Early treatment diabetic retinopathy study research group. The initial laser used in retina treatment with a thermal effect was the xenon arc photocoagulator. Comparison of the modified etdrs with a mild macular grid mmg in. Modified etdrs focalgrid laser photocoagulation has been utilized in more recent clinical trials diabetic retinopathy clinical research drcr protocols i and t in combination with intravitreal injections. Oct 01, 2017 one study compared monthly ranibizumab for dme, with or without navilas focalgrid laser. Given these findings, a larger longterm trial of the mmg technique is not justified. Comparison of modifiedetdrs and mild macular grid laser. Jan 05, 2020 treatment of diabetic macular edema with laser photocoagulation.
Laser is an abbreviation for light amplification by stimulated emission of radiation. To report visual acuity and anatomic changes from baseline to 12 months after modified early treatment diabetic retinopathy study etdrsstyle focalgrid photocoagulation in eyes with noncenterinvolved nonci clinically significant macular edema. A modified etdrs laser treatment is currently recommended. Comparison between treatment with yellow micropulse laser and. Comparison of the modified early treatment diabetic retinopathy study and mild macular grid laser photocoagulation strategies for diabetic macular edema october 2007 evidencebased ophthalmology 8. A pilot study of laser photocoagulation for diabetic macular. Modified etdrs and the mild macular grid laser photocoagulation techniques indications for vitrectomy management of diabetic retinopathy in special circumstances 7. Methods two hundred sixtythree subjects mean age, 59 years with previously untreated diabetic macular edema were randomly assigned to receive laser photocoagulation by either the modified etdrs 162 eyes or mmg 161 eyes technique. Recent findingsthe etdrs reported that argon laser treatment is beneficial in the manage. Comparison of modified etdrs and mild macular grid laser. The etdrs recommended macular laser for clinically significant macular edema csme which was defined as any of the following based on stereoscopic fundus examination. As recommended for the modified etdrs grid laser treatment, patients with dme received a predetermined grid pattern laser treatment of the edematous perifoveolar region in this study setting consisting of 56 laser lesions performed in a homogenous ring pattern after energy titration using the pascal laser system. Oct 23, 2006 modifiedetdrs focal photocoagulation technique the laser treatment session should generally be completed in a single sitting.
Visual acuity, fundus photographs, and optical coherence tomography measurements were obtained at baseline and at 3. Pdf comparison of the modified early treatment diabetic. Though the specific mechanism by which laser photocoagulation reduces diabetic macular edema is not fully understood, a landmark study called the early treatment diabetic retinopathy study etdrs showed that focal direct grid photocoagulation reduces moderate vision loss caused by dme by 50 percent or more. Macular treatment using the modified etdrs protocol, with barely visible laser burns to close microaneurysms, or with a grid pattern in the area of retinal thickening. Visual acuity, optical coherence tomography, fluorescein angiography, and fundus photography data were analyzed.
Keywords diabetic macular edema, early treatment diabetic retinopathy study, focal laser photocoagulation. Proliferative and nonproliferative diabetic retinopathy american. Grid laser is applied to all areas with edema from 500 to 3000 m in all directions and up to 3. This technique changed to a long, slow, moderately. Macular grid grid macular laser can be effective in reducing diffuse macular oedema caused by branch retinal vein occlusions or by diabetic maculopathy. Drcr focalgrid photocoagulation modifiedetdrs technique 1025 page 2 of 2 15 16 if a laser is used that has the capability of producing an automated pattern e. Treatment before macular grid in patients of diabetic. Patient outcomes after application of a modified etdrs laser protocol or mild macular grid laser mmg photocoagulation were evaluated in a randomized.
