title: Combination of vascular endothelial growth factor inhibitors and laser therapy for diabetic macular oedema: a review.
abstract: This review provides a perspective on published and ongoing clinical trials of vascular endothelial growth factor inhibitors (anti-VEGF agents) combined with laser therapy for diabetic macular oedema (DMO). Although there was little short-term benefit in combining prompt macular laser with anti-VEGF therapy for centre-involving DMO in the Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol I study, deferred macular laser was still required in over 40% of study eyes in DRCRnet Protocol T. Macular laser was applied in more than 30% of eyes with centre-involving DMO receiving ranibizumab in the RISE and RIDE studies. For non centre-involving DMO the evidence-base still supports use of focal macular laser alone, although clinicians should be cautious about applying laser too close to the foveal avascular zone with the availability of pharmacotherapy. Ongoing clinical trials are assessing whether selectively targeting areas of peripheral retinal ischaemia with laser reduces the number of anti-VEGF injections to stabilise DMO and whether combining macular micropulse laser with anti-VEGF therapy is beneficial in DMO.
authors.affiliation: Save Sight Institute, Sydney University, Sydney, New South Wales, Australia.|Moorfields Eye Hospital, London, UK.|Royal Free Hospital, London, UK.
authors.forename: Hemal
authors.initials: H
authors.lastname: Mehta
authors.affiliation: Save Sight Institute, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gillies
authors.affiliation: Save Sight Institute, Sydney University, Sydney, New South Wales, Australia.|Sydney Adventist Hospital Clinical School, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Fraser-Bell
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy; D008269:Macular Edema / Q000628:therapy*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
keywords: DME; DMO; diabetic macular oedema; laser; vascular endothelial growth factor inhibitors