Randomized Clinical Trial Evaluating mETDRS versus Normal or High-Density Micropulse Photocoagulation for Diabetic Macular Edema

Randomized Clinical Trial Evaluating mETDRS versus Normal or High-Density Micropulse Photocoagulation for Diabetic Macular Edema

Author Lavinsky, Daniel Autor UNIFESP Google Scholar
Cardillo, Jose A. Autor UNIFESP Google Scholar
Melo Jr., Luiz Alberto Soares Autor UNIFESP Google Scholar
Dare, Alessandro Google Scholar
Farah, Michel Eid Autor UNIFESP Google Scholar
Belfort, Rubens Junior Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Hosp Olhos Araraquara
Abstract PURPOSE. To compare modified Early Treatment Diabetic Retinopathy Study (mETDRS) focal/grid laser photocoagulation with normal-density (ND-SDM) or high-density (HD-SDM) subthreshold diode-laser micropulse photocoagulation for the treatment diabetic macular edema (DME).METHODS. A prospective, randomized, controlled, double-masked clinical trial with patients with previously untreated DME and best corrected visual acuity (BCVA) worse than 20/40 and better than 20/400. Patients were randomized to receive either mETDRS focal/grid photocoagulation (42 patients), NDSDM (39 patients), or HD-SDM (42 patients). Before treatment and 1, 3, 6, and 12 months after treatment, all patients underwent ophthalmic examinations, BCVA, color fundus photography, fluorescein angiography, and optical coherence tomography (OCT).RESULTS. At 12 months, the HD-SDM group had the best improvement in BCVA (0.25 logMAR), followed by the mETDRS group (0.08 logMAR), whereas no improvements were seen in the ND-SDM group (0.03 logMAR). All groups showed statistically significant progressive reduction of central macular thickness (CMT) throughout the study (P < 0.001). the HD-SDM group exhibited the greatest CMT reduction (154 mu m), which was not significantly different from that of the mETDRS group (126 mu m; P = 0.75).CONCLUSIONS. At 1 year, the clinical performance of HD-SDM was superior to that of the mETDRS photocoagulation technique, according to the anatomic and functional measures of improvement used in this investigation. A rationale for this treatment modality as a preferable approach is suggested, and the precise role of subthreshold micropulse laser treatment may become more defined as experience grows, guided by optimized treatment guidelines and more comprehensive trials. (Clinicaltrials.gov number, NCT00552435.) (Invest Ophthalmol Vis Sci. 2011;52:4314-4323) DOI:10.1167/iovs.10-6828
Language English
Date 2011-06-01
Published in Investigative Ophthalmology & Visual Science. Rockville: Assoc Research Vision Ophthalmology Inc, v. 52, n. 7, p. 4314-4323, 2011.
ISSN 0146-0404 (Sherpa/Romeo, impact factor)
Publisher Assoc Research Vision Ophthalmology Inc
Extent 4314-4323
Origin http://dx.doi.org/10.1167/iovs.10-6828
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000293332500051
URI http://repositorio.unifesp.br/handle/11600/33728

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