PMID- 35453154
OWN - NLM
STAT- MEDLINE
DCOM- 20240229
LR  - 20240229
IS  - 1439-3999 (Electronic)
IS  - 0023-2165 (Linking)
VI  - 241
IP  - 2
DP  - 2024 Feb
TI  - Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical 
      Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to 
      Anti-VEGF.
PG  - 197-208
LID - 10.1055/a-1792-3009 [doi]
AB  - PURPOSE: This study aimed to determine the changes that occur in the vasculature, 
      as based on optical coherence tomography angiography (OCTA) after non-damaging 
      endpoint management (EpM), using a continuous wave yellow laser. The study was on 
      eyes with diabetic macular edema (DME) that were resistant to anti-vascular 
      endothelial growth factors (anti-VEGFs). MATERIALS AND METHODS: This was a 
      retrospective analysis of OCTA images of 44 eyes in 44 patients with DME 
      refractory to anti-VEGF. The eyes were treated with a PASCAL Streamline yellow 
      laser (577 nm wavelength, 200 mm spot size). Treatment was administered to the 
      DME area and utilized 10% continuous wave laser energy and 0.50 microm beam diameter 
      spot spacing. Best-corrected visual acuity (BCVA) and enhanced in-depth imaging 
      with optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) 
      images were recorded at baseline, and 3 and 6 months posttreatment. Total 
      choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal 
      vascularity index (CVI) were calculated using Image J software. The macula was 
      divided into five quadrants in accordance with the mapping system in the Early 
      Treatment Diabetic Retinopathy Study (ETDRS). RESULTS: All patients (mean age: 
      58.90 +/- 9.55 years) were diagnosed with diabetes mellitus type 2. Mean BCVA at 
      baseline was 0.30 +/- 0.11 logarithm of the minimum angle of resolution (logMAR) 
      versus 0.23 +/- 0.10 logMAR at 3 months (p = 0.032) and 0.17 +/- 0.10 logMAR at 6 
      months (p = 0.013). The foveal avascular zone area (FAZ) decreased in the deep 
      capillary plexus (DCP) from baseline to 6 months (p = 0.028). Vessel densities 
      (VDs) of the superficial capillary plexus (SCP), DCP, and choriocapillaris 
      decreased significantly in the fovea at 3 and 6 months compared to baseline 
      (p < 0.05 for both follow-up time points). There were significant decreases in 
      SCP and DCP in the superior quadrant at the end of month 6 (p = 0.001 and 
      p = 0.038, respectively). There was a significant decrease in the nasal quadrant 
      of the DCP and choriocapillaris at the end of month 6 (p = 0.024 and p = 0.049, 
      respectively). Although there was a significant decrease in central macular 
      thickness (CMT) (p < 0.001), subfoveal choroidal thickness (SFCT) (p < 0.001), 
      and LA (p = 0.034) at months 3 and 6, there was no significant change in the CVI 
      (p = 0.19). According to the DME recovery rate, 36 eyes (81%) were irradiated 
      once, whereas 8 eyes (19%) were irradiated twice. CONCLUSIONS: Non-damaging EpM 
      therapy using a continuous wave yellow laser in eyes with DME that are resistant 
      to anti-VEGFs induces significant changes in the SCP, choriocapillaris, and, most 
      commonly, the DCP, which caused a significant decrease in VDs during 6 months of 
      follow-up.
CI  - Thieme. All rights reserved.
FAU - Karasu, Bugra
AU  - Karasu B
AD  - Ophthalmology, Beyoglu Eye Training and Research Hospital, Icmeler Mahallesi, 
      Piri Reis Caddesi, Tuzla State Hospital, Tuzla, Turkey.
FAU - Akbas, Yusuf Berk
AU  - Akbas YB
AD  - Ophthalmology, Beyoglu Eye Training and Research Hospital, Bereketzade, Beyoglu, 
      Turkey.
FAU - Aykut, Aslan
AU  - Aykut A
AD  - Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
FAU - Celebi, Ali Riza Cenk
AU  - Celebi ARC
AD  - Ophthalmology, Acibadem Universitesi Tip Fakultesi, Istanbul, Turkey.
LA  - eng
PT  - Journal Article
TT  - Unterschwellige Photokoagulation: Endpunktmanagement mittels Laser, basierend auf 
      optischer Koharenztomografie-Angiografie in Fallen von diabetischem Makulaodem, 
      resistent gegenuber Anti-VEGF-Therapie.
DEP - 20220422
PL  - Germany
TA  - Klin Monbl Augenheilkd
JT  - Klinische Monatsblatter fur Augenheilkunde
JID - 0014133
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - Aged
MH  - *Macular Edema/diagnostic imaging/etiology
MH  - *Diabetic Retinopathy/diagnostic imaging/surgery
MH  - Tomography, Optical Coherence/methods
MH  - Retrospective Studies
MH  - Retinal Vessels
MH  - Fluorescein Angiography/methods
MH  - Visual Acuity
MH  - Light Coagulation
MH  - *Diabetes Mellitus
COIS- The authors declare that they have no conflict of interest.
EDAT- 2022/04/23 06:00
MHDA- 2024/02/29 06:42
CRDT- 2022/04/22 20:16
PHST- 2024/02/29 06:42 [medline]
PHST- 2022/04/23 06:00 [pubmed]
PHST- 2022/04/22 20:16 [entrez]
AID - 10.1055/a-1792-3009 [doi]
PST - ppublish
SO  - Klin Monbl Augenheilkd. 2024 Feb;241(2):197-208. doi: 10.1055/a-1792-3009. Epub 
      2022 Apr 22.