Advantages:

Selective laser coagulation of pigment epithelium (SLCPE) is effective laser procedure for treatment diffuse and focal diabetic macular edema with minimal damage of retina, but cystoid macular edema (CDME) is very torpid to different treatment modalities, and the majority of authors prefer grid laser for its treatment. We suggested that previous intravitreal ranibizumab (0.5 mg) will create conditions for effective SLCPE in patients with cystoid macular edema.

Methods:

We used the combination of intravitreal ranibizumab injection (0.5 mg) with prompt SLCPE (argon micropulse subthreshold) for patients with CDME. 7 patients (3 male, 4 female, mean age 48.3 ±12.5 years) with type 2 diabetes mellitus (14.4 ±6.3 years mean duration), in 7 eyes received 0.5mg ranibizumab injection. After 3 weeks, selective laser of pigment epithelium was performed on all eyes (energy100 mW, pulse duration 0.01 sec, interval between pulses 0.01 sec, pulses envelope n=10, general 1500 pulses). Control examinations were at 1, 3, 6 months and 1 year. Repeat intravitreal injection of ranibizumab 0.5 mg was at 6 months after start of treatment.

Effectiveness / Safety:

Before treatment best-corrected visual acuity (BCVA) was from 0.12 to 0.9 (mean 0.43 ±0.28), macular thickness (MT): 292-754 µm (mean 421.6 ±182.3 µm). After 1 month of observation BCVA significantly improved to 0.72 ±0.13 (T-test for dependent samples, p=0.015), MT improved to 326.4 ±124.0 µm. After 3 months of observation mean BCVA was 0.61 ±0.27, MT 287.1 ±63.5 µm (significant by Wilcoxon matched pair test p=0.04). There were no significant changes in BCVA and MT during further observation.

Take home message:

It is possible to obtain good and stable result in the treatment of diabetic cystoid macular edema by combination of intravitreal ranibizumab and selective laser of pigment epithelium. It permits making rare injections and avoids complications of grid laser, such as scarring in central area, eliminates the side effects of paracentral scotoma.