The photocoagulation treatment technique, as described below, is a modification of the etdrs technique and is the treatment approach that is commonly used in clinical practice. Modifiedetdrs and the mild macular grid laser photocoagulation techniques indications for vitrectomy management of diabetic retinopathy in special circumstances 7. For those subjects with both eyes eligible for the study, one eye was randomized to one treatment technique, while the other eye received the other treatment technique. The efficacy of grid macular laser in preventing loss of vison is supported in branch retinal vein occlusions by the bvos study 1 and in diabetic maculopathy by several studies, most notably the etdrs. Keywords diabetic macular edema, early treatment diabetic retinopathy study, focal laser photocoagulation introduction diabetic macular edema dme is an important. To compare 2 laser photocoagulation techniques for treatment of diabetic macular edema. The concept of ocular therapy using light was published first by meyerschwickerath, who used the sunlight to treat patients with ocular melanoma in 1949. Ongoing studies in eyes with dme, nonproliferative diabetic retinopathy, and good visual acuity will help further define the place of modified etdrs focal grid laser in the treatment of dme. Best corrected early treatment diabetic retinopathy study etdrs visual acuity score 19 letters approximately 20400 or better. Modified etdrs focal photocoagulation should continue to be a standard approach for. Modified grid laser photocoagulation has been shown to stabilize visual acuity in patients with diabetic macular edema, but the effect on extrafoveal visual function is uncertain. Early treatment diabetic retinopathy study report number 1. Modifiedetdrs focal photocoagulation technique the laser treatment session should generally be completed in a single sitting. A total of 263 subjects with 323 eligible eyes were randomized to receive either modified etdrs laser photocoagulation or mild macular grid photocoagulation.
Comparison of the modified early treatment diabetic retinopathy study and mild macular grid laser photocoagulation strategies for diabetic macular edema. Retina today laser therapy for diabetic retinopathy and. Structural and functional changes using spectral domain optical coherence tomography oct and microperimetry mp were studied before and 4 months. Drcr focalgrid photocoagulation modifiedetdrs technique 1025 page 1 of 2 1 focalgrid photocoagulation modifiedetdrs technique 2 3 the laser treatment session should generally be completed in a single sitting. Treatment was repeated if diabetic macular edema persisted. Jul 11, 2018 in this prospective randomized study, 30 eyes from 20 patients with noncenter involving macular edema were randomized into 3 different groups. Macular laser photocoagulation was repeated if dme persisted and such. Structural and functional changes using spectral domain optical coherence tomography oct and microperimetry mp were studied before and 4 months after laser in 37 eyes with clinically significant. Titration in subthreshold groups was performed with 30% of the threshold power, decided with microsecond pulses. Among the 22 eyes of 22 patients with 12month followup, median visual acuity letter score remained within 1 letter. Qualitative and quantitative oct response of diffuse. Laser treatment for diabetic macular edema in the 21st century. Fifty eyes of 29 patients were treated with subthreshold invisible diode laser modified grid photocoagulation for ddme in a prospective pilot clinical trial. Effect of focalgrid photocoagulation on visual acuity and.
The number of spots applied was significantly lower in group c cw as cw laser for modified grid was one burn width apart unlike subthreshold group where confluent laser applications were performed. Modified etdrs focal photocoagulation should continue to be a standard approach for treating diabetic macular edema. Morphological and functional outcomes following modified early. The 4 photocoagulation treatment technique, as described below, is a modification of the etdrs. Modified grid laser photocoagulation for diffuse diabetic macular edema longterm visual results carol m. A pilot study of laser photocoagulation for diabetic. The photocoagulation treatment technique, as described below, is a modification of the etdrs technique and is the treatment approach that is. All patients underwent modified etdrs laser treatment for me. Laser therapy for diabetic retinopathy and diabetic macular edema. Reduction in macular thickness was significantly greater in the group treated with the modified etdrs laser protocol, but no difference was noted in terms of the mean change in bestcorrected va 0 letters in the etdrs group and.
Group i patients n 15 received single intravitreal bevacizumab injection followed by modified macular grid photocoagulation 2 weeks later. Followup laser was done only if cmt was laser photocoagulation techniques for treatment of diabetic macular edema dme. To assess the safety and efficacy of two subthreshold parameters 5 and 15% duty cycle dc compared to standard etdrs early treatment of diabetic retinopathy study continuous wave cw laser. Laser photocoagulation is the most common treatment modality used in diabetic macular oedema dmo. Application to clinical practice modified etdrs focal photocoagulation should. Laser modified etdrs device for visible treatment of the retina, with direct treatment of microaneurysms or grid pattern covering the area of retinal edema. One study compared monthly ranibizumab for dme, with or without navilas focalgrid laser. Macular grid photocoagulation was performed following the modified etdrs laser protocol. Diabetic retinopathy treatment, macular edema treatments. To report visual acuity and anatomic changes from baseline to 12 months after modified early treatment diabetic retinopathy study etdrs style focal grid photocoagulation in eyes with noncenterinvolved nonci clinically significant macular edema. The laser parameter used for each group is listed in table 2. For decades, laser photocoagulation was the firstline therapy for both diabetic retinopathy dr and diabetic macular edema dme. Modifiedetdrs focal photocoagulation technique the laser. Definite retinal thickening due to diabetic macular edema based on clinical exam at or within 500 microns of the macular center for which the investigator believes laser photocoagulation is indicated.
