Role Of Peripheral Pan-Retinal Photocoagulation In Diabetic Macular Edema Treated With Intravitreal Ziv-Aflibercept

Purpose: The aim of this study was to investigate the possibility of decreasing the number of intravitreal anti-VEGF by peripheral pan-retinal photocoagulation (PPRP) in managing diabetic macular edema (DME) in a subcategory of patients who cannot comply to strict anti-VEGF follow-up protocols.Materials and methods: This is a pilot prospective study. Consecutive patients with naive DME were offered the choice of treatment and extend intravitreal ziv-aflibercept if they showed willingness for good compliance or PPRP with modified pro re nata intravitreal injections.Results: Six eyes of 3 patients had PPRP versus 4 eyes of 4 patients had injections only. The number of anti-VEGF injections was markedly decreased when PPRP was administered from a mean number of injections of 16.8 (range 13-21; mean follow-up 24.3 months) to a mean number of 4.5 (range 0-8; mean follow-up 33.7 months). Mean initial central macular thickness (CMT) was 462.0 pm in the injection only group vs 457.3 mu m in the PPRP group. Mean final CMT was 462.0 in the injection only group vs 350.0 in the PPRP group. Baseline and final mean logMAR (Snellen equivalent) best-corrected visual acuity was initially and finally 0.84 (20/137) and 0.60 (20/80) in the injection only group and 0.70 (20/100) and 0.69 (20/98) in the PPRP group, respectively. The monthly cost for the PPRP group was one-third of the monthly cost for the injection only group.Conclusion: PPRP allowed for a decrease in the number of intravitreal anti-VEGF injections in selected DME patients (sick, difficult to ambulate, financial burden, and fear of injections).