Diabetic Macular Edema Treatment: Laser Photocoagulation Versus anti-VEGF Drugs

Abd Elaziz Mohamed Elmadina

doi:10.3889/oamjms.2022.9561

Authors

Abd Elaziz Mohamed Elmadina Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia

DOI:

https://doi.org/10.3889/oamjms.2022.9561

Keywords:

Central macular thickness, Best-corrected vision, Diabetic macular edema, anti-VEGF, Ocular coherence tomography, Laser photocoagulation

Abstract

Abstract:

Objective: The present study was aimed to compare best-corrected vision and central macular thickness for macular edema in diabetes (DME) after utilizing laser, Avastin, and Lucentis.

Methods: A retrospective randomized cross-sectional study was conducted at Alfaisal Eye Center, Khartoum. Best-corrected vision and central macular thickness (CMT) were assessed by Snellen's chart and Heidelberg optical coherence tomography OCT, respectively. Results: In this study, a total of 252 records of DME-treated patients with laser applications, Avastin, and Lucentis were enrolled, their mean age was 57 ± 5.22 yrs. A significant enhancement in best-corrected vision and CMT of studied groups with laser applications, Avastin, and Lucentis was obtained (P= 0.000) with no differences between treated groups (p= 0.445 and 0,479), respectively. Non-significant differences in variable measurements related to gender or age (p = 0.117, 0.781), respectively. CMT of females (260 ± 48 μm) was thinner than males (306 ± 74 μm) after treatment (P = 0.000).

Conclusion: laser applications, Avastin, and Lucentis improved best-corrected vision and reduced central macular thickness significantly with no clear differences between studied groups. Age or gender have a non-significant impact on dependent variables. Females gained thinner results compared to males after treatment.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Fong AH, Lai TY. Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema. Clin Interv Aging. 2013;8:467-83. https://doi.org/10.2147%2FCIA.S36811 PMid:23766636

Daruich A, Matet A, Moulin A, Kowalczuk L, Nicolas M, Sellam A, et al. Mechanisms of macular edema: Beyond the surface. Progr Retin Eye Res. 2018;63:20-68. https://doi.org/10.1016/j.preteyeres.2017.10.006 PMid:29126927 DOI: https://doi.org/10.1016/j.preteyeres.2017.10.006

The National Eye Institute (NEI) Department of Health and Human. USA; 2015. Available from: https://www.nei.nih.gov/. [Last accessed on 2022 Apr 11].

Varma R, Bressler NM, Doan QV, Gleeson M, Danese M, Bower JK, et al. Prevalence of and risk factors for diabetic macular edema in the United States. JAMA Ophthalmol. 2014;132(11):1334-40. https://doi.org/10.1001/jamaophthalmol.2014.2854 PMid:25125075 DOI: https://doi.org/10.1001/jamaophthalmol.2014.2854

Leasher JL, Bourne RR, Flaxman SR, Jonas JB, Keeffe J, Naidoo K; Vision Loss Expert Group of the Global Burden of Disease Study. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: A meta-analysis from 1990 to 2010. Diabetes Care. 2016;39(9):1643-9. https://doi.org/10.1167/iovs.15-17201 DOI: https://doi.org/10.2337/dc15-2171

Sivaprasad S, Raman R, Conroy D, Wittenberg R, Rajalakshmi R, Majeed A . The ORNATE India Project: United Kingdom-India Research Collaboration to tackle visual impairment due to diabetic retinopathy. Eye. 2020;34:1279-86. https://doi.org/10.1038/s41433-020-0854-8 PMid:32398841 DOI: https://doi.org/10.1038/s41433-020-0854-8

Chung YR, Kim YH, Ha SJ, Byeon HE, Cho CH, Kim JH, et al. Role of inflammation in classification of diabetic macular edema by optical coherence tomography. J Diabetes Res. 2019;2019:8164250. https://doi.org/10.1155/2019/8164250 PMid:31930145 DOI: https://doi.org/10.1155/2019/8164250

