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RETINAL ARCHITECTURE RECOVERY AFTER GRID PHOTOCOAGULATION IN DIABETIC MACULAR EDEMA OBSERVED IN VIVO BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY

Mylonas, Georgios MD*; Bolz, Matthias MD*; Kriechbaum, Katharina MD*; Treu, Clara MD*; Deak, Gabor MD*,†; Lammer, Jan MD*; Scholda, Christoph MD*; Schmidt-Erfurth, Ursula MD*

doi: 10.1097/IAE.0b013e31827d2509
Original Study

Purpose: To identify the morphologic changes secondary to macular grid photocoagulation in diabetic macular edema in vivo using spectral domain optical coherence tomography.

Methods: In this prospective cohort study, 13 consecutive patients with vision loss because of clinically significant macular edema associated with diabetes mellitus Type 2 underwent grid laser treatment (PASCAL). Best-corrected visual acuity, Spectralis optical coherence tomography, infrared fundus imaging, and biomicroscopy were performed at baseline, Day 1, Week 1, and Months 1, 2, and 3 after treatment. Fluorescein angiography was performed at baseline and at 3 months.

Results: Mean central 1-mm thickness decreased significantly from 438 ± 123 μm (mean ± SD) at baseline to 391 ± 111 μm (P < 0.05) at 3 months with a nonsignificant trend of best-corrected visual acuity improvement. A wipeout of the photoreceptor layer and the inner segment/outer segment line together with an alteration of the overlaying outer nuclear layer and external limiting membrane was seen at Day 1. The lesion was reduced to a focal hyperreflective deposit on the retinal pigment epithelium boundary. In 55% of lesions, the external limiting membrane as well as the previously interrupted inner segment/outer segment line revealed intact continuity at Month 3. In some areas, repair was incomplete indicated by a focal condensation interrupting the inner segment/outer segment line in the lesion center.

Conclusion: In vivo imaging of morphologic lesion repair in human eyes after PASCAL grid laser of diabetic macular edema demonstrates progressive restoration of the external limiting membrane and inner segment/outer segment integrity as previously described in animal models.

In this prospective cohort study, patients with vision loss because of clinically significant macular edema associated with diabetes mellitus Type 2 underwent grid laser treatment (PASCAL) and were followed over 3 months. After 3 months, in vivo imaging of morphologic lesion repair in human eyes after grid laser of clinically significant macular edema demonstrates progressive restoration of the external limiting membrane and inner segment/outer segment integrity as previously described in animal models.

*Department of Ophthalmology, Medical University of Vienna, Vienna, Austria

Department of Ophthalmology, Semmelweis University, Budapest, Hungary.

Reprint requests: Ursula Schmidt-Erfurth, MD, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; e-mail: ursula.schmidt-erfurth@meduniwien.ac.at

None of the authors have any financial/conflicting interests to disclose.

G. Mylonas and M. Bolz have contributed equally to this paper.

© The Ophthalmic Communications Society, Inc.