Role of focal laser retinal photocoagulation in treatment of diabetic macular edema

Abstract

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.