Comparison of laser and anti VEGF therapy in treatment of diabetic macular edema

Diabetic macular edema is one of the main features of diabetic retinopathy which is associated with diabetes mellitus. Diabetic macular edema is characterized by increased vascular leakage in central part of retina and leading cause of serious central visual impairment in diabetic patients.1 The common characteristic is the increase in levels of vascular endothelial growth factor (VEGF), which is responsible for the disruption of the inner blood–retinal barrier.2 Disruption of the blood retinal barrier leads to the accumulation of subretinal and intraretinal fluid, which in turn alters the macular structure and function. If diabetic macular edema is left untreated, the potential loss of vision from diabetic macular edema poses a significant concern with regard to reduction inhealth-related quality of life affecting the socioeconomic status of community.3 A population-based study in south Wisconsin projected that the prevalence of diabetic macular edema after 20 years ofknown diabetes was around 28% in both type I and II diabetes.4 Assessment of Diabetic Macular Edema with Visual Impairment (PREVAIL) study of patients with diabetes mellitus in seven European countries, concluded that Visual Impairment due to Diabetic macular Edema is a significant complication of Diabetes Mellitus. Progression of diabetic retinopathy can be prevented through control of blood pressure and diabetes.It is well established that the widely used treatments that reduce DME can improve or stabilize visual acuity.5 Early treatment option for patients with visual impairment due to diabetic macular edema was laser photocoagulation. In laser photocoagulation study, two macular laser treatment techniques were defined: focal and grid, both performed between 500 and 300 microns from the fovea but not within the papillary border. In focal/grid photocoagulation laser shots are applied to leaking micro aneurysms directly or delivered in grid pattern on the edematous part of the retina.6 The management option for patients having diabetic macular edema have expanded in recent years. For many years it has been established that vascular endothelial growth factor plays a role in the creation of retinal ischemia and increase vascular permeability that gives rise to macular edema.7 Anti VEGF is new treatment modality in management of diabetic macular edema. In anti VEGF therapy, an antibody is administered as intravitreal injections.8 Given the substantial burden of Visual Impairment due to Diabetic Macular Edema and the developing options and clinical evidence for treatment, it is important to regularly compare the relative efficacy of available therapies. This study compares the relative efficacy of current firstline therapies that have current data.