Hutton DW, Stein JD, Glassman AR, Bressler NM, Jampol LM, Sun JK; DRCR Retina Network. Five-year cost-effectiveness of intravitreous ranibizumab therapy vs. panretinal photocoagulation for treating proliferative diabetic retinopathy: A secondary analysis of a randomized clinical trial. JAMA Ophthalmology. 2019;137(12):1424-32. https://doi:10.1001/jamaophthalmol.2019.4284 PMid:31647496 DOI: https://doi.org/10.1001/jamaophthalmol.2019.4284

Aiello LM. Perspectives on diabetic retinopathy. Am J Ophthalmol. 2003;136(1):122-35. https://doi.org/10.1016/S0002-9394(03)00219-8 PMid:12834680 DOI: https://doi.org/10.1016/S0002-9394(03)00219-8

Mitchell P, Sheidow TG, Farah ME, Mahmood S, Minnella AM. Effectiveness and safety of ranibizumab 0.5 mg in treatment-naïve patients with diabetic macular edema: Results from the real-world global LUMINOUS study. PLoS One. 2020;15(6):e0233595. https://doi.org/10.1371/journal.pone.0233595 PMid:32492069 DOI: https://doi.org/10.1371/journal.pone.0233595

Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti-vascular endothelial growth factor for diabetic macular oedema: A network meta-analysis. Cochrane Database Syst Rev. 2018;10: 1. https://doi.org/10.1002/14651858.CD007419.pub3 DOI: https://doi.org/10.1002/14651858.CD007419.pub6

Formoso G, Marata AM, Magrini N, Bero L. A clearer view of evidence in treating macular degeneration: Off-label policies and independent research. Cochrane Database Syst Rev. 2014;(9):ED000090. https://doi.org/10.1002/14651858.ED000090 PMid:25228121 DOI: https://doi.org/10.1002/14651858.ED000090

Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, Berg K, Chakravarthy U, Gerendas BS, et al. Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237(4):185-222. https://doi.org/10.1159/000458539 PMid:28423385 DOI: https://doi.org/10.1159/000458539

Cai S, Bressler NM. Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema: Recent clinically relevant findings from DRCR.net Protocol T. Curr Opinion Ophthalmol. 2017;28(6):636-43. https://doi.org/10.1097/ICU.0000000000000424 PMid:28837425 DOI: https://doi.org/10.1097/ICU.0000000000000424

Bressler NM, Odia I, Maguire M, Glassman AR, Jampol LM, MacCumber MW, et al. Association between change in visual acuity and change in central subfield thickness during treatment of diabetic macular edema in participants randomized to aflibercept, bevacizumab, or ranibizumab: A post hoc analysis of the protocol T randomized clinical trial. JAMA Ophthalmol. 2019;137(9):977-85. https://doi.org/10.1001/jamaophthalmol.2019.196 PMid:31246237 DOI: https://doi.org/10.1001/jamaophthalmol.2019.1963

Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2014;8(8):CD005139. https://doi.org/10.1002/14651858.CD005139.pub3 PMid:25170575 DOI: https://doi.org/10.1002/14651858.CD005139.pub3

Schmucker C, Ehlken C, Agostini HT, Antes G, Ruecker G, Lelgemann M, et al. A safety review and meta-analyses of bevacizumab and ranibizumab: Off-label versus goldstandard. PLoS One. 2012;7(8):e42701. https://doi.org/10.1371/journal.pone.0042701 PMid:22880086 DOI: https://doi.org/10.1371/journal.pone.0042701

Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: Two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology. 2016;123(6):1351-9. https://doi.org/10.1016/j.ophtha.2016.02.022 DOI: https://doi.org/10.1016/j.ophtha.2016.02.022

