12-month results of the standardised combination therapy for diabetic macular oedema: intravitreal bevacizumab and navigated retinal photocoagulation.

AIM: To evaluate the efficacy of a standardised combination therapy for clinically significant diabetic macular oedema using bevacizumab injections followed by navigated laser photocoagulation to stabilise retinal thickness. METHODS: In this pilot study we retrospectively reviewed charts and imaging of 23 eyes treated with the standardised combination regimen. Eyes initially received monthly bevacizumab injections, followed by navigated laser photocoagulation when central retinal thickness (CRT) was <440 µm. Patients were then followed monthly for 12 months. RESULTS: At the time of navigated laser after bevacizumab treatment mean vision gain was +10.4 Early Treatment Diabetic Retinopathy Study letters (p<0.01) and CRT reduction was 146 µm (p<0.001). At 12 months from baseline, the vision gain remained stable at +10.6 Early Treatment Diabetic Retinopathy Study letters (p<0.01), and CRT reduction was stable at 137 µm (p<0.001). At 12 months from laser, the vision gain was 7.8 letters from baseline (p<0.01), with no significant change compared with the gain at 12 months from baseline (p=0.108). At 12 months from laser, CRT reduction was 125 µm from baseline (p<0.001), with no significant change compared with CRT reduction at 12 months from baseline (p=0.601). Total injections needed were 4.4 from baseline to month 12, with 1.3 reinjection needed after laser. 57% of the eyes didn't require injections after laser, while 43% needed two additional injections. CONCLUSIONS: Standardised combination therapy using bevacizumab injections followed by navigated laser treatment for clinically significant diabetic macular oedema demonstrated significant visual gain and CRT reduction after bevacizumab treatment and stabilisation after navigated laser up to 12 months. The number of injections required in 12 months was lower than reported in previous combination studies.

Time required for navigated macular laser photocoagulation treatment with the Navilas.

BACKGROUND: Navilas laser is a novel technology combining photocoagulation with imaging, including fluorescein angiographic (FA) images which are annotated and aligned to a live fundus view. We determine the time necessary for planning and treatment of macular edema utilizing the Navilas. METHODS: The screen recordings during treatments were retrospectively analyzed for treatment type, number of laser shots, the duration of planning (measured from the time the planning image was selected to time of marking the last planned treatment spot), and total time of laser application. RESULTS: A total of 93 treatments (30 grid, 30 focal and 33 combined treatments) by four physicians from three sites were included. An average of 125 spots were applied to each eye. The total time spent for each focal treatment - including the planning was 7 min 47 s (±3 min and 32 s). CONCLUSIONS: Navilas is a novel device providing a time efficient platform for evaluating FA images and performing threshold macular laser photocoagulation.

Clinical evaluation and treatment accuracy in diabetic macular edema using navigated laser photocoagulator NAVILAS.

PURPOSE: To evaluate the clinical use and accuracy of a new retinal navigating laser technology that integrates a scanning slit fundus camera system with fluorescein angiography (FA), color, red-free, and infrared imaging capabilities with a computer steerable therapeutic 532-nm laser. DESIGN: Interventional case series. PARTICIPANTS: Eighty-six eyes of 61 patients with diabetic retinopathy and macular edema treated by NAVILAS. METHODS: The imaging included digital color fundus photographs and FA. The planning included graphically marking future treatment sites (microaneurysms for single-spot focal treatment and areas of diffuse leakage for grid pattern photocoagulation) on the acquired images. The preplanned treatment was visible and overlaid on the live fundus image during the actual photocoagulation. The NAVILAS automatically advances the aiming beam location from one planned treatment site to the next after each photocoagulation spot until all sites are treated. Aiming beam stabilization compensated for patient's eye movements. The pretreatment FA with the treatment plan was overlaid on top of the posttreatment color fundus images with the actual laser burns. This allowed treatment accuracy to be calculated. Independent observers evaluated the images to determine if the retinal opacification after treatment overlapped the targeted microaneurysm. MAIN OUTCOME MEASURES: Safety and accuracy of laser photocoagulation. RESULTS: The images were of very good quality compared with standard fundus cameras, allowing careful delineation of target areas on FA. Toggling from infrared, to monochromatic, to color view allowed evaluation and adjustment of burn intensity during treatment. There were no complications during or after photocoagulation treatment. An analysis of accuracy of 400 random focal targeted spots found that the NAVILAS achieved a microaneurysm hit rate of 92% when the placement of the treatment circle was centered by the operating surgeon on the microaneurysm. The accuracy for the control group analyzing 100 focal spots was significantly lower at 72% (P<0.01). CONCLUSIONS: Laser photocoagulation using the NAVILAS system is safe and achieves a higher rate of accuracy in photocoagulation treatments of diabetic retinopathy lesions than standard manual-technique laser treatment. Precise manual preplanning and positioning of the treatment sites by the surgeon is possible, allowing accurate and predictable photocoagulation of these lesions. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Refractory intraocular pressure increase after phakic posterior chamber intraocular lens implantation.

PURPOSE: To describe a complication resulting from the implantation of a posterior chamber intraocular lens in a phakic eye. DESIGN: Interventional case report. METHODS: We examined a 37-year-old woman with severe myopia who had implantation of a phakic posterior chamber intraocular lens. RESULTS: The patient developed pigmentary glaucoma with refractory increase in intraocular pressure, despitemedical therapy and intraocular lens removal. Trabeculectomy was required to reduce the pressure. CONCLUSION: This case demonstrates that pigmentary glaucoma secondary to implantation of a phakic posterior chamber intraocular lens can lead to filtering surgery to decrease intraocular pressure.