S. R. Vora, C. L. Hagedorn, N. Khan, M. Aslan, J. P. Concato, R. A. Adelman

Purpose:

To evaluate functional and fundoscopic outcomes among patients receiving multiple treatments with macular laser photocoagulation for clinically significant diabetic macular edema.

Methods:

A retrospective record review was conducted of all patients who had multiple macular laser treatments for diabetic macular edema from September, 1988 to May, 2004 at the Yale Eye Center. Patients with at least two laser treatments were included; exclusion criteria were retinal complications, panretinal photocoagulation, or follow-up of less than six months after the most recent treatment. As part of routine follow-up for diabetic macular edema, visual acuity and fundoscopic findings (by fundus exam, fluorescein angiography, and fundus photos) were assessed before a given laser treatment, at 3 months, 6 months, 1 year, and 1+ year afterwards; the 6 month (or closest available) exam was used in current analyses.

Results:

The study included 63 eyes from 43 patients. For the first laser treatment, 42 of the 56 eyes (75%) with at least 6 months follow-up showed fundoscopic improvement in edema at 6 months, 9 (16%) were stable and 5 (9%) showed worsening. No statistically significant difference was found in the proportion of patients with worsened fundoscopic findings for the first treatment (5/56; 9%) compared to follow up treatments: 8/59 (14%), p=0.57 for treatment 2; 3/34 (9%), p=0.99 for treatment 3; 5/23 (22%), p=0.99 for treatments 4-7. Similarly, the changes in Snellen visual acuities showed no quantitative or statistically significant difference.

Conclusion:

This study found that follow-up macular laser treatments for diabetic macular edema had similar outcomes compared to the first macular laser treatment. The majority of eyes that receive re-treatment after initial laser therapy will respond with improvement in macular edema.

Take-home message:

Repeat laser photocoagulation treatments for diabetic macular edema show similar rates of improvement as the first treatment, causing decreased edema in the majority of eyes.