Plaza-Ramos P, Borque E, Garcia-Layana A. Evaluation of ranibizumab and aflibercept for the treatment of diabetic macular edema in daily clinical practice. PLoS One. 2019;14(10):e0223793. https://doi.org/10.1371/journal.pone.0223793 PMid:31644594

Bhandari S, Nguyen V, Fraser-Bell S, Mehta H, Viola F, Baudin F, et al. Ranibizumab or aflibercept for diabetic macular edema: Comparison of 1-year outcomes from the fight retinal blindness! Registry. Ophthalmology. 2020;127(5):608-15. https://doi.org/10.1016/j.ophtha.2019.11.018 PMid:31932092 DOI: https://doi.org/10.1016/j.ophtha.2019.11.018

El Awad SM, Elrahman NM, Ahmad MI, Qureshi MA, Younis AM, Bhatti AA, et al. Comparison of anti VEGF and laser photocoagulation in diabetic macular edema (DME). EC Ophthalmol. 2020;11:19-24. Available from: http://localhost:8080/xmlui/handle/123456789/562..[Last accessed on 2022 Apr 11].

Hee MR, Izatt JA, Swanson EA, Huang D, Schuman JS, Lin CP. Optical coherence tomography of human retina. Arch Ophthalmol. 1995;113(3):325-32. https://doi.org/10.1016/j.ophtha.2005.10.052 DOI: https://doi.org/10.1001/archopht.1995.01100030081025

Toth CA, Narayan DG, Boppart SA, Hee MR, Fujimoto JG, Birngruber R, et al. A comparison of retinal morphology viewed by optical coherence tomography and by light microscopy. Arch Ophthalmol. 1997;115(11):1425-8. https://doi.org/10.1001/archopht.1997.01100160595012 PMid:9366674 DOI: https://doi.org/10.1001/archopht.1997.01100160595012

Gregori NZ, Feuer W, Rosenfeld PJ. Novel method for analyzing snellen visual acuity measurements. Retina. 2010;30(7):1046-50 https://doi.org/10.1097/IAE.0b013e3181d87e04 PMid:20559157 DOI: https://doi.org/10.1097/IAE.0b013e3181d87e04

Michaelides M, Kaines A, Hamilton RD, Fraser-Bell S, Rajendram R, Quhill F, et al. 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. 2010;117:1078-86. https://doi.org/10.1016/j.ophtha.2010.03.045 PMid:20416952 DOI: https://doi.org/10.1016/j.ophtha.2010.03.045

Jorge EC, Jorge EN, Botelho M, Farat JG, Virgili G, El Dib R. Monotherapy laser photocoagulation for diabetic macular oedema. Cochrane Database Syst Rev. 2018;10(10):CD010859. https://doi.org/10.1002/14651858.CD010859.pub2 PMid:30320466 DOI: https://doi.org/10.1002/14651858.CD010859.pub2

Romero-Aroca P. Is laser photocoagulation treatment currently useful in diabetic macular edema? Med Hypothesis Discov Innov Ophthalmol. 2015;4(1):5-8. PMid:25861668. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389291/pdf/mehdiophth-4-005.pdf. [Last accessed on 2022 Apr 10].

Romero-Aroca P, Reyes-Torres J, Baget-Bernaldiz M, Blasco- Suñe C. Laser treatment for diabetic macular edema in the 21st century. Curr Diabetes Rev. 2014;10(2):100-2. https://doi.org/10.2174/1573399810666140402123026 DOI: https://doi.org/10.2174/1573399810666140402123026

PMid:24852439. Available from: https://www.ingentaconnect.com/content/ben/cdr/2014/00000010/00000002/art00003. [Last accessed on 2022 Apr 12].

Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193-203. https://doi.org/10.1056/nejmoa1414264 DOI: https://doi.org/10.1056/NEJMoa1414264

Nguyen QD, Shah SM, Khwaja AA, Channa R, Hatef E, Do DV, et al. Two-year outcomes of the Ranibizumab for edema of the mAcula in diabetes (READ-2) study. Ophthalmology. 2010;117(11):2146-51. https://doi.org/10.1159/000446992 DOI: https://doi.org/10.1016/j.ophtha.2010.08.016

Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al. The RESTORE study: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118(4):615-25. https://doi.org/10.1016/j.ophtha.2011.01.031 PMid:21459215 DOI: https://doi.org/10.1016/j.ophtha.2011.01.031

Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: Results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012;119(4):789-801. https://doi.org/10.1016/j.ophtha.2011.12.039 PMid:22330964 DOI: https://doi.org/10.1016/j.ophtha.2011.12.039

Plaza-Ramos P, Borque E, García-Layana A. Evaluation of ranibizumab and aflibercept for the treatment of diabetic macular edema in daily clinical practice. PLoS One. 2019;14(10):e0223793. https://doi.org/10.1371/journal.pone.0223793 PMid:31644594 DOI: https://doi.org/10.1371/journal.pone.0223793

Campos A, Campos EJ, do Carmo A, Caramelo F, Martins J, Sousa JP, et al. Evaluation of markers of outcome in real-world treatment of diabetic macular edema. Eye Vis. 2018;5(1):1-10. https://doi.org/10.1186/s40662-018-0119-9 PMid:30386806 DOI: https://doi.org/10.1186/s40662-018-0119-9

Gonzalez VH, Campbell J, Holekamp NM, Kiss S, Loewenstein A, Augustin AJ, et al. Early and long-term responses to anti-vascular endothelial growth factor therapy in diabetic macular edema: Analysis of protocol I data. Am J Ophthalmol. 2016;172:72-9. https://doi.org/10.1016/j.ajo.2016.09.012 PMid:27644589 DOI: https://doi.org/10.1016/j.ajo.2016.09.012

Tsai MJ, Hsieh YT, Peng YJ. Real-life experience of ranibizumab for diabetic macular edema in Taiwan. Int Ophthalmol. 2019;39(7):1511-22. https://doi.org/10.1007/s10792-018-0970-7 PMid:29926364 DOI: https://doi.org/10.1007/s10792-018-0970-7

Shao Y, Yu Y, Li C, Pei CG, Tu P, Han Y, et al. Clinical observation of the efficacy of Bevacizumab combined with argon green laser in treating fundus macular edema. Exp Ther Med. 2017;13(4):1480-4. https://doi.org/10.3892/etm.2017.4145 PMid:28413496 DOI: https://doi.org/10.3892/etm.2017.4145

Distefano LN, Garcia-Arumi J, Martinez-Castillo V, Boixadera A. Combination of anti-VEGF and laser photocoagulation for diabetic macular edema: A review. J Ophthalmol. 2017;2017:2407037. https://doi.org/10.1155/2017/2407037 PMid:28348882 DOI: https://doi.org/10.1155/2017/2407037

Arthur E, Young SB, Elsner AE, Baskaran K, Papay JA, Muller MS, et al. Central macular thickness in diabetic patients: A sex-based analysis. Optom Vis Sci. 2019;96(4):266-75. https://doi.org/10.1097/OPX.0000000000001363 PMid:30907864 DOI: https://doi.org/10.1097/OPX.0000000000001363

Ozawa GY, Bearse MA Jr., Adams AJ. Male-female differences in diabetic retinopathy? Curr Eye Res. 2015;40(2):234-46. https://doi.org/10.3109/02713683.2014.958500 PMid:25545999 DOI: https://doi.org/10.3109/02713683.2014.958500

Kim EJ, Lin WV, Rodriguez SM, Chen A, Loya A, Weng CY. Treatment of diabetic macular edema. Curr Diab Rep. 2019;19(9):1- 10. https://doi.org/10.1007/s11892-019-1188-4 PMid:31359157 DOI: https://doi.org/10.1007/s11892-019-1188-4