Macular Grid Laser 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).

English

BACKGROUND The reported prevalence of diabetic retinopathy in diabetics is around 40 %. Diabetic macular oedema (DME) is defined as macular thickening resulting from diabetic retinopathy, due to leakage from micro aneurysms, or from a diffuse leakage of hyper permeable capillaries. Intravitreal injection of triamcinolone acetonide (IVTA) has gained considerable interest and clinical use because it often has beneficial effect on retinal thickening in DME. The synergistic action of IVTA and laser photocoagulation might increase and prolong the beneficial effects of IVTA in reducing ME. Hence the need for a study to compare efficacies of grid laser, and combination of sequential IVTA and grid laser in treating patients with DME. We wanted to evaluate functional and morphological outcome of grid laser versus combination of sequential intravitreal triamcinolone acetonide and grid laser in treatment of diabetic macular oedema. METHODS The study included 62 eyes with DME. There were 31 eyes which received grid laser photocoagulation (group 1) and 31 eyes which received grid laser photocoagulation following IVTA (group 2) and visual acuity, CMT on OCT was compared at baseline and after day 1, 1st week, 4th week and 12th week. Outcome and comparative efficacies were evaluated. RESULTS Our study shows reduced macular thickness and improved visual acuity in group 2 compared to group 1 in all follow ups. On intragroup analysis, we found a significant reduction in CMT in both groups at 1 week, 4 weeks and 12 weeks as compared to baseline. In our study we also compared CMT between group 1 and group 2 which did not show significant difference at baseline. But, difference in CMT from baseline at each follow up which is at 1 week, 4 weeks and 12 weeks between two groups showed more reduction in CMT in group 2 compared to group 1. CONCLUSIONS There was a significant reduction in CMT in all the follow ups of both groups, but group 2 had more reduction in CMT compared to group 1. The synergistic action of IVTA and laser photocoagulation might increase and prolong the beneficial effect of IVTA in reducing ME. This study found evidence of synergistic effects of IVTA and laser photocoagulation in DME in terms of improving visual acuity and in reducing CMT compared to grid laser alone and should be tried as a modality of treatment in DME. KEYWORDS DME, IVTA, CMT, Macular grid laser, OCT

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.

Results of Intravitreal Bevacizumab as an Adjunct to mETDRS Grid Laser in Diabetic Macular Edema

Purpose: To assess the efficacy of Intravitreal Bevacizumab as an adjuvant to grid laser photocoagulation in patients with diffuse macular edema (DME) in type II diabetes.
 Study Design: Quasi experimental study.
 Place and Duration of Study: Institute of ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, from September 2016 to November 2018
 Methods: Ninety five patients with diffuse macular edema in type II diabetes were selected by convenient sampling. Group I patients were treated with ETDRS grid laser photocoagulation. Group II patients were treated with ETDRS grid laser photocoagulation followed by intravitreal bevacizumab after one week monthly for 2 months and then as per need. All patients were examined after 1st, 2nd and 3rd month and mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT).Statistical analysis was done on SPSS version 20.0. Paired t-test was used to compare mean values and p valve < 0.05 was accepted as statistically significant.
 Results: The results of study were compared with the baseline values. The mean change in BCVA in group 1 was from 46 ± 18 letters to 52 ± 17. BCVA in group 2 was from 46 ± 18 letters to 56 ± 17 (P < 0.001). The decrease in macular edema thickness was more in group II than group I (P < 0.001).
 Conclusion: Macular Grid laser with or without Intravitreal Bevacizumab significantly improves vision and decreases macular edema but combined treatment led to more stable improvement in DME during follow-up.
 Key Words: Modified ETDRS laser, Bevacizumab, Macular edema, Anti-VEGF.

