Macular Laser Photocoagulation Research Articles

Intravitreal Bevacizumab Alone or Combined with Macular Laser Photocoagulation for Recurrent or Persistent Macular Edema Secondary to Branch Retinal Vein Occlusion

Background. To evaluate the efficacy of intravitreal bevacizumab (IVB) injection with or without macular laser photocoagulation (MLP) for recurrent or persistent macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. Thirty-four eyes underwent IVB injection for ME secondary to BRVO as a primary treatment. Twenty of the 34 eyes experienced recurrent or persistent ME after the first IVB. Nine of the 20 eyes (Group 1) were retreated with IVB combined with MLP. The remaining 11 eyes (Group 2) were retreated with IVB alone. Results. In Group 1, the postoperative best corrected visual acuity (BCVA) improved compared with the preoperative value at all follow-up visits, although no statistically significant improvement was observed at 6 months. In contrast, BCVA significantly improved from 0.53 to 0.40 at 6 months (P < 0.05) in Group 2. Conclusion. Combined therapy tended to have a smaller effect on visual acuity compared with IVB monotherapy.

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.

Anti-vascular endothelial growth factor therapy for diabetic macular edema.

Diabetes mellitus is a serious health problem that affects over 350 million individuals worldwide. Diabetic retinopathy (DR), which is the most common microvascular complication of diabetes, is the leading cause of new cases of blindness in working-aged adults. Diabetic macular edema (DME) is an advanced, vision-limiting complication of DR that affects nearly 30% of patients who have had diabetes for at least 20 years and is responsible for much of the vision loss due to DR. The historic standard of care for DME has been macular laser photocoagulation, which has been shown to stabilize vision and reduce the rate of further vision loss by 50%; however, macular laser leads to significant vision recovery in only 15% of treated patients. Mechanisms contributing to the microvascular damage in DR and DME include the direct toxic effects of hyperglycemia, sustained alterations in cell signaling pathways, and chronic microvascular inflammation with leukocyte-mediated injury. Chronic retinal microvascular damage results in elevation of intraocular levels of vascular endothelial growth factor A (VEGF), a potent, diffusible, endothelial-specific mitogen that mediates many important physiologic processes, including but not limited to the development and permeability of the vasculature. The identification of VEGF as an important pathophysiologic mediator of DME suggested that anti-VEGF therapy delivered to the eye might lead to improved visual outcomes in this disease. To date, four different inhibitors of VEGF, each administered by intraocular injection, have been tested in prospective, randomized phase II or phase III clinical trials in patients with DME. The results from these trials demonstrate that treatment with anti-VEGF agents results in substantially improved visual and anatomic outcomes compared with laser photocoagulation, and avoid the ocular side effects associated with laser treatment. Thus, anti-VEGF therapy has become the preferred treatment option for the management of DME in many patients.

Controversies in the surgical treatment of RVO ‐ Associated macular edema

AbstractMacular edema is the main cause of decreased visual acuity in retinal vein occlusions (RVOs). Most approaches to the management of RVOs, such as grid macular laser photocoagulation and intraocular injections of drugs, are addressed to reduce the permeability of the macular vascular net and to increase the vitreoretinal fluid exchange of oxygen and protecting factors. However, we need to solve the primary mechanism of the disease: the vein occlusion. In order to reperfuse the thrombosed vein, Radial Optic Neurotomy (RON) is a surgical procedure aimed at solving the “compartment syndrome” that may exist in eyes with CRVO or hemicentral RVO. Sheathotomy specifically releases the compressive factor at the arteriovenous crossings by sectioning the adventicial seath. Recombinant tissue plasminogen activator (r‐tPA) has been administered by several routes, including systemic, intravitreal and by endovascular cannulation of retinal vessels. PPV with peeling of the internal limiting membrane has also been suggested. Surgery remains a good treatment option for patients with very recent and edematous occlusion with poor visual acuity, as reperfusion of the vein is the best approach to treat the macular edema and avoid ischemic complications.

