Advertisement

Predictive factors of outcome of selective retina therapy for diabetic macular edema

  • 28 Accesses

Abstract

Purpose

To investigate the predictive factors of clinical outcome of selective retina therapy (SRT) for diabetic macular edema (DME).

Methods

This retrospective study included 22 eyes of 22 patients (15 males and 7 females), who were treated with SRT for DME at the Department of Ophthalmology of Osaka City University Hospital and observed at least 6 months after the treatment. The mean age was 64 years (range 40–81). Thirteen of the 22 eyes (59%) had a treatment history other than SRT before. SRT laser (527 nm, 1.7 µs, 100 Hz) was used for treatment. Changes in the best-corrected visual acuity (BCVA) (logMAR) and central macular thickness (CMT) in optical coherence tomography were examined at baseline, 3-month follow-up, and 6-month follow-up. Factors associated with the rate of change in CMT at 3 and 6 months after SRT were examined.

Results

The mean BCVA (logMAR) was 0.26 ± 0.31, 0.22 ± 0.27 and 0.23 ± 0.29 at baseline, 3 months and 6 months, respectively (p = 0.15 at 3 months, 0.40 at 6 months; compared to baseline). The mean CMT was 502 ± 163, 493 ± 204, and 416 ± 185 μm at baseline, 3 months, and 6 months, respectively (p = 0.69 at 3 months, 0.01 at 6 months; compared to baseline). The multivariate analysis found a significant negative association with previous macular photocoagulation (p = 0.03) at 3 months and a positive association with a history of insulin use (p = 0.02) and previous panretinal photocoagulation (p = 0.03) at 6 months after SRT.

Conclusion

The CMT was significantly decreased at 6 months after SRT in DME. The history of insulin use and panretinal photocoagulation may positively and the history of macular photocoagulation may negatively affect the outcome of SRT, which must be considered when determining the therapeutic indications for SRT.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Cheung N, Mitchell P, Wong TY (2010) Diabetic retinopathy. Lancet 376:124–136

  2. 2.

    Tan GS, Cheung N, Simo R, Cheung GC, Wong TY (2017) Diabetic macular oedema. Lancet Diabetes Endocrinol 5:143–155

  3. 3.

    Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. ETDRS report number 1. Arch Ophthalmol 103:1796–1806

  4. 4.

    Patelli F, Fasolino G, Radice P, Russo S, Zumbo G, Di Tizio FM, Frisone G, Marchi S (2005) Time course of changes in retinal thickness and visual acuity after intravitreal triamcinolone acetonide for diffuse diabetic macular edema with and without previous macular laser treatment. Retina 25:840–845

  5. 5.

    Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, Hartnett E, Ip MS, Kim JE, Kollman C (2009) Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol 127:245–251

  6. 6.

    Scott IU, Ip MS, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Chan CK, Gonzalez VH, Singerman LJ, Tolentino M (2009) A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6. Arch Ophthalmol 127:1115–1128

  7. 7.

    Laidlaw DA (2008) Vitrectomy for diabetic macular oedema. Eye (Lond) 22:1337–1341

  8. 8.

    Diabetic Retinopathy Clinical Research Network Writing Committee (2010) Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology 117:1087–1093

  9. 9.

    Simunovic MP, Hunyor AP, Ho IV (2014) Vitrectomy for diabetic macular edema: a systematic review and meta-analysis. Can J Ophthalmol 49:188–195

  10. 10.

    Wells JA, Glassman AR, Ayala AR, Jampol LM, Bressler NM, Bressler SB, Brucker AJ, Ferris FL, Hampton GR, Jhaveri C, Melia M, Beck RW (2016) Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology 123:1351–1359

  11. 11.

    Brown DM, Nguyen QD, Marcus DM, Boyer DS, Patel S, Feiner L, Schlottmann PG, Rundle AC, Zhang J, Rubio RG, Adamis AP, Ehrlich JS, Hopkins J (2013) Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology 120:2013–2022

  12. 12.

