Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to Anti-VEGF

Abstract

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 µm 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.

Zusammenfassung

Zweck Diese Studie zielte darauf ab, die Veränderungen zu bestimmen, die im Gefäßsystem auftreten, basierend auf der optischen Kohärenztomografieangiografie (OCTA) nach nicht schädigendem Endpunktmanagement (EpM) unter Verwendung eines gelben Dauerstrichlasers. Die Studie betraf Augen mit diabetischem Makulaödem (DMÖ), die gegen antivaskuläre endotheliale Wachstumsfaktoren (Anti-VEGF) resistent waren.

Materialien und Methoden Dies war eine retrospektive Analyse von OCTA-Bildern von 44 Augen bei 44 Patienten mit gegenüber Anti-VEGF refraktärem DMÖ. Die Augen wurden mit einem gelben PASCAL-Streamline-Laser (577 nm Wellenlänge, 200 mm Spotgröße) behandelt. Die Behandlung wurde im DMÖ-Bereich durchgeführt und es wurden 10% Dauerstrichlaserenergie und ein Punkt mit einem Strahldurchmesser von 0,50 µm Abstand verwendet. Bestkorrigierte Sehschärfe (BCVA), verbesserte Tiefenbildgebung mit optischer Kohärenztomografie (EDI-OCT) und Fundusautofluoreszenzbilder (FAF: Fundusautofluoreszenz) wurden zu Studienbeginn sowie 3 und 6 Monate nach der Behandlung aufgezeichnet. Der gesamte choroidale Bereich (TCA), der luminale Bereich (LA), der stromale Bereich (SA) und der choroidale Vaskularitätsindex (CVI) wurden mit der Image-J-Software berechnet. Die Makula wurde in Übereinstimmung mit dem Mapping-System in der Early Treatment Diabetic Retinopathy Study (ETDRS) in 5 Quadranten eingeteilt.

Ergebnisse Bei allen Patienten (Durchschnittsalter: 58,90 ± 9,55 Jahre) wurde Diabetes mellitus Typ 2 diagnostiziert. Die mittlere BCVA zu Studienbeginn betrug 0,30 ± 0,11 Logarithmus des minimalen Auflösungswinkels (logMAR) gegenüber 0,23 ± 0,10 logMAR nach 3 Monaten (p = 0,032) und 0,17 ± 0,10 logMAR nach 6 Monaten (p = 0,013). Die foveale avaskuläre Zone (FAZ) nahm im tiefen Kapillarplexus (DCP) vom Ausgangswert bis 6 Monate (p = 0,028) ab. Gefäßdichten (VDs) des oberflächlichen Kapillarplexus (SCP), DCP und Choriokapillaris nahmen in der Fovea nach 3 und 6 Monaten im Vergleich zum Ausgangswert signifikant ab (p < 0,05 für beide Nachbeobachtungszeitpunkte). Es gab signifikante Abnahmen von SCP und DCP im oberen Quadranten am Ende von Monat 6 (p = 0,001 bzw. p = 0,038). Es gab eine signifikante Abnahme im nasalen Quadranten des DCP und der Choriokapillaris am Ende von Monat 6 (p = 0,024 bzw. p = 0,049). Obwohl es eine signifikante Abnahme der zentralen Makuladicke (CMT) (p < 0,001), der subfovealen Aderhautdicke (SFCT) (p < 0,001) und des LA (p = 0,034) in den Monaten 3 und 6 gab, gab es keine signifikante Veränderung des CVI (p = 0,19). Gemäß der DMÖ-Wiederfindungsrate wurden 36 Augen (81%) 1 × bestrahlt, während 8 Augen (19%) 2 × bestrahlt wurden.

Schlussfolgerungen Eine nicht schädigende EpM-Therapie mit einem gelben Dauerstrichlaser in Augen mit DMÖ, die gegen Anti-VEGFs resistent sind, induziert signifikante Veränderungen im SCP, in der Choriokapillaris und am häufigsten im DCP, was zu einer signifikanten Abnahme der VDs während eines 6-monatigen Follow-ups führt.

Key words

non-damaging EpM yellow laser - anti-VEGF-resistant diabetic macular edema - optical coherence tomography angiography - choroidal vascularity index

Schlüsselwörter

nicht schädigender gelber EpM-Laser - Anti-VEGF-resistentes diabetisches Makulaödem - optische Kohärenztomografie-Angiografie - choroidaler Vaskularitätsindex

Publikationsverlauf

Eingereicht: 23. Januar 2022

Angenommen: 27. Februar 2022

Artikel online veröffentlicht:
22. April 2022

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