MACULAR LASER GRID ALONE VERSUS COMBINED WITH INTRAVITREAL TRIAMCINOLONE PLUS BEVACIZUMAB FOR DIABETIC MACULAR EDEMA

Diabetic retinopathy is the leading cause of blindness among individuals of working age in advanced societies, most of the vi sion loss resulting from diabetic macula r edema (DME) . Macular laser photocoagulation or i ntravitreal tiamcinolone or anti - vascular endothelial growth factor injection are modalities of therapy for diabetic macular edema. T his study aim was to present the clinical outcomes of 60 eyes of 41 patie nts with diffuse DME who treated with macular laser grid (MLG) alone or combined with intravitreal triamcinolone (IVTA) and intravitreal bevacizumab (IVB) injection. Thirty eyes (group1) treated with MLG and 30 eyes (group 2) treated with MLG + IVB + IVTA. The values of BCVA, central macular thickness ( CMT ) , intraocular pressure ( IOP ) and complications were compared between two groups. At baseline, BCVA was 0.35 ± 0,18 LogMAR (logarithm of the minimum angle of resolution ) in the group 1 and 0.36 ± 0.36 ± 0. 14 logMAR in the group 2. At 6 and 20 months after initial treatment in both groups had no significant improvement in BCVA, whereas had a significan t improvement in CMT (p < 0.001) compared with baseline. An increase in IOP was present in 13 % and cataract was developed in 6.7 % in the group 2. At 6 th and 20 th month , MLG and MLG + IVTA + IVB provided improvement of BCVA and CMT in the both groups . There was no significant difference in BCVA and CMT betwee n two groups. Increased IOP and devel opment of catar act was recorded i n the group 2 secondary to IVTA . MLG may be preffer ed for treatment of DME because of side events of IVTA + IVB.

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

PurposeTo evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.MethodsTwenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both.ResultsThe mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012).ConclusionsVitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.

Comparison of Natural Course, Intravitreal Triamcinolone and Macular laser photocoagulation for Treatment of Mild Diabetic Macular Edema

Purpose: To assess the natural course of the mild diabetic macular edema(DME) and to compare the visual outcomes with the patients with receiving either macular laser photocoagulation or intravitreal injection of triamcinolone acetonide(IVTA).Methods: 28 eyes with central macular thickness (CMT) of between 250 to 300µm were followed without treatment and 48 eyes with CMT between 300 to 500µm had been divided into 3 subgroups according to treatment. We evaluated the best corrected visual acuity (BCVA) and CMT of natural course group and compared the BCVA and CMT of the patients who had been treated with IVTA or macular laser treatment.Results: The eyes with DME between 250 to 300µm showed no significant change in BCVA and CMT at 6 month. Among the eyes with DME between 300 to 500µm, all 3 subgroups showed no statistically significant change of BCVA at any follow up period and no significant difference was revealed among the subgroups. All subgroups showed significant reduction of CMT after 1 month and maintained until final follow-up and there was no significant difference among subgroups.Conclusions: Mild DME between 250 to 500µm did not show significant worsening of BCVA or macular edema without any specific treatment.

Optical coherence tomography confirmed resolution of macular edema in a diabetic patient after hemodialysis.

The authors report the first case, to their knowledge, of resolution of diffuse macular edema after hemodialysis, which has been confirmed by optical coherence tomography. A 53-year-old white woman with type 2 diabetes developed worsening macular edema and was examined in the ophthalmology clinic and scheduled for macular grid laser photocoagulation. The laser, however, was deferred for 4 weeks because she had also developed end-stage renal failure and required hemodialysis. When she was reviewed in the ophthalmology clinic 4 weeks later for laser therapy, it was found that her macular edema had resolved, vision had improved, and laser was unnecessary. Review at 6 months showed that the macular edema remains resolved. Ophthalmologists should be aware that hemodialysis may reduce macular edema in such patients.

Critical appraisal of ranibizumab in the treatment of diabetic macular edema

Diabetic retinopathy is the leading cause of blindness among individuals of working age in industrialized nations, with most of the vision loss resulting from diabetic macular edema (DME). The formation of DME depends on the action of several growth factors and inflammatory mediators, but vascular endothelial growth factor (VEGF) appears to be critical for breaking down the blood-retinal barrier and promoting the accumulation of macular edema. Laser photocoagulation has been the standard-of-care for three decades, and although it stabilizes vision, significant gains in visual acuity after treatment are unusual. Several VEGF inhibitors (pegaptanib, aflibercept, and ranibizumab) have been initially developed and tested for the treatment of age-related macular degeneration and subsequently for DME. In Phase I, II, and III trials for DME, ranibizumab has been shown to be superior to macular laser photocoagulation and intraocular triamcinolone acetonide injections for improving visual acuity and drying the macula. As a result, ranibizumab is the only anti-VEGF drug that has been approved by the United States Food and Drug Administration for the treatment of DME. Most experts now consider intravitreal anti-VEGF therapy to be standard-of-care for DME involving the fovea.