    Diabetic Retinopathy Clinical Research Network (2015) Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 372:1193–1203

  13. 13.

    Elman MJ, Ayala A, Bressler NM, Browning D, Flaxel CJ, Glassman AR, Jampol LM, Stone TW (2015) Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: 5-year randomized trial results. Ophthalmology 122:375–381

  14. 14.

    Bakri SJ, Snyder MR, Reid JM, Pulido JS, Ezzat MK, Singh RJ (2007) Pharmacokinetics of intravitreal ranibizumab (Lucentis). Ophthalmology 114:2179–2182

  15. 15.

    Park SJ, Choi Y, Na YM, Hong HK, Park JY, Park KH, Chung JY, Woo SJ (2016) Intraocular pharmacokinetics of intravitreal aflibercept (Eylea) in a rabbit model. Investig Ophthalmol Visual Sci 57:2612–2617

  16. 16.

    Roider J, Brinkmann R, Wirbelauer C, Laqua H, Birngruber R (1999) Retinal sparing by selective retinal pigment epithelial photocoagulation. Arch Ophthalmol 117:1028–1034

  17. 17.

    Brinkmann R, Roider J, Birngruber R (2006) Selective retina therapy (SRT): a review on methods, techniques, preclinical and first clinical results. Bull Soc Belge Ophtalmol 302:51–69

  18. 18.

    Roider J, Liew SH, Klatt C, Elsner H, Poerksen E, Hillenkamp J, Brinkmann R, Birngruber R (2010) Selective retina therapy (SRT) for clinically significant diabetic macular edema. Graefes’s Arch Clin Exp Ophthalmol 248:1263–1272

  19. 19.

    Park YG, Kim JR, Kang S, Seifert E, Theisen-Kunde D, Brinkmann R, Roh YJ (2016) Safety and efficacy of selective retina therapy (SRT) for the treatment of diabetic macular edema in Korean patients. Graefes’s Arch Clin Exp Ophthalmol 254:1703–1713

  20. 20.

    Elsner H, Pörksen E, Klatt C, Bunse A, Theisen-Kunde D, Brinkmann R, Birngruber R, Laqua H, Roider J (2006) Selective retina therapy in patients with central serous chorioretinopathy. Graefes’s Arch Clin Exp Ophthalmol 244:1638–1645

  21. 21.

    Klatt C, Saeger M, Oppermann T, Pörksen E, Treumer F, Hillenkamp J, Fritzer E, Brinkmann R, Birngruber R, Roider J (2011) Selective retina therapy for acute central serous chorioretinopathy. Br J Ophthalmol 95:83–88

  22. 22.

    Yasui A, Yamamoto M, Hirayama K, Shiraki K, Theisen-Kunde D, Brinkmann R, Miura Y, Kohno T (2017) Retinal sensitivity after selective retina therapy (SRT) on patients with central serous chorioretinopathy. Graefes’s Arch Clin Exp Ophthalmol 255:243–254

  23. 23.

    Klein KA, Cleary TS, Reichel E (2017) Effect of intravitreal aflibercept on recalcitrant diabetic macular edema. Int J Retina Vitreous 3:16

  24. 24.

    Kang SW, Park CY, Ham DI (2004) The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema. Am J Ophthalmol 137:313–322

  25. 25.

    Roider J, Hillenkamp F, Flotte T, Birngruber R (1993) Microphotocoagulation: selective effects of repetitive short laser pulses. Proc Natl Acad Sci U S A 90:8643–8647

  26. 26.

    Roider J, Brinkmann R, Wirbelauer C, Laqua H, Birngruber R (2000) Subthreshold (retinal pigment epithelium) photocoagulation in macular diseases: a pilot study. Br J Ophthalmol 84:40–47

  27. 27.

