Figure 4

Multimodal imaging of a patient with diabetic macular edema pretreated with anti-VEGF and fluorescein angiography (FA)-based focal/grid laser. Late-phase indocyanine green angiography (ICGA) performed at baseline reveals the presence of two teleangiectatic capillaries (TC) nasally from the fovea (A) in near proximity to the peak of the edema (G). High resolution OCT single line scans leading right through the center of the larger TC show hyporeflectivity of its lumen, compared to the surrounding vessel wall (B). Minutes after the first laser session no change in the TCs lumen was detected (C). Consequently, 6 months after laser therapy the TC was still present without a tendency for either shrinking or resolution (E). Within the first 6 months after laser therapy the extent of the edema increased (H). Therefore, ICGA was repeated, with poor visualization of the TC that was initially targeted with laser, due to partial blocking of the ICG signal by an overlying spot bleeding (D; red arrow). However, the OCT scan clearly shows, that the TC is still present (E). During the second laser session, a darkening of the TCs lumen was observed with OCT (F). Consequently, a marked reduction of the edema was seen as early as 2 months after laser therapy (I). 17 months after re-treatment with ICGA-guided focal laser coagulation only little parafoveal retinal swelling remained without central involvement of the edema. (J) No additional treatment with anti-VEGF was needed in this patient. Visual acuity increased from 20/32 Snellen visual acuity at baseline to 20/20 23 months after the intial laser therapy with no need for any anti-VEGF injections.