FEOph Symposium 2016

Saal A&B 15:00 - 16:15 01.10.2016
Symposium Sa18
Do we still need the laser in diabetic macular edema? – FEOph Symposium and Roundtable Discussion
Vorsitzende/r: Anselm Kampik (München), Wagih Aclimandos (London), Pierre-Jean Pisella (Tours), Pier-Enrico Gallenga (Chieti), Salvador García-Delpech (Valencia)

During the FEOph Symposium, junior speakers from France, Great Britain, Germany, Italy and Spain are holding lectures with focus on „Do we still need the laser in diabetic macular edema?“. The presentations are followed by a roundtable discussion with five experts from these countries who will discuss the different national approaches and strategies.
Organisator: Philip Gass (München)
Referent/in: Valentina Sarao (Udine)
The management of diabetic macular edema (DME) is complex and various treatment approaches are needed. Despite a growing interest of intravitreal drugs, laser therapy maintains a key position in the treatment of DME. Conventional laser therapeutic effects are the results of a photothermal process in which retina tissue is irreversibly damaged. Tissue-sparing subthreshold laser can be considered a valid substitute to conventional laser to achieve therapeutic effects without the burden of repeated intravitreal injections.
Referent/in: Marc Govare (Bordeaux)
Referent/in: Evangelia Papavasileiou (London)
Fluorescein angiography (FFA) is the gold standard for evaluating the retina vasculature and understanding of the anatomic and physiologic characteristics of diabetic retinopathy, but it has the risk of adverse effects and known defects in imaging of all the layers of the retinal vasculature. On the other hand, Optical coherence tomography (OCT) angiography can image vessels based on flow characteristics and may provide improved information. The aim of our presentation is to compare conventional FFA with OCT angiography in diabetic retinopathy.
Referent/in: Raúl Torrecillas-Picazo (Valencia)
Swept source (SS) and spectral domain (SD) optical coherence tomography angiography (OCTA) can be use to non-invasively evaluate the retinal microvasculature in diabetic human subjects. OCTA can clearly visualize retinal non-perfused areas and enables closer observation of each layer of the retinal capillaries. OCTA is clinically useful to decide laser treatment.
Referent/in: Tina Rike Herold (München)
Purpose: The prospective CAVNAV study previously showed that a combination of navigated laser photocoagulation (Navilas) and intravitreal injections with ranibizumab achieved similar visual gains at year 1 compared to ranibizumab monotherapy with a significantly reduced number of injections. Specifically, visual outcomes similar to major clinical trials were reached in both cohorts (+8.4 ETDRS letters vs. +6.9 letters; while post-loading-phase injections dropped by approx. 75% (0.88 ±1.23 vs. 3.88±2.32, p < 0.001). The purpose of this study was to determine if the long-term stability of visual gains and lower need of injections in combination therapy patients stated at year 1 could be maintained in a 3 year-follow-up period. Setting: Retrospective analysis of 66 patients of the CAVNAV study in the long term follow-up from month 12 to 36 Methods: The charts of CAVNAV patients in both arms remaining under the care of the investigators were subjected to retrospective analysis to determine BCVA at 12, 24 and 36 months and injection count from months 13-36. BCVA measurements following the original 1 year study were taken using logMAR charts. Injections had been provided with standard of care using PRN based on change in BCVA and CRT using Spectral domain OCT scans. Main outcome measures was change in BCVA and mean number of injections from baseline (12 months) to month 36. Results: BCVA was stable within one line of vision in both groups between from 12 through 36 months, with both cohorts showing a change of 0.05 ±0.2 logMAR. The lead in BCVA of the cohort with navigated laser of approximately 2 lines was also maintained through month 36. Following the initial reduction in required injections at month 12, combination therapy patients continued to require 2.1 times fewer injections over the next 24 months (2.67 ± 2.6 vs 4.83 ±3.93 injections for monotherapy). Conclusion: Combination of navigated laser and ranibizumab achieved BCVA gains comparable to anti-VEGF monotherapy. These results could be maintained through month 36. Concerning the number of required ranibizumab injections we observed a reduction of 3 injections in year 1 and further 1.5 injections in year 2 and 3 compared to the monotherapy group. Thus, adding navigated laser photocoagulation to intravitreal anti-VEGF therapy may represent a superior therapeutic approach to DME patients with stable functional results and lower injection burden.
Referent/in: Hansjürgen Agostini (Freiburg)
Referent/in: Patricia Bayo-Calduch (Valencia)
Referent/in: Laurent Kodjikian (Lyon)
Referent/in: Dominic McHugh (London)
Referent/in: Michele Reibaldi (Catania)