    Framme C, Walter A, Prahs P, Theisen-Kunde D, Brinkmann R (2008) Comparison of threshold irradiances and online dosimetry for selective retina treatment (SRT) in patients treated with 200 nanoseconds and 1.7 microseconds laser pulses. Lasers Surg Med 40:616–624

  28. 28.

    AbdelKader DH, Osman MA, Elgizawy SA, Faheem AM, McCarron PA (2016) The Role of insulin in wound healing process: mechanism of action and pharmaceutical applications. J Anal Pharm Res 2:00007

  29. 29.

    Leschey KH, Hackett SF, Singer JH, Campochiaro PA (1990) Growth factor responsiveness of human retinal pigment epithelial cells. Invest Ophthalmol Vis Sci 31:839–846

  30. 30.

    Stefánsson E, Machemer R, de Juan E Jr, McCuen BW II, Peterson J (1992) Retinal oxygenation and laser treatment in patients with diabetic retinopathy. Am J Ophthalmol 15:36–38

  31. 31.

    Tejada S, Batle JM, Ferrer MD, Busquets-Cortés C, Monserrat-Mesquida M, Nabavi SM, Del Mar Bibiloni M, Pons A, Sureda A (2019) Therapeutic effects of hyperbaric oxygen in the process of wound healing. Curr Pharm Des 25:1682–1693

  32. 32.

    Lee SS, Ghosn C, Yu Z, Zacharias LC, Kao H, Lanni C, Abdelfattah N, Kuppermann B, Csaky KG, D’Argenio DZ, Burke JA, Hughes PM, Robinson MR (2010) Vitreous VEGF clearance is increased after vitrectomy. Invest Ophthalmol Vis Sci 51:2135–2138

  33. 33.

    Falavarjani KG, Nguyen QD (2013) Adverse events and complications associated with intravitreal injection of anti-VEGF agents a review of literature. Eye (Lond) 27:787–794

  34. 34.

    Tolentino M (2011) Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol 56:95–113

  35. 35.

    Nguyen-Khoa BA, Goehring EL, Werther W, Fung AE, Do DV, Apte RS, Jones JK (2012) Hospitalized cardiovascular events in patients with diabetic macular edema. BMC Ophthalmol 12:11

  36. 36.

    Sim DA, Keane PA, Tufail A, Egan CA, Aiello LP, Silva PS (2015) Automated retinal image analysis for diabetic retinopathy in telemedicine. Curr Diabetes Rep 15:14

  37. 37.

    Simo R, Sundstrom JM, Antonetti DA (2014) Ocular anti-VEGF therapy for diabetic retinopathy: the role of VEGF in the pathogenesis of diabetic retinopathy. Diabetes Care 37:893–899

  38. 38.

    Ohkoshi K, Yamaguchi T (2010) Subthreshold micropulse diode laser photocoagulation for diabetic macular edema in Japanese patients. Am J Ophthalmol 149:133–139

  39. 39.

    Luttrull JK, Dorin G (2012) Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review. Curr Diabetes Rev 8:274–284

  40. 40.

    Inagaki K, Ohkoshi K, Ohde S, Deshpande GA, Ebihara N, Murakami A (2015) Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561–577-nm) direct photocoagulation for diabetic macular edema. Jpn J Ophthalmol 59:21–28

Download references

Author information

Correspondence to Manabu Yamamoto.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of our hospital, carried out on the basis of the Declaration of Helsinki, and registered with the University Hospital Medical Information Network (UMIN) (No. 000010471).

Informed consent

Written informed consent was obtained from all patients prior to enrollment.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yamamoto, M., Miura, Y., Hirayama, K. et al. Predictive factors of outcome of selective retina therapy for diabetic macular edema. Int Ophthalmol (2020). https://doi.org/10.1007/s10792-020-01288-6

Download citation

Keywords

  • Macular edema
  • Diabetic retinopathy
  • Laser therapy
  • Retinal pigment epithelium