As reported in the Archives of Ophthalmology, a 3 year study finds that laser photocoagulation is just as effective as intravitreal steroid injection for the treatment of clinically significant macular edema (CSME), aka diabetic macular edema (DME). This DRCR.net study compared standard laser photocoagulation against intravitreal steroids given in two different strengths.
The study involved 840 eyes of 693 patients. Over a 3 year period;
1. the vision in laser treated eyes was better than either of the two strengths of steroid
2. more patients initially receiving steroids needed alternate laser treatment compared to random selection
3. 75% of laser treatment group did not need re-treatment compared to the steroid group (both steroid groups had fewer people that required retreatment)
4. the incidence of cataract was higher in the intravitreal steroid group(s)
What does this mean? First, this is a good study. (A good study is both prospective and randomized). A study like this seems to indicate that, when given exact circumstances, that is, patients that have exactly the same problem, laser photocoagulation is as good, or better, than intravitreal steroids. If you had two identical eyes, both requiring treatment for diabetic macular edema, you should choose laser photocoagulation.
But this isn’t real life. This study also says that intravitreal steroid therapy is an effective way to treat patients with diabetic macular edema. There are lots and lots of patients with diabetic macular edema that can not be treated with laser photocoagulation (sometimes the laser can not be used to treat swelling right in the middle of the macula as permanent blind spots may be created). In these cases, I would recommend steroid treatment.
So, in some cases laser can’t be used and steroid treatment may be a better option. Apparently, it works pretty well, but may be not as well as laser.
Link to the article.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist