Navigated macular laser decreases retreatment rate for diabetic macular edema: a comparison with conventional macular laser

Aljoscha S Neubauer,^1,* Julian Langer,^1,* Raffael Liegl,¹ Christos Haritoglou,¹ Armin Wolf,¹ Igor Kozak,² Florian Seidensticker,¹ Michael Ulbig,¹ William R Freeman,² Anselm Kampik,¹ Marcus Kernt,<sup>1

1</sup>Ludwig-Maximilians University, Department of Ophthalmology, Munich, Germany; ²Jacobs Retina Center, University of California San Diego, La Jolla, CA, USA

^*These authors contributed equally to this work

Background: The purpose of this study was to evaluate and compare clinical outcomes and retreatment rates using navigated macular laser versus conventional laser for the treatment of diabetic macular edema (DME).
Methods: In this prospective, interventional pilot study, 46 eyes from 46 consecutive patients with DME were allocated to receive macular laser photocoagulation using navigated laser. Best corrected visual acuity and retreatment rate were evaluated for up to 12 months after treatment. The control group was drawn based on chart review of 119 patients treated by conventional laser at the same institutions during the same time period. Propensity score matching was performed with Stata, based on the nearest-neighbor method.
Results: Propensity score matching for age, gender, baseline visual acuity, and number of laser spots yielded 28 matched patients for the control group. Visual acuity after navigated macular laser improved from a mean 0.48 ± 0.37 logMAR by a mean +2.9 letters after 3 months, while the control group showed a mean −4.0 letters (P = 0.03). After 6 months, navigated laser maintained a mean visual gain of +3.3 letters, and the conventional laser group showed a slower mean increase to +1.9 letters versus baseline. Using Kaplan-Meier analysis, the laser retreatment rate showed separation of the survival curves after 2 months, with fewer retreatments in the navigated group than in the conventional laser group during the first 8 months (18% versus 31%, respectively, P = 0.02).
Conclusion: The short-term results of this pilot study suggest that navigated macular photocoagulation is an effective technique and could be considered as a valid alternative to conventional slit-lamp laser for DME when focal laser photocoagulation is indicated. The observed lower retreatment rates with navigated retinal laser therapy in the first 8 months suggest a more durable treatment effect.

Keywords: navigated focal laser, macular laser, Navilas^®, diabetic macular edema, diabetes mellitus, diabetic retinopathy