Perm Medical JournalPerm Medical JournalПермский медицинский журнал (сетевое издание "Perm medical journal")0136-14492687-1408Eco-Vector7138610.17816/pmj38256-69Literature reviewОбзор литературыReview ArticleRole of focal laser retinal photocoagulation in treatment of diabetic macular edemaРоль фокальной лазерной коагуляции сетчатки в лечении диабетического макулярного отекаIonkinaI. V.ИонкинаИ. В.
Russian Federation

Candidate of Medical Sciences, ophthalmologist of self-supporting polyclinic

кандидат медицинских наук, врач-офтальмолог хозрасчетной поликлиники

ionkina_iv@mail.ruGrinevA. G.ГриневА. Г.
Russian Federation

MD, PhD, Associate Professor, Department of Ophthalmology, Head of Ophthalmological Unit № 1

доктор медицинских наук, доцент кафедры офтальмологии, заведующий 1-м офтальмологическим отделением

ionkina_iv@mail.ruZherebtsovaO. M.ЖеребцоваО. М.
Russian Federation

ophthalmologist, Ophthalmological Unit № 1

врач-офтальмолог 1-го офтальмологического отделения

ionkina_iv@mail.ruSverdlovsk Regional Clinical Hospital № 1Свердловская областная клиническая больница № 1Ural State Medical Universityг.Уральский государственный медицинский университетSverdlovsk Regional Clinical Hospital № 1Свердловская областная клиническая больница № 11503202138256690806202108062021Copyright ©; 2021, Ionkina I.V., Grinev A.G., Zherebtsova O.M.Copyright ©; 2021, Ионкина И.В., Гринев А.Г., Жеребцова О.М.2021Ionkina I.V., Grinev A.G., Zherebtsova O.M.Ионкина И.В., Гринев А.Г., Жеребцова О.М.http://creativecommons.org/licenses/by-sa/4.0https://permmedjournal.ru/PMJ/article/view/71386

Vascular endothelial growth factor (anti-VEGF) inhibitors in action have demonstrated efficacy and safety in the treatment of diabetic macular edema (DME), and have changed both the goal and prospects for treatment of this disease. Consequently, the role of focal laser retinal photocoagulation in the treatment of DME has been actively debated. However, technical advances in new laser systems, treatment protocols for anti-VEGF drug research, and the functional impact of modern focal photocoagulation are necessary to assess the role of laser coagulation in the treatment of DME. A wide range of clinical studies of laser therapy was necessary as an additional treatment for 20 to 50 % of patients receiving monotherapy with anti-VEGF drugs in patients with diabetic macular edema. In addition, a lower frequency of repeated treatment and a more stable reduction in retinal thickness have been demonstrated in other studies. However, the lack of information about the laser systems used, their technical characteristics, and application protocols often make it difficult to compare directly the results of anti-VEGF tests. Therefore, the aim of our work was to analyze the currently available data related to the potential role of focal laser photocoagulation in the treatment of DME, including a detailed review of the most commonly used laser systems. The results obtained with sub-threshold diode micro-pulse laser photocoagulation may be a valuable option as an adjunct therapy to treatment with angiogenesis inhibitors. Current evidence suggests that focal laser therapy should still exist as an adjunct therapy for many patients.

Ингибиторы ангиогенеза (анти-VEGF) продемонстрировали высокую эффективность и безопасность в лечении диабетического макулярного отека, а также позволили изменить взгляд как на цель, так и перспективы лечения данного заболевания. Активно ведется дискуссия о роли фокальной лазеркоагуляции сетчатки при лечении диабетического макулярного отека. Технические достижения в разработке новых лазерных систем, множественные исследования эффективности анти-VEGF-препаратов и функциональное влияние современной фокальной лазеркоагуляции необходимы для оценки роли использования лазеркоагуляции при лечении диабетического макулярного отека. Широкий спектр клинических исследований показал необходимость лазерной терапии в качестве дополнительной у пациентов, получающих монотерапию анти-VEGF-препаратами. Кроме того, были продемонстрированы: низкая частота повторного лазерного лечения и более стабильное снижение толщины сетчатки. Однако отсутствие информации об используемых лазерных системах, их технических характеристиках и протоколах применения часто затрудняет прямое сравнение результатов лечения с анти-VEGF-препаратами.