Representativity of macular edema mapping using en face optical coherence tomography, retinal thickness map, and fluorescein angiography

Aim.To study the representativity of macular edema mapping using en face optical coherence tomography (OCT), retinal thickness map, and fluorescein angiography (FA).
 Methods.In this retrospective cross-sectional study, 8 patients (15 eyes) with diabetic macular edema (2 females and 6 males, mean age 66.58.1 years) were included. All patients OCT (retinal thickness map and en face OCT) and FA were performed. En face slab was constructed between inner plexiform layer and retinal pigment epithelium. Thearea of macular edema was measured by two masked graders independently.
 Results.There was no statistically significant difference in the area of macular edema between FA, en face OCT, and retinal thickness maps, 12.78.1, 14.58.4, 10.46.9 mm2, respectively (ANOVA3,p=0.34). Intraclass correlation coefficient for three methods was 0.87 and 0.95, for individual and mean values, respectively.
 Conclusion.En face OCT is an adequate non-invasive alternative for FA in evaluating the area of macular edema and planning of grid macular laser photocoagulation.

Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO. Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up. Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO.
 Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up.
 Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

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.

Focal laser application versus bevacizumab for treatment of central serous chorioretinopathy

Aim To report and compare the efficacy of macular grid laser versus intravitreal bevacizumab injection (IVBI) in patients with central serous chorioretinopathy (CSCR). Patients and methods A prospective study on 36 eyes of 35 patients with CSCR was conducted. The diagnosis of CSCR was established by fluorescein angiography and optical coherence tomography (OCT). All patients underwent measurement of best-corrected visual acuity, intraocular pressure, dilated fundus examination, and (OCT) imaging at baseline and follow-up visits. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Patients were classified into group A, comprising 19 patients who were treated with macular grid laser and group B, comprising 17 patients who were treated with IVBI. The outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and resolution of leakage. All cases were evaluated after 3, 6, 12, and 24 weeks. Data were classified into two groups and statistically analyzed. Results In group A, the mean age of patients was 43.6 years (range, 23–52 years), there were 11 (57.89%) males and eight (42.10%) females, and the mean of follow-up period was 9.2 months (range, 7–18 months). The mean log MAR visual acuity score improved from 0.8 to 0.40 after 3 months of follow-up. The mean baseline central macular thickness (CMT) was 466 µm (range, 358–576 µm), which decreased to 309 µm (range, 268–356 µm) after 6 weeks, with statistically significance difference change from the baseline, and to 247 µm (range, 225–319 µm) after 3 months, with statistically significance difference change from the baseline (P Conclusion Both macular grid laser and IVBI for CSCR can lead to improvements of visual acuity and hasten recovery period. Macular grid laser may be considered as effective as anti-vascular endothelial growth factor for treatment of CSCR. More studies using larger scales may be needed to clarify the uncertain relationship between pathogenesis and results of treatment.

Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation.

To compare retinal function changes in eyes with proliferative diabetic retinopathy (PDR) after intravitreal ranibizumab (IVR), combined or not with conventional (ETDRS) or multispot laser panretinal (PASCAL) photocoagulation (PRP). This study included laser-naive PDR patients that required PRP. Eyes were randomly and prospectively assigned to receive IVR or IVR combined with PASCAL or EDTRS. PRP was performed at baseline in 1 (PASCAL) or 2 (ETDRS) sessions. In eyes with macular edema, macular short pulse grid laser was associated with IVR at baseline and IVR was repeated monthly or quarterly if neovascularization was detected on angiography. Comprehensive ophthalmological evaluations, including SD-OCT, were performed at baseline and every 4weeks after treatment. Full-field electroretinography (ERG: extended ISCEV standard) was performed at baseline and at 12, 24 and 48weeks. IVR = 13, PASCAL = 15 and ETDRS = 15 eyes finished 48-week follow-up. There was a statistically significant BCVA improvement of 0.1-0.3 logMAR in all groups, and fluorescein angiography leakage area (FLA) reduced in 56%, 73%, and 73% from baseline for ETDRS, IVR and PASCAL, respectively, up to 48weeks without significant differences between groups (p > 0.05). A significant a- and b-wave amplitudes reduction was observed for dark- and light-adapted ERG for ETDRS and PASCAL, but only minor dark-adapted b-wave reduction was found for IVR, up to 48weeks. As an example, at week 48, combined response b-wave amplitude reduced in 181.5 ± 31.4µV, 128.0 ± 27.9µV and 82.4 ± 15.2µV for ETDRS, PASCAL and IVR (p < 0.05 each group), respectively. No significant difference was observed between ETDRS and PASCAL for any ERG parameter. IVR combined with single or multiple spot PRP causes similar retinal function impairment during 48weeks of observation, while IVR alone seems to be similarly effective controlling FLA without changing retinal function.

