Laser-based strategies to treat diabetic macular edema: history and new promising therapies

Abstract

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. The management of DME is complex and often various treatment approaches are needed. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal pharmacologic therapies (e.g., corticosteroids and anti-VEGF drugs), laser photocoagulation still remains the current standard in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME and describe the developments in laser systems. And we will also discuss the new laser techniques and review the latest results including benefits of combined therapy. In this paper, we briefly summarize the major laser therapeutics for the treatment of diabetic macular edema and allude to some future promising laser therapies.

Figure 1

(a) The laser pulse energy was increased stepwise with every pulse by 3% of the dynamic range. In the chosen example, laser irradiation was ceased automatically after the 16th pulse due to detection of microbubble formation. (b) The dual dosimetries show that adequate turnoff system works properly (e.g., turnoff at the 16th pulse).

Figure 2

Color fundus photographs showing the reduction in hard exudates before (a) and 3 months (b) after SRT for DME. Laser test spots were applied (red arrow) and SRT treatment was performed (yellow arrowhead). OCT scans showing the reduction of retinal thickness. OCT scan and retinal thickness map before (d) and 3 months after SRT (e).