Mansouri A, Sampat K M, Malik K J, Steiner J N, Glaser B M
The National Retina Institute, Towson, MD, USA.
Eye (Lond). 2014 Dec;28(12):1418-24. doi: 10.1038/eye.2014.264. Epub 2014 Nov 14.
To determine if the severity of diabetic macular edema influences the effectiveness of subthreshold micropulse (STMP) laser treatment.
A total of 63 eyes of 58 patients with diabetic macular edema were divided into two groups based on their initial central foveal thickness (CFT). Group 1 had CFT ≤400 μm, group 2 had CFT >400 μm. The change from baseline in CFT and visual acuity were compared at 3, 6 and 12 months follow-up. Patients were considered for retreatment with micropulse laser at 3 months if macular edema had not improved. Patients were considered for rescue anti-VEGF injections if there was clinically significant macular edema at 6 months follow-up. Number of laser retreatments, injections, and any adverse effects from STMP laser were recorded.
Group 1 (n=33) experienced an average of 55 μm reduction in CFT and 0.2 log MAR gain in visual acuity at 12 months (P<0.001). No patient required rescue anti-VEGF injections. Group 2 (n=30) experienced no significant change in CFT or visual acuity by 6 months despite retreatment with STMP in 19 eyes. From 6 to 12 months follow-up, all the patients in group 2 received rescue Bevacizumab injections that resulted in 307 μm reduction in CFT and 0.3 log MAR improvement in visual acuity (P<0.001). No adverse effects from STMP laser were recorded.
Severity of edema can influence the effects of STMP laser. STMP monotherapy is safe and effective in treating edema of mild to moderate severity.
确定糖尿病性黄斑水肿的严重程度是否会影响阈下微脉冲（STMP）激光治疗的效果。
将58例糖尿病性黄斑水肿患者的63只眼根据初始中心凹厚度（CFT）分为两组。第1组CFT≤400μm，第2组CFT>400μm。在随访3、6和12个月时比较CFT和视力相对于基线的变化。如果黄斑水肿在3个月时没有改善，则考虑对患者进行微脉冲激光再治疗。如果在随访6个月时有临床上显著的黄斑水肿，则考虑进行挽救性抗VEGF注射。记录激光再治疗次数、注射次数以及STMP激光的任何不良反应。
第1组（n = 33）在12个月时CFT平均降低55μm，视力提高0.2 log MAR（P<0.001）。没有患者需要挽救性抗VEGF注射。第2组（n = 30）尽管19只眼进行了STMP再治疗，但到6个月时CFT和视力均无显著变化。在6至12个月的随访中，第2组的所有患者均接受了挽救性贝伐单抗注射，导致CFT降低307μm，视力提高0.3 log MAR（P<0.001）。未记录到STMP激光的不良反应。
水肿的严重程度可影响STMP激光的疗效。STMP单一疗法在治疗轻度至中度水肿方面安全有效。
