Can subthreshold micropulse yellow laser treatment change the anti-vascular endothelial growth factor algorithm in diabetic macular edema? A randomized clinical trial

Purpose: To compare the efficacy of subthreshold micropulse yellow laser (SMYL) and intravitreal aflibercept injection (IAI) combination therapy with IAI monotherapy in the treatment of diabetic macular edema (DME) and to evaluate the number of injections and SMYL sessions required. Methods: This prospective study compared a group of 28 patients treated with a combination of SMYL and IAI with a group of 28 patients treated only with IAI. All patients initially received 3 monthly IAIs, and the monotherapy group was given additional injections as needed. The combination therapy patients additionally received SMYL after the loading phase. The primary outcome measures were the change in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to month 12; the secondary outcomes were the mean number of required injections and SMYL sessions. Results: In the monotherapy group, the BCVA improved from 0.38 � 0.10 to 0.20 � 0.10 logMAR; in the combination group, BCVA improved from 0.40 � 0.09 to 0.17 � 0.06 logMAR at the end of the 12th month. The CMT was reduced from 451.28 � 44.85 to 328.8 � 49.69 ?m in the monotherapy group and from 466.07 � 71.79 to 312.0 � 39.29 ?m in the combination group. Improvement of the mean BCVA and reduction of the mean CMT were similar in each group. The combination group required significantly fewer injections (3.21 � 0.41 vs 5.39 � 1.54; P < 0.001). By month 12, 75% of patients in the monotherapy group had required additional IAIs when compared with 16% in the combination group (P < 0.001). Conclusion: SMYL combination therapy demonstrated significant visual improvements in patients with DME. In the combination group, the retreatment rate and number of required injections were significantly lower compared with the IAI monotherapy group.

Laser-Induced Choroidal Neovascularization in Central Serous Chorioretinopathy: 4 Cases

PURPOSE: To report the choroidal neovascularization of 4 patients in central serous chorioretinopathy treated with laser treatment. CASE SUMMARY: We reported 4 patients with central serous chorioretinopathy. Three patients were treated with focal laser photocoagulation, and 1 patient with photodynamic treatment. All patients newly developed choroidal neovascularization (CNV) after treatment at the area of laser treatment. Three patients received intravitreal anti-VEGF injection and 1 patient received argon laser photocoagulation for the treatment of CNV. After the treatment, the CNV was resolved with improved visual acuity. CONCLUSIONS: Laser treatment may be efficacious tool to achieve rapid resolution in central serous chorioretinopathy until now. However, more caution at the time of treatment and close follow-up after treatment are warranted.

The Effect of Triple Therapy on Patients with Subretinal Hemorrhage Accompanied by Choroidal Neovascularization

PURPOSE: To presents the effect of triple therapy including C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy on patients with subretinal hemorrhage accompanied by choroidal neovascularization. METHODS: Twelve eyes of 12 patients suffering from subretinal hemorrhage accompanied by choroidal neovascularization with onset of the symptom within a week prior to three-day prone positioning after C3F8 gas injection were included in the present study. Next, intravitreal anti-VEGF injection and photodynamic therapy was performed. Then, within two months, intravitreal bevacizumab or ranibizumab injection was performed. RESULTS: After stabilization of the submacular hemorrhagic lesion, ten eyes of ten patients showed improved visual acuity, one eye showed no improvement, and decreased visual acuity developed in one patient. LogMAR visual acuity improved after the initial treatment from 1.05 +/- 0.43 to 0.74 +/- 0.58 and 0.53 +/- 0.51 at three and six months, respectively. The improvement was considered to be clinically significant. CONCLUSIONS: An appropriate regimen for treating broad submacular hemorrhage accompanied by choroidal neovascularization has not been established. The authors of the patients had obtained positive results from C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy. In the future, additional studies should be conducted.