Is laser photocoagulation still effective in diabetic macular edema? Assessment with optical coherence tomography in Nepal

AIM: To find out the outcome of laser photocoagulation in clinically significant macular edema (CSME) by optical coherence tomography (OCT). · METHODS: It was a prospective, non-controlled, case series study enrolling 81 eyes of 64 patients with CSME between August 2008 and January 2010. All patients received modified grid photocoagulation with frequency doubled Nd: YAG laser. Each patient was evaluated in terms of best-corrected visual acuity (BCVA) and regression or progression of maculopathy after laser therapy at 1, 3 and 6 months. Spearman’s correlation test was used to show the correlation between BCVA and total macular volume (TMV). Analysis of variance (ANOVA) was used to compare among groups and independent t-test was used to compare in each group. · RESULTS: There is high correlation between BCVA and TMV (P ≤0.001). BCVA improved in 50.6%, remained static in 39.5 % and deteriorated in 9.9% patients after 6 month of treatment. The Baseline TMV (mean and SD) were 9.26±1.83, 10.4±2.38, 11.5±3.05, 8.89±0.75 and 9.47±1.98 mm3 for different OCT patterns, ST (sponge like thickening), CMO (cystoid macular edema), SFD (subfoveal detachment), VMIA (Vitreo macular interface abnormality) and average TMV respectively (P =0.04). After 6 months of laser treatment, the mean TMV decreased from 9.47±1.98mm3 to 8.77±1.31mm3(P =0.01). In ST there was significant decrease in TMV, P =0.01, Further within these groups at 6 months, they were significantly different, P =0.01. · CONCLUSION: OCT showed the different morphological variant of CSME while the response of treatment is different. TMV decreased the most and hence showed the improvement in vision after 6 months of laser treatment. In the era of Anti vascular endothelial growth factors (VEGFs), efficacy of laser seems to be in shadow but it is still first line of treatment in developing nation like Nepal where antiVEGFs may not be easily available and affordable.

Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion

AIM：To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion（CRVO）treated with intravitreal injections of bevacizumab,macular grid photocoagulation combined with pan retinal photocoagulation（PRP）,or both（bevacizumab＋grid＋PRP）.· METHODS：Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema.Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12 mo after treatment.Excluded were patients with diabetes or any other retinal disease.We reviewed the medical records of patients treated in one ophthalmology departmentcomparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both.The main outcome measures were the differences in best corrected visual acuity（BCVA） and in macular thickness,as assessed by optical coherence tomography,between the enrollment and the final follow up visits.· RESULTS：Sixty-five patients met inclusion criteria.There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography（131.5±41.2,108.6±29.2,and 121.1±121.1,P=0.110）,or in visual acuity（0.128±0.077,0.088±0.057,and 0.095±0.065）,for intravitreal injections,macular grid photocoagulation＋PRP and a combination of the treatments,respectively,P =0.111.The proportions of patients with macular edema after treatment were：26.1%,28.6%,and 14.3%,respectively,P=0.499.· CONCLUSION：Similar benefit was observed for intravitreal injections,laser photocoagulation,or a combined regimen in the treatment of CRVO.A nonstatistically significant trend for reduction in macular edema was observed following combined treatment.