Navigated macular laser decreases retreatment rate for diabetic macular edema: a comparison with conventional macular laser

BackgroundThe purpose of this study was to evaluate and compare clinical outcomes and retreatment rates using navigated macular laser versus conventional laser for the treatment of diabetic macular edema (DME).MethodsIn this prospective, interventional pilot study, 46 eyes from 46 consecutive patients with DME were allocated to receive macular laser photocoagulation using navigated laser. Best corrected visual acuity and retreatment rate were evaluated for up to 12 months after treatment. The control group was drawn based on chart review of 119 patients treated by conventional laser at the same institutions during the same time period. Propensity score matching was performed with Stata, based on the nearest-neighbor method.ResultsPropensity score matching for age, gender, baseline visual acuity, and number of laser spots yielded 28 matched patients for the control group. Visual acuity after navigated macular laser improved from a mean 0.48 ± 0.37 logMAR by a mean +2.9 letters after 3 months, while the control group showed a mean −4.0 letters (P = 0.03). After 6 months, navigated laser maintained a mean visual gain of +3.3 letters, and the conventional laser group showed a slower mean increase to +1.9 letters versus baseline. Using Kaplan-Meier analysis, the laser retreatment rate showed separation of the survival curves after 2 months, with fewer retreatments in the navigated group than in the conventional laser group during the first 8 months (18% versus 31%, respectively, P = 0.02).ConclusionThe short-term results of this pilot study suggest that navigated macular photocoagulation is an effective technique and could be considered as a valid alternative to conventional slit-lamp laser for DME when focal laser photocoagulation is indicated. The observed lower retreatment rates with navigated retinal laser therapy in the first 8 months suggest a more durable treatment effect.

Combined intravitreal ranibizumab and grid laser photocoagulation for branch retinal vein occlusion with macular edema

Objective To observe the effectiveness of combined therapy of intravitreal injections of ranibizumab and macular grid laser photocoagulation for branch retinal vein occlusion (BRVO) with macular edema (ME).Methods Forty-six patients of BRVO with ME were enrolled in this study.All the patients were examined for corrected visual acuity of Early Treatment Diabetic Retinopathy Study (ETDRS),slit lamp microscope,direct ophthalmoscope,intraocular pressure,fundus color photography,fundus fluorescein angiography and optical coherence tomography.The patients were divided into three groups by different treatments:injection group (18 eyes) received intravitreal injections of ranibizumab only,joint group (17 eyes) received intravitreal injections of ranibizumab combined with grid laser photocoagulation,and laser group (11 eyes) received laser photocoagulation only.The follow-up ranged from three to 15 months,with a mean of (8.0±3.2) months.The same equipment and methods were used to return visit in follow-up period.Repeated injections were adopted in injection group and joint group according to the results of subsequent visits.Then the repeated times of injection in two groups were compared.The visual acuity,macular retinal thickness (CRT) and ocular and systemic adverse reactions about drugs and treatments were followed up.The last follow-up time was considered as the judgment time for the therapeutic effects.Results The mean repeat times of injection in the injection group was 5.4±0.4,which more than that in the joint group 3.2±0.6 (t =12.17,P＜0.05).No ocular or systemic adverse events were observed in follow-up period.ETDRS visual acuity of injection group,joint group and laser group increased by 7.30 ± 8.68,8.50±6.04,1.55±6.85 letters respectively after treatment.The differences were statistically significant before and after treatment in injection group and joint group (t=3.58,5.78; P＜0.05),but there was no significant difference in laser group (t=0.75,P＞0.05).The difference was not statistically significant between injection group and joint group (t=0.45,P＞0.05).The difference was statistically significant between injection group and laser group,but also between joint group and laser group (t=2.13,2.81; P＜0.05).CRT of injection group,joint group and laser group decreased by (110.56±43.08),(125.47±35.19),(50.73 ± 19.68) μm respectively after treatment,with statistically significant differences ( t =-10.89,-14.70,-8.55; P＜ 0.05).Conclusion In the treatment of BRVO with ME,intravitreal injection of ranibizumab combined with macular grid laser photocoagulation can reduce repeat times of injection,improve visual function and relieve ME. Key words: Retinal vein occlusion/therapy; Antibodies, monoclonal/therapeutic use; Laser coagulation

