To evaluate the role of adjuvant micropulse laser with aflibercept injections in the management of treatment naive center involving DME, looking at decreased treatment burden and increased efficacy as outcomes after 1 year.
This was a prospective, single center, randomized trial that included 40 eyes (40 patients) with previously untreated center involved DME. Patients were randomly assigned to receive either aflibercept plus micropulse laser (group A) or aflibercept monotherapy (group B).
Overall, 40 patients were included in the study; they were randomized into either group A (aflibercept + micropulse; 20 patients) or group B (aflibercept monotherapy; 20 patients). The mean number of injections after the loading dose was 4.5 ± 1.4 in group A and was 5.4 ± 1.7 in group B, and the difference between both groups was statistically significant (P = 0.029).
Adding 577-nm micropulse laser to aflibercept is effective for treatment naïve DME and is associated with decreased number of injections.
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Klein R, Klein BE, Moss SE, Cruickshanks KJ (1995) The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV The long-term incidence of macular edema. Ophthalmology 102:7–16
Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol 103(12):1796–1806
Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L et al (2012) RISE and RIDE Research Group. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 119:789–801
Michaelides M, Kaines A, Hamilton RD et al (2010) A prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema (BOLT study) 12-month data: report 2. Ophthalmology 117(6):1078.e2–1086.e2
Brown DM, Schmidt-Erfurth U, Do DV et al (2015) Intravitreal aflibercept for diabetic macular edema: 100-week results from the VISTA and VIVID studies. Ophthalmology 122(10):2044–2052
Wells JA, Glassman AR, Ayala AR et al (2016) Diabetic retinopathy clinical research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology 123(6):1351–1359
Elman MJ, Ayala A, Bressler NM et al (2015) Diabetic retinopathy clinical research network. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: 5-year randomized trial results. Ophthalmology 122(2):375–381
Guyer DR, D’Amico DJ, Smith CW (1992) Subretinal fibrosis after laser photocoagulation for diabetic macular edema. Am J Ophthalmol 113:652–656
Hudson C, Flanagan JG, Turner GS, Chen HC, Young LB, McLeod D (1998) Influence of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on short-wavelength and conventional automated perimetry. Diabetologia 41:1283–1292
Schatz H, Madeira D, McDonald HR, Johnson RN (1991) Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol 109:1549–1551
Lewis H, Schachat AP, Haimann MH et al (1990) Choroidal neovascularization after laser photocoagulation for diabetic macular edema. Ophthalmology 97:503–510 (discussion 510–1)
Mainster MA (1999) Decreasing retinal photocoagulation damage: principles and techniques. Semin Ophthalmol 14:200–209
Figueira J, Khan J, Nunes S et al (2009) Prospective randomized controlled trial comparing sub-threshold micropulse diode laser photocoagulation and conventional green laser for clinically significant diabetic macular oedema. Br J Ophthalmol 93:1341–1344
Vujosevic S, Bottega E, Casciano M, Pilotto E, Convento E, Midena E (2010) Microperimetry and fundus autofluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. Retina 30:908–916
Lavinsky D, Cardillo JA, Melo LA Jr, Dare A, Farah ME, Belfort R Jr (2011) Randomized clinical trial evaluating mETDRS versus normal or high-density micropulse photocoagulation for diabetic macular edema. Invest Ophthalmol Vis Sci 52:4314–4323
Vujosevic S, Martini F, Convento E et al (2013) Subthreshold laser therapy for diabetic macular edema: metabolic and safety issues. Curr Med Chem 20:3267–3271
Vujosevic S, Martini F, Longhin E et al (2015) Subthreshold micropulse yellow laser versus subthreshold micropulse infrared laser in center-involving diabetic macular edema: morphologic and functional safety. Retina 35:1594–1603
Abouhussein MA (2016) Micropulse laser for diabetic macular edema. Delta J Ophthalmol 17:167–171
Friberg TR, Karatza EC (1997) The treatment of macular disease using a micropulsed and continuous wave 810-nm diode laser. Ophthalmology 104:2030–2038
Luttrull JK, Musch DC, Mainster MA (2005) Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular oedema. Br J Ophthalmol 89:74–80
Roider J (1999) Laser treatment of retinal diseases by subthreshold laser effects. Semin Ophthalmol 14:19–26
Dorin G (2004) Evolution of retinal laser therapy: minimum intensity photocoagulation (MIP). Can the laser heal the retina without harming it? Semin Ophthalmol 19:62–68
Pollack JS, Kim JE, Pulido JS, Burke JM (1998) Tissue effects of subclinical diode laser treatment of the retina. Arch Ophthalmol 116:1633–1639
Luttrull JK, Dorin G (2012) Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review. Curr Diabetes Rev 8:274–284
Mainster MA (1986) Wavelength selection in macular photocoagulation. Tissue optics, thermal effects, and laser systems. Ophthalmology 93:952–958
Chen G, Tzekov R, Li W, Jiang F, Mao S, Tong Y (2016) Subthreshold micropulse diode laser versus conventional laser photocoagulation for diabetic macular edema: a meta-analysis of randomized controlled trials. Retina 36(11):2059–2065
Mansouri A, Sampat KM, Malik KJ, Steiner JN, Glaser BM (2014) Medscape. Efficacy of subthreshold micropulse laser in the treatment of diabetic macular edema is influenced by pre-treatment central foveal thickness. Eye (Lond) 28(12):1418–1424
Terashima H, Hasebe H, Okamoto F et al (2018) Combination therapy of intravitreal ranibizumab and subthreshold micropulse photocoagulation for macular edema secondary to branch retinal vein occlusion: 6-month result. Retina 2018. Epub ahead of print
Moisseiev E, Abbassi S, Thinda S et al (2018) Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema. Eur J Ophthalmol 28(1):68–73
Conflict of interest
All authors declare no conflicts of interest.
All procedures performed were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Abouhussein, M.A., Gomaa, A.R. Aflibercept plus micropulse laser versus aflibercept monotherapy for diabetic macular edema: 1-year results of a randomized clinical trial. Int Ophthalmol (2020) doi:10.1007/s10792-019-01280-9
- Diabetic macular edema
- Micropulse laser