Does laser still have a role in the management of retinal vascular and neovascular diseases?

Abstract

PURPOSE:

To discuss the current role of laser therapies in the management of retinal vascular and neovascular diseases.

DESIGN:

Perspective.

METHODS:

Laser's role in the management of diabetic retinopathy, age-related macular degeneration, and venous occlusive disease is discussed, with emphasis on comparing laser with anti-vascular endothelial growth factor (VEGF) therapy and discussion of situations where these treatment methods can be complementary.

RESULTS:

Thermal panretinal photocoagulation remains the usual practice for treatment of neovascularization in proliferative diabetic retinopathy and after venous occlusive events. Focal/grid laser still has a role for patients with macular edema resulting from diabetes or venous occlusion that is poorly responsive to anti-VEGF agents and in patients who are unable or unwilling to return for frequent injections. Focal/grid laser also is used as combination therapy with anti-VEGF agents for these indications. Focal laser can be used for extrafoveal choroidal neovascularization to avoid the treatment burden and risks of multiple injections. Photodynamic therapy may be beneficial in the treatment of central serous chorioretinopathy and idiopathic polypoidal choroidal vasculopathy and as combination therapy with anti-VEGF agents in age-related macular degeneration.

CONCLUSIONS:

Anti-VEGF agents are effective in preventing vision loss and improving vision in multiple diseases, including diabetic retinopathy, neovascular age-related macular degeneration, and retinal vein occlusions. Despite a substantial decrease in its use for these conditions in recent years, laser therapies continue to serve important roles in our ability to combat retinal pathologic features and will remain a pivotal component of our practices for at least the next several years.

• Authors: Ankur M Shah, Neil M Bressler, Lee M Jampol
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 152 Issue 3 Pg. 332-339.e1 (Sep 2011) ISSN: 1879-1891 [Electronic] United States
• PMID: 21742309 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• VEGFA protein, human
• Vascular Endothelial Growth Factor A

Topics

• Angiogenesis Inhibitors (therapeutic use)
• Combined Modality Therapy
• Diabetic Retinopathy (drug therapy, surgery)
• Humans
• Laser Coagulation
• Retinal Neovascularization (drug therapy, surgery)
• Retinal Vein Occlusion (drug therapy, surgery)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Vision Disorders (prevention & control)
• Wet Macular Degeneration (drug therapy, surgery)