Optical coherence tomography-guided selective focal laser photocoagulation: a novel laser protocol for diabetic macular edema

  • Joo Youn Shin
  • Suk Ho ByeonEmail author
  • Oh Woong Kwon
Retinal Disorders



To compare the anatomic and functional results between optical coherence tomography (OCT)-guided selective focal laser photocoagulation (OCT–laser) and conventional modified Early Treatment Diabetic Retinopathy Study (mETDRS) laser treatment for diabetic macular edema (DME).


We analyzed treatment outcomes in 47 consecutive eyes treated with OCT–laser compared to 31 matched eyes treated with mETDRS. In the OCT–laser group, we identified ‘significant actively-leaking microaneurysms on OCT’ (SALMO) which are responsible for edema in OCT B-scan images, and thoroughly ablated them with photocoagulation. Best-corrected visual acuity (BCVA) and retinal thickness by OCT were compared at baseline and 12 months after treatment between two groups.


OCT–laser treatment resulted in significant improvements in BCVA, central subfield thickness (CST), and maximum retinal thickness (MRT) from baseline at 12 months from the time of therapy (+2.5 letter score, p = 0.04; −45.56 μm in CST, p < 0.001; −91.6 μm in MRT, p < 0.001). The mean number of treated ‘SALMO’ was 5.6 ± 4.0 (range 1–26), while the number of MAs in ‘treatable lesions’ by fluorescein angiography (FA) in the same eye was 16.3 ± 11.8 (range 2–42). There was no difference between OCT–laser and mETDRS groups in changes of these parameters from baseline at 12 months (p = 0.56, p = 0.89, p = 0.43 respectively). Fundus autofluorescence (FAF) and OCT revealed less tissue damage in OCT–laser-treated eyes, compared to eyes treated with mETDRS (p < 0.001).


OCT–laser shows similar anatomic and functional outcomes compared to conventional laser (modified ETDRS), with significantly less retinal damages.


Diabetic macular edema Diabetic retinopathy Focal laser photocoagulation Macular laser photocoagulation Microaneurysm Spectral-domain optical coherence tomography 



This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2013R1A1A2007865)

Meeting Presentation: Partly presented at the 36th annual meeting of the Macular Society, Feb 2013, Dana Point, CA, USA.

The authors want to thank Hye Sun Lee (Biostatistics Collaboration Unit, Yonsei University College of Medicine) for statistical support.

Conflict of interest

The authors have no proprietary or commercial interest in any materials discussed in this article.

Supplementary material

Online Resource 1

Serial morphological changes on OCT after OCT-guided selective focal laser photocoagulation. Serial regression pattern of ‘significant actively leaking microaneurysms on OCT’ (SALMO) with resolution of adjacent edema after OCT-guided selective focal laser photocoagulation (MPG 4448 kb)