В связи с этим проанализированы имеющиеся в настоящее время литературные данные о роли фокальной лазеркоагуляции сетчатки в лечении диабетического макулярного отека, включая подробный обзор наиболее часто используемых лазерных систем. Полученные результаты о субпороговой диодной микроимпульсной лазеркоагуляции могут стать методом выбора в качестве дополнительной терапии к лечению ингибиторами ангиогенеза. Существующие на сегодняшний день данные показывают, что фокальная лазерная терапия все еще должна существовать как дополнительная терапия для многих пациентов.

anti-VEGFdiabetic macular edemaretinal laser coagulationанти-VEGFдиабетический макулярный отеклазеркоагуляция сетчаткиFong D.S., Strauber S.F., Aiello L.P. et al. Comparison of the modified Early Treatment Diabetic Retinopathy Study and mild macular grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol 2007; 125: 469–480.Do D.V., Nguyen Q.D., Boyer D. et al One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology 2012; 119: 1658–1665.Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1987; 94: 761–774.Luttrull J.K., Musch D.C., Mainster M.A. Subthreshold diode micropulse photocoagulation for the treatment of clinically significant diabetic macular oedema. Br J Ophthalmol 2005; 89: 74–80.Neubauer A.S., Langer J., Liegl R. et al. Navigated macular laser decreases retreatment rate for diabetic macular edema: a comparison with conventional macular laser. Clin Ophthalmo 2013; 17: 121–128.Mitchell P., Bandello F., Schmidt-Erfurth U. et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology 2011; 118: 615–625.Luttrull J.K., Dorin G. Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review. Curr Diabetes Rev 2012; 8: 274–284.Franz Fankhauser S.K. Lasers in ophthalmology: basic, diagnostic, and surgical aspects: a review. Monroe, NY: Kugler Publications 2003; 175.Michaelides M., Kaines A., Hamilton R.D. et al. A prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema (BOLT study) 12-month data: report 2. Ophthalmology 2010; 117: 1078–1086.Modi D., Chiranand P., Akduman L. Efficacy of patterned scan laser in treatment of macular edema and retinal neovascularization. Clin Ophthalmol 2009; 3: 465–470.Muqit M.M., Sanghvi C., McLauchlan R. et al. Study of clinical applications and safety for Pascal(R) laser photocoagulation in retinal vascular disorders. Acta Ophthalmol 2012; 90: 155–161.Sanghvi C., McLauchlan R., Delgado C. et al. Initial experience with the Pascal photocoagulator: a pilot study of 75 procedures. Br J Ophthalmol 2008; 92: 1061– 1064.Blumenkranz M.S., Yellachich D., Andersen D.E. et al. Semiautomated patterned scanning laser for retinal photocoagulation. Retina 2006; 26: 370–376.Jain A., Blumenkranz M.S., Paulus Y. et al. Effect of pulse duration on size and character of the lesion in retinal photocoagulation. Arch Ophthalmol 2008; 126: 78–85.Dorin G. Subthreshold and micropulse diode laser photocoagulation. Ophthalmol 2003; 18: 147–153.Pankratov M.M. Pulsed delivery of laser energy in experimental thermal retinal photocoagulation. In: Society of photo-optical instrumentation engineers. Proc SPIE 1990; 1202: 205–213.Guyer D.R., D’Amico D.J., Smith C.W. Subretinal fibrosis after laser photocoagulation for diabetic macular edema. Am J Ophthalmol 1992; 113: 652–656.Vujosevic S., Bottega E., Casciano M. et al. Microperimetry and fundus auto-fluorescence in diabetic macular edema: subthreshold micropulse diode laser versus modified early treatment diabetic retinopathy study laser photocoagulation. Retina 2010; 30: 908–916.Lavinsky D., Cardillo J.A., Jr Melo L.A. et al. Randomized clinical trial evaluating mETDRS versus normal or highdensity micropulse photocoagulation for diabetic macular edema. Invest Ophthalmol Vis Sci 2011; 52: 4314–4323.Moisseiev E., Abbassi S., Thinda S. et al. Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema. Eur J Ophthalmol 2017; 28: 68–73.Bressler S.B., Almukhtar T., Aiello L.P. et al. Green or yellow laser treatment for diabetic macular edema: exploratory assessment within the Diabetic Retinopathy Clinical Research Network. Retina 2013; 33: 2080–2088.Sramek C.K., Leung L.S., Paulus Y.M. et al. Therapeutic window of retinal photocoagulation with green (532-nm) and yellow (577-nm) lasers. Ophthalmic Surg Lasers Imaging 2012; 43: 341–347.Kernt M., Cheuteu R.E., Cserhati S. et al. Pain and accuracy of focal laser treatment for diabetic macular edema using a retinal navigated laser (Navilas). Clin Ophthalmol 2012; 6: 289–296.Schatz H., Madeira D., McDonald H.R. et al. Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol 1991; 109: 1549–1551.Tababat-Khani P., Bengtsson B., Agardh E. Effects of focal/grid laser treatment on the central visual field in diabetic macular oedema: a 2-year follow-up study. Acta Ophthalmol 2016; 94: 240–245.Gonzalez V.H., Boyer D.S., Schmidt-Erfurth U. et al. Microperimetric assessment of retinal sensitivity in eyes with diabetic macular edema from a phase 2 study of intravitreal aflibercept. Retina 2015; 35: 687–694.Elman M.J., Aiello L.P., Beck R.W. et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 2010; 117: 1064–1077.Massin P., Bandello F., Garweg J.G. et al. Safety and effcacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care 2010; 33: 2399–2405.Nguyen Q.D., Shah S.M., Khwaja A.A. et al. Twoyear outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study. Ophthalmology 2010; 117: 2146–2151.Heier J.S., Korobelnik J.F., Brown D.M. et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID studies. Ophthalmology 2016; 123: 2376–2385.Wells J.A., Glassman A.R., Ayala A.R. et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology 2016; 123: 1351–1359.Liegl R., Langer J., Seidensticker F. et al. Comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema. PLoS One 2014; 9: e113981.Payne J.F., Wykoff C.C., Clark W.L. et al. Randomized trial of treat and extend ranibizumab with and without navigated laser for diabetic macular edema: TREX-DME 1 year outcomes. Ophthalmology 2017; 124: 74–81.Aiello L.P., Avery R.L., Arrigg P.G. et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J 2014; 331: 1480–1487.Bek T. Diabetic maculopathy caused by disturbances in retinal vasomotion. A new hypothesis. Acta Ophthalmol Scand 1999; 77: 376–380.Berger A., Sheidow T., Cruess A.F. et al. Efficacy/safety of ranibizumab monotherapy or with laser versus laser monotherapy in DME. Can J Ophthalmol 2015; 50: 209–216.Brown D.M., Schmidt-Erfurth U., Do D.V. et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the VISTA and VIVID studies. Ophthalmology 2015; 122: 2044–2052.Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol 1985; 103: 1796–1806.Figueira J., Khan J., Nunes S. et al. Prospective randomised controlled trial comparing sub-threshold micropulse diode laser photocoagulation and conventional green laser for clinically significant diabetic macular oedema. Ophthalmol 2009; 93: 1341–1344.Gao X., Xing D. Molecular mechanisms of cell proliferation induced by low power laser irradiation. J Biomed Sci 2009; 16: 4.Gottfredsdottir M.S., Stefansson E., Jonasson F. et al. Retinal vasocon-striction after laser treatment for diabetic macular edema. Am J Ophthalmol 1993; 115: 64–67.Ishibashi T., Li X., Koh A. et al. The REVEAL study: ranibizumab monotherapy or combined with laser versus laser monotherapy in asian patients with diabetic macular edema. Ophthalmology 2015; 122: 1402–1415.Haller J.A., Lewis H., Schachat A.P., Haimann M.H. et al. Choroidal neovascularization after laser photocoagulation for diabetic macular edema. Ophthalmology 1990; 97: 503–510; discussion 501–510.Nguyen Q.D., Shah S.M., Van Anden E. et al. Supplemental oxygen improves diabetic macular edema: a pilot study. Invest Ophthalmol Vis Sci 2004; 45: 617–624.Nguyen Q.D, Brown D.M, Marcus D.M et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 2012; 119: 789–801.Stefansson E. Ocular oxygenation and the treatment of diabetic retinopathy. Surv Ophthalmol 2006; 51: 364–380.Radin P.P., Chiesa L., Cavarzeran F. Diabetic macular edema: correlation between microperimetry and optical coherence tomography findings. Invest Ophthalmol Vis Sci 2006; 47: 3044–3051.