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Is there still a role of macular laser treatment in branch retinal vein occlusion in the era of intravitreal injections?

DOI:10.1111/aos.14261 期刊:Acta Ophthalmologica 出版年份:2019 更新时间:2025-09-19 17:13:59
摘要: We aimed to evaluate whether macular laser still has a role in the treatment of macular oedema (MO) caused by branch retinal vein occlusion (BRVO) and provide an overview of recent studies on commonly available treatment options. A literature search was last conducted in PubMed on 26 February 2019, limited to human randomized controlled trials published in English since 2008. Seventeen articles addressing 13 trials were included in this assessment. In trials evaluating intravitreal corticosteroid and macular laser, triamcinolone was non-inferior to laser in regard to visual acuity (VA) and central retinal thickness (CRT) outcomes. Combination treatment of dexamethasone and laser resulted in better VA and lower CRT after 6 months. In trials evaluating vascular endothelial growth factor (VEGF) inhibitors versus macular laser treatment, or sham and rescue laser, better VA and CRT of VEGF inhibition treatment was consistently reported. Results of combination treatment versus VEGF inhibition monotherapy were inconsistent, with four of six studies reporting comparable outcomes and injection burden. Study comparison was affected by considerable differences in study design and inadequate reporting of laser protocol and rescue laser. Studies evaluating angiostatic treatment as monotherapy largely report the use of rescue laser, indicating that some patients would benefit from supplemental laser treatment even in the era of intravitreal therapy. Thus, we suggest further studies on optimal design of combination therapy prioritizing longer follow-up time to sufficiently evaluate the delayed effect of laser.
作者: Anne M?ller Stenner,Katrine Hartmund Frederiksen,Jakob Grauslund
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To evaluate whether macular laser still has a role in the treatment of macular oedema (MO) caused by branch retinal vein occlusion (BRVO) and provide an overview of recent studies on commonly available treatment options.

Conventional macular laser treatment as monotherapy was non-inferior in functional and structural outcomes compared to intravitreal VEGF inhibitors. Rescue laser was widely needed in studies of angiostatic agents implying that some patients might benefit from alternative treatment regimens. When comparing combination therapy and monotherapy, results were inconsistent and inconclusive. Optimal treatment design of combination therapy is still a relevant topic for further research, and future studies should aim for a prolonged follow-up time to evaluate the effect of laser sufficiently.

The review is limited by difficulties in direct comparison of included studies due to variations in inclusion criteria especially regarding treatment naivety and time since diagnosis, follow-up period, retreatment criteria for intravitreal treatment and laser treatment as well as differences in laser treatment protocol when this is thoroughly defined.

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