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

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.