Laser treatment for diabetic macular edema is still the preferred treatment for most patients with diabetic retinopathy. Despite all the recent news about intraocular injections of anti-VEGF and steroid medications, the laser remains the mainstay.
The most common manifestation of diabetic retinopathy is the development of macular edema (also known as diabetic macular edema (DME) or clinically significant macular edema (CSME)). Almost all patients who develop diabetic retinopathy develop some degree of swelling in the macula. The normal retinal blood vessels begin to leak into the surrounding tissue. It is not unlike a “soaker” hose for your lawn. Of all the stages of diabetic retinopathy, this is the most common and does NOT lead to blindness.
The development of swelling, or edema, can decrease the central vision. This is the most common way vision is lost. The surgical goal is to arrest further swelling by treating the retina with laser photocoagulation. The laser treatment is focused on areas of leakage called “microaneurysms” which are the actual incompetent areas in the normal retinal vessels.
Once treated, the macular swelling usually stays the same. About 80% of the time, the macular edema, and vision stabilize! My job is achieve status quo. At times, especially when caught early, the vision improves as the swelling decreases. Rarely, the laser doesn’t work.
Intraocular injections of Avastin® for macular edema or intraocular Kenalog® can be used for cases in which laser doesn’t work. In the future, Ozurdex® or other intraocular sustained release delivery systems may be useful.
The laser used is usually a “hot” laser, that is, it works by transferring heat to the tissue. The procedure is performed in the office setting, takes no longer than a regular office visit and is painless. There is no post-operative care needed.
The result of the laser can take months to assess. I usually will not see a patient back for another 4 monthas or so.
Ophthalmologist, Retina Specialist