Laser treatment for diabetic macular edema in the 21st century

Abstract

Diabetic macular edema (DME) is the leading cause of blindness in the diabetic population. The diabetes Control and Complications Trial reported that 27% of patients affected by type 1 diabetes develop DME within 9 years of onset. Other studies have shown that in patients with type 2 diabetes, the prevalence increased from 3% to 28% within 5 years of diagnosis to twenty years after the onset. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal therapies for DME (e.g., corticosteroids, and anti-VEGF drugs), laser photocoagulation remains the current gold standard and the only treatment with proven efficacy in a wide range of clinical trials for this condition. Despite being the standard technique for comparison and evaluation of the emerging treatments, we have generally poor understanding of the ETDRS recommendations, and we often forget about the results of laser in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME with an extensive review of the ETDRS results and discuss the laser techniques. Furthermore, we will describe the new developments in laser systems and review the current indications and results. Finally, we will discuss the results of laser treatments versus the current pharmacological therapies. We conclude by trying to provide a general overview that which laser treatment must be indicated and what types of lasers are currently recommended.

Fig. (1)

Red-free fundus photography showing diffuse diabetic macular edema.

Fig. (2)

Macular fibrosis secondary to a grid laser treatment. Spectral Domain-OCT image shows the subretinal fibrosis. The red-free fundus photography shows a scar located at fovea, surrounded by the laser impact sites.

Fig. (3)

Retinal fundus photography after ten years of a laser treatment. There is an observable increase in the size of the initial laser spots, and a lot of hyperpigmented areas can be seen in the laser scars.

Fig. (4)

In this image we can observe an epiretinal membrane, which tractions the macula to the laser burns.