Time required for navigated macular laser photocoagulation treatment with the Navilas®

Navilas laser is a novel technology combining photocoagulation with imaging, including fluorescein angiographic (FA) images which are annotated and aligned to a live fundus view. We determine the time necessary for planning and treatment of macular edema utilizing the Navilas. The screen recordings during treatments were retrospectively analyzed for treatment type, number of laser shots, the duration of planning (measured from the time the planning image was selected to time of marking the last planned treatment spot), and total time of laser application. A total of 93 treatments (30 grid, 30 focal and 33 combined treatments) by four physicians from three sites were included. An average of 125 spots were applied to each eye. The total time spent for each focal treatment - including the planning was 7 min 47 s (±3 min and 32 s). Navilas is a novel device providing a time efficient platform for evaluating FA images and performing threshold macular laser photocoagulation.

Intravitreal bevacizumab injection with grid laser photocoagulation for macular oedema in branch retinal vein occlusion

AbstractPurpose To evaluate the effects of intravitreal bevacizumab (IVB) with grid laser photocoagulation for macular edema in branch retinal vein occlusion (BRVO).Methods This was a retrospective case series. Ten eyes in 10 patients with macular edema secondary to BRVO with at least 3 months of symptom duration were included. The mean follow‐up term was 70.2 ± 8.4 weeks. Patients underwent IVB at baseline and macular grid laser photocoagulation 1 week later. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were examined during the monthly follow‐up. If persistent or recurrent fluid collection appeared in optical coherence tomography (OCT) , additional IVB were performed. To evaluate differences between baseline and post‐treatment BCVA and CMT, Fisher exact test was performed.Results The mean baseline BCVA was 0.31±0.17 (mean±SD), and the mean CMT was 530±109 µm. The mean BCVA at 4, 12 and 24 weeks were 0.49±0.21 (p=0.030), 0.47±0.60 (p=0.038), and 0.41±0.85 (p=0.041), respectively. The mean CMT were 285±75 µm (p&lt;0.01), 304±120 µm (p&lt;0.01), and 325±145 µm (p=0.015). A mean 1.85 injections were administered and the second injection was done at a mean 3.52 months after baseline.Conclusion IVB and additional grid photocoagulation were effective for macular edema in BRVO, and the improvement maintained for 6 months.

TWO-YEAR RESULTS OF A RANDOMIZED TRIAL OF INTRAVITREAL BEVACIZUMAB ALONE OR COMBINED WITH TRIAMCINOLONE VERSUS LASER IN DIABETIC MACULAR EDEMA

The purpose of this study was to report the 24-month findings of a randomized clinical trial comparing intravitreal bevacizumab (IVB) injection alone or in combination with intravitreal triamcinolone acetonide (IVT) versus macular laser photocoagulation (MPC) as a primary treatment for diabetic macular edema. The eyes were randomly assigned to 1 of the 3 study arms: the IVB group, patients who received 1.25 mg IVB; the IVB/IVT group, patients who received 1.25 mg of IVB and 2 mg of IVT; and the MPC group, patients who underwent focal or modified grid laser. Of 150 eyes (50 in each group) in the primary trial, 123, 119, and 113 eyes completed follow-ups at 12, 18, and 24 months, respectively. A total of 39 (78%), 36 (72%), and 38 (76%) eyes in the IVB, IVB/IVT, and MPC groups remained in the study within 24 months, respectively. Retreatment was performed at 3-month intervals whenever indicated. Data from a 24-month follow-up are presented. Changes in best-corrected visual acuity and central macular thickness up to 24 months were the main outcome measures in this study. Retreatment was required in 37 (94.9%), 27 (75.0%), and 31 (81.6%) eyes, respectively, in the IVB, IVB/IVT, and MPC groups up to 24 months. The significant superiority of visual acuity improvement in the IVB group, which had been noted at Month 6, did not sustain thereafter up to 24 months, and the difference among the groups was not significant at all visits. However, the mean visual acuity improvement was greater in the IVB group than the other groups and in the IVB/IVT group compared with the MPC group. The reduction of central macular thickness was more in the IVB group in relation to the other two treatment groups; however, the difference among the groups was not statistically significant at any of the follow-up visits. In terms of vision improvement, the significant superiority of the IVB over the combined IVB/IVT and MPC treatment that had been observed at Month 6 did not sustain up to 24 months. This means that although IVB treatment may be a better choice than two other options in short term, the magnitude of this beneficial effect diminishes over time.

