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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*

Retina:
doi: 10.1097/IAE.0b013e31827d2509
Original Study
Abstract

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 Brief

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.

Author Information

*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.