We prospectively investigated the effect of baseline oct intraretinal morphological changes on the outcome of the macular grid laser in terms of foveal thickness and etdrs va. The early treatment diabetic retinopathy study etdrs has demonstrated the value of laser treatment in preventing or reversing visual loss from dmo. Michaelides m, kaines a et al a prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema bolt study 12 month data. To evaluate current standardofcare modified etdrs focalgrid photocoagulation metdrs as compared with a novel, potentially milder but. Comparison of different settings for yellow subthreshold. Proliferative and nonproliferative diabetic retinopathy. Diabetic retinopathy and diabetic macular edema are treated by lasers that produce thermal photocoagulation. Comparison between treatment with yellow micropulse laser. Retinal thickening within 500 m of the foveal center. An alternative approach mild macular grid, mmg is the application of mild, widely spaced burns throughout the macula, avoiding the foveal. Treatment of focal vs diffuse diabetic macular edema. In recent years, intravitreal antivegf injections have become popular as treatments for diabetic eye disease, and their safety and efficacy have been demonstrated in clinical trials.
Laser treatment is applied to areas of discrete leaking ma between 500 m and 3,000 m from the fovea. Modified grid laser photocoagulation for diffuse diabetic macular. Morphological and functional outcomes following modified. Apr 15, 2011 macular grid photocoagulation was performed following the modified etdrs laser protocol. Oct 15, 2006 a total of 263 subjects with 323 eligible eyes were randomized to receive either modified etdrs laser photocoagulation or mild macular grid photocoagulation. Patient outcomes after application of a modified etdrs laser protocol or mild macular grid laser mmg photocoagulation were evaluated in a randomized controlled trial that included 263 eyes with previously untreated dme, in patients who had 12month followup. Early treatment diabetic retinopathy study etdrs landmark. The role of laser in diabetic macular edema retinal physician. According to the modified etdrs protocol, focal laser photocoagulation is used to treated noncenterinvolving focal csme. Group ii patient n 15 received single posterior subtenon triamcinolone pst injection followed by modified macular grid photocoagulation 4 weeks later.
The early treatment diabetic retinopathy study historical. The laser was performed after 3 injections in one group and after cmt decreased to. Comparison of the modified early treatment diabetic. The group of eyes that underwent navilas focalgrid laser had improved va and reduced injection burden. Summary the etdrs provided outcomes data for dme, both untreated and following laser therapy. Ongoing studies in eyes with dme, nonproliferative diabetic retinopathy, and good visual acuity will help further define the place of modified etdrs focalgrid laser in the treatment of dme. Conventional retinal laser photocoagulation for diabetic retinopathy is. Laserbased strategies to treat diabetic macular edema. Nov 03, 2003 best corrected early treatment diabetic retinopathy study etdrs visual acuity score 19 letters approximately 20400 or better.
To compare two laser photocoagulation techniques for treatment of diabetic macular edema dme. The predictive value of optical coherence tomography after. As commented, the first laser used in retina treatment was the argon laser, which was then followed by the red krypton laser and finally the dye laser which allowed the light to change from yellow to green. On the other hand, many experiments on retinal damage from sunlight were performed in the late 1800s, but they are not published. The aim was to report morphological and functional outcomes following modified early treatment diabetic retinopathy study etdrs laser in diabetic macular edema dme. In vivo retinal morphology after grid laser treatment in. The early treatment diabetic retinopathy study historical re. Retinal physician the role of laser in diabetic macular.
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