  1. 1.
    Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 1. Arch Ophthalmol 103:1796–1806CrossRefGoogle Scholar
  2. 2.
    Aiello LP, Edwards AR, Beck RW et al (2010) Factors associated with improvement and worsening of visual acuity 2 years after focal/grid photocoagulation for diabetic macular edema. Ophthalmology 117:946–953CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Diabetic Retinopathy Clinical Research Network, Elman MJ, Aiello LP et al (2010) Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 117:1064–1077CrossRefGoogle Scholar
  4. 4.
    Blair NP, Shahidi M, Lai WW, Zelkha R (2008) Correlation between microaneurysms and retinal thickness in diabetic macular edema. Retina 28:1097–1103CrossRefPubMedGoogle Scholar
  5. 5.
    Writing Committee for the Diabetic Retinopathy Clinical Research Network, Fong DS, Strauber SF et al (2007) Comparison of the modified Early Treatment Diabetic Retinopathy Study and mild macular grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol 125:469–480CrossRefGoogle Scholar
  6. 6.
    Van Dijk HW, Verbraak FD, Kok PHB et al (2013) Variability in photocoagulation treatment of diabetic macular oedema. Acta Ophthalmol 91(8):722–727CrossRefPubMedGoogle Scholar
  7. 7.
    Massin P, Bandello F, Garweg JG et al (2010) Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care 33:2399–2405CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Nguyen QD, Brown DM, Marcus DM et al (2012) Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 119:789–801CrossRefPubMedGoogle Scholar
  9. 9.
    Mitchell P, Bandello F, Schmidt-Erfurth U et al (2011) The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology 118:615–625CrossRefPubMedGoogle Scholar
  10. 10.
    Do DV, Nguyen QD, Khwaja AA et al (2013) Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment. JAMA Ophthalmol 131:139–145CrossRefPubMedGoogle Scholar
  11. 11.
    Wang H, Chhablani J, Freeman WR et al (2012) Characterization of diabetic microaneurysms by simultaneous fluorescein angiography and spectral-domain optical coherence tomography. Am J Ophthalmol 153:861–867CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Horii T, Murakami T, Nishijima K et al (2010) Optical coherence tomographic characteristics of microaneurysms in diabetic retinopathy. Am J Ophthalmol 150:840–848CrossRefPubMedGoogle Scholar
  13. 13.
    Byeon SH, Chu YK, Hong YT et al (2012) New insights into the pathoanatomy of diabetic macular edema: angiographic patterns and optical coherence tomography. Retina 32:1087–1099CrossRefPubMedGoogle Scholar
  14. 14.
    Early Treatment Diabetic Retinopathy Study Research Group (1987) Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Ophthalmology 94:761–774CrossRefGoogle Scholar
  15. 15.
    Shahidi M, Ogura Y, Blair NP et al (1991) Retinal thickness analysis for quantitative assessment of diabetic macular edema. Arch Ophthalmol 109:1115–1119CrossRefPubMedGoogle Scholar
  16. 16.
    Lobo CL, Bernardes RC, Cunha-Vaz JG (2000) Alterations of the blood-retinal barrier and retinal thickness in preclinical retinopathy in subjects with type 2 diabetes. Arch Ophthalmol 118:1364–1369CrossRefPubMedGoogle Scholar
  17. 17.
    Early Treatment Diabetic Retinopathy Study Research Group (1995) Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Arch Ophthalmol 113:1144–1155CrossRefGoogle Scholar
  18. 18.
    Lee SN, Chhablani J, Chan CK et al (2013) Characterization of microaneurysm closure after focal laser photocoagulation in diabetic macular edema. Am J Ophthalmol 155:905–912CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Tso MO (1982) Pathology of cystoid macular edema. Ophthalmology 89:902–915CrossRefPubMedGoogle Scholar
  20. 20.
    Wolter JR (1981) The histopathology of cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 216:85–101CrossRefGoogle Scholar
  21. 21.
    Snodderly DM, Weinhaus RS (1990) Retinal vasculature of the fovea of the squirrel monkey, Saimiri sciureus: three-dimensional architecture, visual screening, and relationships to the neuronal layers. J Comp Neurol 297:145–163CrossRefPubMedGoogle Scholar
  22. 22.
    Kozak I, Oster SF, Cortes MA et al (2011) Clinical evaluation and treatment accuracy in diabetic macular edema using navigated laser photocoagulator NAVILAS. Ophthalmology 118:1119–1124CrossRefPubMedGoogle Scholar
  23. 23.
    Maeshima K, Utsugi-Sutoh N, Otani T, Kishi S (2004) Progressive enlargement of scattered photocoagulation scars in diabetic retinopathy. Retina 24:507–511CrossRefPubMedGoogle Scholar
  24. 24.
    Han DP, Mieler WF, Burton TC (1992) Submacular fibrosis after photocoagulation for diabetic macular edema. Am J Ophthalmol 113:513–521CrossRefPubMedGoogle Scholar
  25. 25.
    Nguyen QD, Shah SM, Khwaja AA et al (2010) Two-year outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study. Ophthalmology 117:2146–2151CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Joo Youn Shin
    • 1
  • Suk Ho Byeon
    • 1
    Email author
  • Oh Woong Kwon
    • 1
    • 2
  1. 1.The Institute of Vision Research, Department of OphthalmologyYonsei University College of MedicineSeoulKorea
  2. 2.Nune Eye HospitalSeoulKorea

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