photocoagulation on diffuse diabetic macular edema

Purpose This study aimed to perform a short-term evaluation of best-corrected visual acuity (BCVA) and assess improvement central foveal thickness (CFT) in patients with diffuse diabetic macular edema (DME) after an intravitreal injection of triamcinolone alone, bevacizumab (Avastin) alone, or a combination of both, followed by modified grid macular laser photocoagulation. Study design This was a randomized prospective interventional study. Materials and methods This was a randomized prospective interventional study that included 90 eyes of 78 patients with diffuse DME, divided into three groups of interventions: group A received a single intravitreal triamcinolone injection, group B received a single bevacizumab (Avastin) injection, and group C received a single injection of both, followed by a modified grid macular laser photocoagulation 2 weeks after the injection. Patients were observed for a 6-month period and their BCVA, intraocular pressure (IOP), and CFT were recorded. Results In group A, the mean preoperative BCVA was 0.17 ± 0.15 and 0.345 ± 0.211 decimal at 6 months, in group B, the mean preoperative BCVA was 0.245 ± 0.162 and 0.462 ± 0.171 decimal at 6 months, and in group C, the mean preoperative BCVA was 0.238 ± 0.152 and 0.617 ± 0.200 decimal at 6 months, with a statistically significant improvement in all groups throughout the follow-up period ( P In group A, the mean preoperative CFT was 458.17 ± 79.4 μm and at 6 months the mean CFT was 358.53 ± 74.92 μm. In group B, the mean preoperative CFT was 398.40 ± 41.17 μm and at 6 months, the mean CFT was 335.10 ± 46.99 μm. In group C, the mean preoperative CFT was 388.00 ± 43.61 μm, and at 6 months, the mean CFT was 304.37 ± 54.44 μm. Statistical analysis of the difference in CFT between 3 and 6 months showed that there was no statistical difference between groups A and B ( P = 0.6), but there was a statistically significant difference when comparing groups A and C ( P = 0.006) and also when comparing groups B and C ( P = 0.003). Conclusion Combined Avastin and triamcinolone intravitreal injection, followed by modified grid macular photocoagulation led to more stable improvement in the treatment of eyes with diffuse DME.