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.

Comparison between multispot laser and conventional laser in the treatment of diabetic clinically significant macular edema

Objectives The purpose of this study was to assess the safety and efficacy of multispot laser and conventional laser in the treatment of nonproliferative diabetic retinopathy with clinically significant macular oedema (CSME) in relation to the visual outcome, central macular thickness (CMT) using optical coherence tomography, and presence of adverse events. Patients and methods This prospective randomized study included a total of 50 eyes from the research institute of ophthalmology in 2015 that were divided into two groups of 25 patients each. Group A patients underwent focal or modified grid macular laser photocoagulation using green laser 532 nm. Group B patients underwent focal or modified grid macular laser photocoagulation using multispot laser photocoagulation Valon TT. Inclusion criteria were as follows: type II diabetes and clinically significant macular edema. Best-corrected visual acuity (BCVA), optical coherence tomography readings, intraocular pressure (IOP), and adverse events were recorded preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results The mean preoperative BCVA in conventional laser was 0.294 ± 0.17 decimal and that in multispot laser was 0.30 ± 0.21. The mean BCVA 3 months after laser in group A was 0.4820 ± 0.244 decimal (P = 0.001) and that in group B was 0.50 ± 0.20 (P = 0.001). The mean preoperative CMT in group A was 375.92 ± 65.69 μm and that in group B was 361.0 ± 50.400 μm. The mean CMT 3 months after laser in group A was 314.44 ± 85.94 μm (P = 0.001) um and that in group B was 0322.67 ± 57.50 μm (P = 0.001). The multispot system parameters used a higher power of 155 ± 90.1 mW (P = 0.001) compared with the conventional laser to produce the same therapeutic visible effect. Conclusion Multispot system was safe, rapid, and effective in the treatment of clinically significant macular edema in short-term follow-up periods and had a short exposure time. Although the short pulse duration of the multispot system necessitated the use of a higher power, it was not associated with adverse effects.

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.

Long-term Outcome of Laser Photocoagulation Combined with Ranibizumab Intravitreal Injection in Macular Edema Secondary to Retinal Vein Occlusion

Objective: To investigate the efficacy of laser photocoagulation combined with ranibizumab intravitreal injection in macular edema secondary to retinal vein occlusion in long term. Methods: 35 eyes with branch retinal vein occlusion (BRVO) and 37 eyes with central retinal vein occlusion (CRVO) treated with or without laser combined with ranibizumab were investigated in this retrospective study. Laser was conducted 7-10 days after the third ranibizumab injection if fluorescein angiography showed ischemic area. In BRVO, patients may receive both macular grid and local peripheral retinal laser. In CRVO, patients just received peripheral retinal laser. We estimated the changes in visual acuity, central retinal thickness (CRT), number of injections and laser over 14 months. Results: Both BCVA and CRT improved significantly in BRVO (P<0.05) but only CRT improved significantly in CRVO (P<0.05) among 14 months. The mean number of injections was 4.06 in BRVO and 8.14 in CRVO. Mean number of macular grid and peripheral laser was 0.31 and 0.86 in BRVO. Mean number of peripheral laser was 0.41 in CRVO. Conclusion: Laser photocoagulation was important to patients with macular edema secondary to RVO after ranibizumab injections and may reduce the number of injections relatively in long term.

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.