Objective/Purpose
To evaluate the impact of navigated retinal photocoagulation on the number of intravitreal anti-VEGF injections necessary to maintain visual gain in patients with diabetic macular edema (DME), compared to anti-VEGF mono-therapy.

Materials/Patients
A consecutive series of 15 eyes with DME that demonstrated a reduction in retinal thickness to <445 um (Spectralis OCT) after an initial serial of 3 anti-VEGF injections were then given a single session of navigated laser therapy using Navilas. Subjects were then followed for 12month, to assess the number of anti-VEGF injections required to maintain stable clinical improvement, using an approved observation and retreatment paradigm for anti-VEGF therapy for ranibizumab, and compared to 27 eyes having had ranibizumab mono-therapy.

Methods
Initial visual acuity (VA) was 30±15.2 in the ranibizumab + navigated laser group vs. 24±14.9 letters LogMAR in the ranibizumab mono-therapy group. Best corrected VA improved in both groups on average by 2 lines after the 3 initial monthly anti-VEGF injections. After 12 month VA remained stable in both groups (7.1 ±8.22 vs 6.3 ±6.77 letters). After an upload of three consecutive monthly applied ranibizumab injections, combined treated eyes needed 0.5 ± 0.8 ranibizumab injections, compared to 5.2 ± 3.2 injections in the ranibizumab mono-therapy group (p<0.001).

Results and Conclusion
Additional navigated laser therapy applied after 3 initial anti-VEGF injections in DME patients seems to be effective in preserving visual gains, comparable to anti-VEGF mono-therapy. In addition, navigated macular laser may help to reduce the number of injections needed significantly.

[ Keyword ]
ranibizumab / laser / navilas / anti-VEGF / diabetic macular edema (DME)

[ Conflict of Interest ]
Yes

[ Conflict of Interest (Potential conflict) ]
M. Kernt and A. S. Neubauer are Consultants for OD-OS