Fotocoagulação de acordo com o protocolo ETDRS modificado versus laser diodo sublimiar em micropulsos para tratamento de edema macular diabético: Ensaio clínico-comparativo/ / Randomized Clinical Trial Evaluating mETDRS versus Normal or High-Density Micropulse Photocoagulation for Diabetic Macular Edema
AUTOR(ES)
Daniel Lavinsky
FONTE
IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia
DATA DE PUBLICAÇÃO
29/06/2011
RESUMO
Purpose: To compare modified Early Treatment Diabetic Retinopathy Study (ETDRS) focal/grid laser photocoagulation with normal-density (ND-SDM) or high-density (HD-SDM) subthreshold diode-laser micropulse photocoagulation for the treatment diabetic macular edema (DME). Methods: We conducted a prospective, randomized, controlled, double-masked clinical trial with patients with previously untreated DME and best corrected visual acuity (BCVA) worse than 20/40 and better than 20/400. Patients were randomized to receive either modified ETDRS focal / grid photocoagulation (42 patients), ND-SDM (39 patients) or HD-SDM (42 patients). Before treatment and 3, 6 and 12 months after treatment, all patients underwent ophthalmic examinations, BCVA, color fundus photography, fluorescein angiography and optical coherence tomography (OCT). Results: At 12 months, the HD-SDM group had the best improvement in BCVA (0.25 logMAR), followed by the modified ETDRS group (0.08 logMAR), while no improvements were seen in the ND-SDM group (0.03 logMAR). All groups showed statistically significant progressive reduction of CMT throughout the study (p<0.001). The HD-SDM group exhibited the greatest CMT reduction (154 μm), which was not significantly different from that of the modified ETDRS group (126 μm; p=0.75). Conclusions: At 1 year, the clinical performance of HD-SDM was superior to that of the modified ETDRS photocoagulation technique based on the anatomic and functional measures of improvement used in this investigation. A rationale for this treatment modality as a preferable approach is suggested, and the precise role of sub-threshold micropulse laser treatment may become more defined as experience grows, guided by optimized treatment guidelines and more comprehensive trials.
ASSUNTO(S)
retinopatia diabética fotocoagulação edema macular lasers semicondutores oftalmologia photocoagulation, diabetic macular edema
ACESSO AO ARTIGO
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