Pain and accuracy of focal laser treatment for diabetic macular edema using a retinal navigated laser (Navilas®)

Abstract

Marcus Kernt*, Raoul E Cheuteu*, Sarah Cserhati, Florian Seidensticker, Raffael G Liegl, Julian Lang, Christos Haritoglou, Anselm Kampik, Michael W Ulbig, Aljoscha S Neubauer Department of Ophthalmology, Ludwig Maximilian University of Munich, Germany*These authors contributed equally to this studyAim: To investigate treatment-related pain and the accuracy of navigated laser photocoagulation in the treatment of clinically significant macular edema.Methods: Focal laser treatment of diabetic macular edema in 54 consecutive patients was digitally planned on fundus images and performed using the navigated laser photocoagulation system Navilas® (OD-OS GmbH, Teltow, Germany). Treatment-related pain was quantified on a visual analog scale directly after treatment and compared with a matched control group who received conventional laser treatment (n = 46). In addition, for Navilas-treated patients, the accuracy of spot placement on color images was analyzed 1 month after treatment.Results: In total, 5423 laser spots (mean 100 per eye) were analyzed. With navigated treatment, 90% of laser spots were visible on color images, of which 96% were within 100 µm from the target. Eighty percent of the laser spots were placed and visible within the 100 µm target on an intention-to-treat basis for color imaging. Optical coherence topography confirmed that laser effects were limited to the outer retina. Treatment-related pain following navigated laser photocoagulation was significantly lower than that of conventional laser treatment (1.6 vs 4.4 on a visual analog scale, P < 0.001).Conclusion: Navigated laser effects could be visualized to a high percentage on post-treatment color images, and their location showed a high concordance to targeted areas. Patients reported that treatment-related pain following Navilas laser photocoagulation was significantly lower than pain following conventional laser treatment.Keywords: diabetic retinopathy, navigated laser therapy, pattern laser, diabetes