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