How do we evaluate the role of focal/grid photocoagulation in the treatment of diabetic macular ede-ma?

Søren Leer Blindbæk, Tunde Peto, Jakob Grauslund

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Abstract

Vascular endothelial growth factor inhibitors (anti-VEGF) have consistently demonstrated efficacy and safety and changed both the aim and perspectives of diabetic macular edema (DME) treatment. Hence, the present and future role of focal/grid laser photocoagulation in DME-treatment has been subjected to some debate. However, extensive insight into technical advances in novel laser systems, treatment pro-tocols of anti-VEGF trials and the functional impact of modern focal/grid photocoagulation is needed to evaluate the present and future role of photocoagulation in DME-treatment.
Across a wide range of clinical trials laser therapy was required as adjunctive/rescue treatment in approx-imately 20-50% of patients receiving anti-VEGF monotherapy for center involving DME. Further, a lower retreatment rate and a more stable reduction of retinal thickness have been demonstrated in more stud-ies. However, lacking information on the laser systems used, their technical specifications and protocols of application often complicates direct comparison of results in anti-VEGF trials. Hence, this paper aimed to provide an overview of the current available data relevant to the potential role of focal/grid laser pho-tocoagulation in DME-treatment including a thorough overview of the current most commonly used laser systems.

Results with subthreshold diode micropulse laser photocoagulation are intriguing and may offer a valua-ble option as adjunctive therapy to anti-VEGF treatment. However, more well designed studies on com-bination therapy are warranted to determine the full potential of modern retinal photocoagulation sys-tems.
In conclusion, current data suggest that focal/grid laser therapy should still be an option for consideration as adjunctive therapy in many patients.
Original languageEnglish
Number of pages8
JournalActa Ophthalmologica
Early online date21 Dec 2018
DOIs
Publication statusPublished - 29 Apr 2019

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