#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Treating Diabetic Macular Edema by a Micropulse Laser – First Findings


Authors: M. Závorková;  L. Procházková
Authors‘ workplace: Oční klinika UJEP, Krajská zdravotní a. s., Masarykova nemocnice Ústí nad Labem primářka MUDr. Ivana Liehneová Ph. D.
Published in: Čes. a slov. Oftal., 71, 2015, No. 5, p. 223-228
Category: Original Article

Overview

Introduction:
Diabetic macular edema (DME) is the most common cause of a visus dicrease in patients suffering type 2 diabetes. DME originates in abnormal macula capillars permeability. This study presents the findings of observing patients with DME after by micropulse laser therapy with the wavelength of 577 nm.

Methods:
The study covers 23 eyes of 15 patients with focal or difuse DME. In all patients we performed a 577 nm micropulse laser therapy of the macula, proceeding by a technique of placing spots next to each other in the shape of EDTRS optotype letters. In average we performed 3 treatments per eye.

Results:
Best-corrected visual acuity (BCVA) was 61,8 of a letter at the beginning, 62,5 of a letter after 3 months, 59,5 of a letter after 6 months, 57,6 of a letter after 9 months and 59,2 of a letter after 12 months. The average difference between BVAC at the beginning and after a year was -2.7 of a letter. A T-test does shows statistically insignificant difference.

The average central retinal thickness (CRT) was 380,4 µm at the beginning, 368,1 µm after 3 months, 327,5 µm after 6 months, 329,2 µm after 9 months and 301,0 µm after 12 months. The difference between the average CRT at the beginning and after 12 months was -79,5 µm. A T-test shows statistically significant difference.

Discussion:
Our studied group reported visus improvement or stabilization in 61% of eyes and decrease or stabilization of DME in 83% of eyes. Without treatment a deterioration would occur due to the progressive nature of the disorder. Taking into account these results and relevant literature we resolved to change our treatment methods in favour of placing laser spots as close as possible. An evaluative study of this method will follow.

Conclusion:
In the studied group the average CRT improved and the average BCVA remained virtually equal. Treating DME by means of a micropulse laser has proven to be an effective method. It does not leave scars on retina and thus prevents creating scotoms. If the edema is higher or a resistent cyst occurs in the macula, it is recommended to combine laser and anti-VEGF therapies. In case of insufficient effects of a laser therapy there is a possibility of combining it with an anti-VEGF treatment.

Key words:
diabetic macular edema, laser treatment, micropulse laser


Sources

1. Beck, RW., Moke, PS., Turpin, AH. at al.: A computerized method of visual acuity testing: adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol, 135; 2003, 2: 194–205.

2. Elman, MJ., Aiello, LP., Beck, RW.: Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology, 117; 2010: 1064 –1077.

3. Feistmann, JA., Rosenthal, JL.: Making the Jump to MicroPulse Laser Therapy for Treating the Macula, An effective first-line therapy or adjunct to current treatments. MicroPulse safely treats areas of the retina including the fovea.Iridex [online] Dostupné na WWW:
http://www.iridex.com/Portals/0/pdf/Rosenthal_Feistmann_webinar_writeup.pdf

4. Chen, E., Looman, M., Laouri, M. et al.: Burden of illness of diabetic macular edema: literature review. Curr Med Res Opin, 26; 2010, 7: 1587–97.

5. Kalvodová, B.: Screening diabetické retinopatie v ČR – guideline. Čes a Slov Oftal, 58; 2002: 3–10.

6. Kalvodová, B., Oudová, P.: Screening diabetické makulopatie. Čes a Slov Oftal, 58; 2002: 11–15.

7. Kalvodová, B., Pelikánová, T. et al.: Doporučené postupy pro diagnostiku a léčbu diabetické retinopatie. Čes a Slov Oftal, 68; 2012: 236–241.

8. Lavinsky, D., Cardillo, JA., Mělo, LA. Jr. et al.: Randomized clinical trial evaluating mETDRS versus normal or high-density micropulse photocoagulation for diabetic macular edema. Invest Ophthalmol Vis Sci, 52; 2011, 7: 4314–23.

9. Luttrull, JK., Dorin, G.: Subtreshold Diode Micropulse Laser Photocoagulation (SMD) as Invisible Retinal Phototherapy for Diabetic Macular Edema: A Review, Current Diabetes Reviews, 2012; 8: 274–284.

10. Mansour, S., Gossage, D.: Tissue-sparing MicroPulse 577 nm Laser Therapy: The “Aha” Moment from the Ultimate Skeptic. Supplement to Retina today, 2012, 6/7: 4–6.

11. Mitchell P., Bandello F., Schmidt-Erfurth U.: The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology, 2011; 118: 615–625.

12. Pelikánová, T.: Patogeneze Diabetické retinopatie. Vnitř Lék, 53; 2007, 5: 498–505.

13. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol, 103; 1985:1796–1806.

14. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology, 98; 1991, 5 Suppl: 766–85.

15. Shamsi, HN., Masaud, JS., Ghazi NG.: Diabetic macular edema: New promising therapies. World J Diabetes, 4; 2013, 6: 324–38.

16. Sosna, T., Švancarová, R., Netuková, M. et al.: Současný pohled na diabetický makulární edém. Čes a Slov Oftal, 68; 2012: 91–97.

17. Sosna, T., Švancarová, R., Netuková, M.: Diabetická retinopatie – rizikové faktory, prevence a terapie. Čes a Slov Oftal, 66; 2010: 195–203.

18. Studnička, J.: Diabetický makulární edém – nové možnosti léčby. Čes a Slov Oftal, 68; 2012: 61–63.

19. Vujosevic, S., Bottega, E., Casciano, M. et al.: Microperimetry and fundus autofluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. Retina, 30; 2010 6: 908–16.

20. Williams, R. Airey, M. Baxter, H.: Epidemiology of diabetic retinopathy and macular oedema: a systematic review, Eye [online]. 2004, č.18. [cit. 2 July 2004] Dostupné na WWW: <http://www.nature.com/eye/journal/v18/n10/full/6701476a.html#abs>

21. Yu, AK., Merrill, KD., Truong, SN. et al.: The comparative histologic effects of subthreshold 532- and 810-nm diode micropulse laser on the retina. Invest Ophthalmol Vis Sci, 54; 2013, 3: 2216–24.

22. Zvolský, M.: Činnost oboru diabetologie, péče o diabetiky v roce 2012, ÚZIS ČR [online]. 2013 č.24 [cit. 9. července 2013] Dostupné na WWW: www.uzis.cz/rychle-informace/cinnost-oboru-diabetologie-pece-diabetiky-roce-2012

Labels
Ophthalmology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#