A Three-year Follow-up of Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Diffuse Diabetic Macular Edema

PurposeTo report the three-year outcomes of macular laser photocoagulation following intravitreal injection of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME).MethodsA prospective, randomized controlled study was completed. Eighty-six eyes of 74 patients with diffuse DME were randomized into two groups. Eyes assigned to the combination group (n = 48) were subjected to macular laser photocoagulation three weeks after IVTA. Eyes in the IVTA group (n = 38) underwent IVTA alone. Central macular thickness was measured by optical coherence tomography, and the number of additional treatments and mean time to recurrence were assessed.ResultsThirty-seven eyes in the combination group and 26 eyes in the IVTA group completed the three-year follow-up. Recurrence of DME after initial treatment was not observed for nine of the 37 (24.3%) eyes in the combination group or for one of the 26 (3.9$) eyes in the IVTA group (p = 0.028). DME was absent for 19.9 months after treatment in the combination group compared to 10.3 months in the IVTA group (p = 0.027). The mean number of additional treatments was 0.92 in the combination group and 1.88 in the IVTA group (p = 0.001).ConclusionsResults in the subset of subjects who completed the three-year follow-up demonstrated that laser photocoagulation following IVTA is more effective than IVTA monotherapy for diffuse DME. Combination therapy required fewer additional treatments and resulted in a lower recurrence rate than IVTA monotherapy.

Combination therapy for diabetic macular edema.

Diabetic macular edema is a main reason for visual loss in diabetic patients. Until recent years, macular laser photocoagulation was the only available therapy. The awareness that inflammation is an important factor in the pathogenetic process of DME gave reason for intravitreal treatment with corticosteroids. The introduction of anti-VEGF drugs brought a revolutionary change in the treatment of DME. This paper will review the important clinical trials with an emphasis on combination therapies.

Short-term results of intravitreal dexamethasone implant (OZURDEX®) in treatment of recalcitrant diabetic macular edema: A case series

Context:Dexamethasone Posterior-Segment Drug Delivery System is a novel, biodegradable, sustained-release drug delivery system (OZURDEX®) for treatment of macular edema following retinal vein occlusion and posterior uveitis. However, its potential role in management of diabetic macular edema has not been reported yet.Aim:The aim was to evaluate the safety and efficacy of (OZURDEX®) in patients with recalcitrant diabetic macular edema (DME).Setting and Design:A retrospective, interventional case series from a tertiary eye care center in India is presented. Inclusion criteria comprised patients presenting with recalcitrant DME, 3 or more months after one or more treatments of macular laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (VEGF) injections. Exclusion criteria included history of corticosteroid-responsive intraocular pressure (IOP) rise, cataract extraction, or other intraocular surgery within 3 months. The main outcome measure was visual acuity at 1 and 4 months after OZURDEX® injection. Secondary outcome measures included change in central macular thickness on Optical coherence tomography (OCT) and changes in IOP following intravitreal OZURDEX® implant. Of 18 eyes (17 patients) with recalcitrant diabetic macular edema that underwent OZURDEX® implant, three eyes (two patients) had follow-up of more than 3 months post-injection.Results:Mean age of patients was 56 years. Mean duration of diabetes mellitus was 16.6 years. Systemic control of DM was good as assessed by FBS/PPBS and HbA1c. The pre-operative mean central macular thickness was 744.3 μm and improved to 144 and 570 μm at months 1 and 4, respectively. Preoperative mean BCVA was 0.6 logMAR units and improved to 0.3 and 0.46 logMAR units at month 1 and 4, respectively. The mean follow-up was 4.3 months (range 4-5 months).Conclusion:OZURDEX® appears efficacious in management of recalcitrant diabetic macular edema. The results of the ongoing POSURDEX® study will elaborate these effects better.

