ABSTRACT

Purpose:

To determine if macular laser therapy slows down the progression of posterior vitreous detachment trough its stages. This effect has not been described yet.

Material & Methods:

Out of 820 eyes in 433 patients with diabetic macular edema (DME), those with any vitreoretinal pathology which might interfere with the process of posterior vitreous detachment (PVD) were excluded from the study. 366 eyes in 211 patients were divided into four groups according to treatment arms: 96 eyes treated with laser only (LK), 66 eyes treated with intravitreal anti-VEGF (IVT), 148 eyes treated with laser followed by intravitreal antiVEGF (LK+IVT) and 39 eyes treated with intravitreal anti-VEGF followed by laser (IVT+LK). Stage of PVD (absent, partial, complete) was assessed by OCT at baseline and month 3, 6, 9, 12, 15,18, 21, 24, 36 and 48. Statistical analysis for each data group estimated mean time to progression adjusted to treatment modality and PVD stage.

Results:

Mean time to progression from absent to partial PVD was 22.1 months in IVT group, 34.0 months in IVT+LK group, 38.3 months in LK+IVT group and 43.7 months in LK group. Statistically significant difference in duration to progression was found between groups LK and LK+IVT (p=0.022), LK and IVT (p<0.001), LK and IVT+LK (p<0.001), LK+IVT and IVT (p<0.001) and also IVT+LK and IVT (p=0.038). The difference was not statistically significant between groups LK+IVT and IVT+LK (p=0.287). Mean time to progression from partial to complete PVD was 17.3 months in IVT group, 28.1 months in IVT+LK group, 33.6 months in LK+IVT group and 44.9 months in LK group. Statistically significant difference in duration to progression was found between groups LK and LK+IVT (p<0.001), LK and IVT (p<0.001), LK and IVT+LK (p<0.001), LK+IVT and IVT (p<0.001) and also IVT+LK and IVT (p=0.002). The difference was not statistically significant between groups LK+IVT and IVT+LK (p=0.513). Mean time to progression from absent to complete PVD was 36.7 months in IVT group, 43.3 months in IVT+LK group, 45.9 months in LK+IVT group and no progression was identified in LK group. Statistically significant difference in duration to progression was found between groups LK and LK+IVT (p=0.029), LK and IVT (p<0.001), LK and IVT+LK (p<0.005), LK+IVT and IVT (p<0.001) and also IVT+LK and IVT (p=0.007). The difference was not statistically significant between groups LK+IVT and IVT+LK (p=0.637).

Conclusion:

Our study shows, that intravitreal application of antiVEGF in patients with DME significantly (p<0.038) slows down progression of PVD and macular laser significantly (p<0.022) speeds up this process independently from its stage. This significance is even higher (p<0,001) for LK group compared to all other treatment arms when progressing from partial to complete PVD. Diabetic patients are more likely to develop DME within the time frame of progression over partial PVD stage. Posterior vitreous traction may play role in this mechanism or some other, pre-tractional component may be involved, which has yet to be identified. The goal of DME therapy is restoration of central vision, which walks hand in hand with better quality of life in diabetic patients. Current guidelines for DME treatment favour intravitreal antiVEGF drugs with laser treatment deferred for at least 6 months. Results of this study recommend laser treatment deferral until PVD is complete.


CONTACT DETAILS

 

Alexik MIKULAS
Ocne oddelenie, Fakultna nemocnica s poliklinikou Zilina
Zilina
Slovakia
Email : mikulas.alexik@gmail.com
Cell Phone: +421918977336
Work Phone: +421918977336