Combination of vitrectomy, IVTA, and laser photocoagulation for diabetic macular edema unresponsive to prior treatments; 3-year results

To evaluate the long-term effects of combined therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation on diabetic macular edema (DME) unresponsive to prior treatment. Medical records of 46 eyes of 41 subjects who underwent sequential combined therapy consisting of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for refractory DME of non-tractional origin were reviewed. Best-corrected visual acuity (BCVA), central subfield thickness (CST) of macula, and number of additional treatments were analyzed. Forty eyes of 35 patients completed a 3-year follow-up. The mean (± SD) CSTs before and 6months, 1year, 2years, and 3years after the administration of combined therapy in these eyes were 499.1 ± 174.9, 224.2 ± 110.2, 273.4 ± 173.5, 237.5 ± 84.2 and 219.4 ± 66.6 µm, respectively (p < 0.001). The mean (± SD) logMAR BCVA before and 6months, 1year, 2years, and 3years after the combined therapy were 0.82 ± 0.32, 0.69 ± 0.40, 0.63 ± 0.39, 0.61 ± 0.46, and 0.55 ± 0.44, respectively (p < 0.001). Thirty-one of 40 eyes (77.5%) exhibited no recurrence of DME after the combined therapy. No visually significant complications other than progression of lens opacity and elevation of intraocular pressure were noted during the study period. This study demonstrated the long-term stability and efficacy of the combined therapy described herein for the treatment of refractory DME.

Combined Intravitreal Bevacizumab and Grid Laser Photocoagulation for Macular Edema Secondary to Branch Retinal Vein Occlusion

To evaluate long-term efficacy of intravitreal bevacizumab (IVB) versus combined IVB and macular grid laser photocoagulation for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). In this prospective study, 18 eyes were randomized into 2 groups according to treatment: Group 1 (9 eyes) underwent IVB at baseline, at month 1, and at month 2; Group 2 (9 eyes) underwent same IVB protocol combined with macular grid laser photocoagulation. Macular edema and visual acuity represented the endpoints of the study. IVB reinjections were performed in both groups if recurrent macular edema was diagnosed. Spectral domain optical coherence tomography examination as well as visual acuity examination were performed during follow-up. Statistical evaluation was performed for a matched-pair analysis. In Group 1, median baseline central retinal thickness (CRT) decreased from 420 µm (95% confidence interval 355.6-484.4) to 323 µm (261.44-384.56) at month 12 (p=0.06); median baseline BCVA improved from 0.7 logMAR (0.54-0.86) to 0.4 logMAR (0.29-0.51) at month 12 (p<0.01). In Group 2, baseline CRT decreased from 386 µm (353.91-418.09) to 238 µm (200.58-275.42) at month 12 (p<0.01); median BCVA improved from 0.6 logMAR (0.45-0.75) to 0.2 logMAR (0.12-0.28) at month 12 (p<0.01). A statistically significant difference (p=0.03) was found regarding the median number of injections (Group 1: 4±1.1; Group 2: 3±0.4). Both treatment modalities appeared effective to control BRVO-induced macular edema. In the combined-treatment Group, we observed a lower number of reinjections during follow-up, suggesting the efficacy of grid laser photocoagulation to reduce the number of intravitreal injections and maintain short- and long-term results of the therapy.

Intravitreal injection of bevacizumab combined with macular grid laser photocoagulation for macular edema in branch retinal vein occlusion

To evaluate the effects of combined therapy of intravitreal injections of bevacizumab (IVB) and additional macular grid laser photocoagulation for recurrent macular edema in branch retinal vein occlusion (BRVO). This was a retrospective interventional case series in which 44 eyes of 44 patients with macular edema due to BRVO were studied. The mean follow-up term was 77.2 ± 12.4 weeks. All patients underwent IVB as a primary therapy. After two to three IVB, 19 of the 44 eyes (43.2%) underwent laser photocoagulation in the macular edema area to prevent the recurrence of the edema. In the other 25 eyes (56.8%), macular edema was successfully treated with IVB only. Visual acuity and central macular thickness (CMT) were examined during the follow-up. The mean visual acuity and the mean CMT in both groups improved significantly after the IVB. Following macular grid laser photocoagulation for recurrent macular edema, the mean visual acuity was maintained for 24 weeks, however, the mean CMT increased significantly after 12 weeks. Additional grid laser photocoagulation for recurrent macular edema in BRVO after IVB maintained mean visual acuity with limited effects on the further recurrence of macular edema.