Department of Ophthalmology, University of Padova, Padova, Italy.
IRCCS - Fondazione Bietti, Rome, Italy.
Sci Rep. 2019 Jul 11;9(1):10034. doi: 10.1038/s41598-019-46515-y.
Subthreshold micropulse laser (SMPL) is a tissue-sparing technique whose efficacy is demonstrated for diabetic macular edema (DME) treatment. However, its mechanism of action is poorly known. A prospective observational study was performed on naïve DME patients treated with SMPL, to evaluate the changes of aqueous humor (AH) inflammatory and vaso-active biomarkers after treatments. AH samples of eighteen DME eyes were collected before and after SMPL. Ten non-diabetic AH samples served as controls. Full ophthalmic evaluation, spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography were performed in DME group. Glass chip protein array was used to quantify 58 inflammatory molecules. Central retinal thickness (CRT) and visual acuity were also monitored. Several molecules showed different concentrations in DME eyes versus controls (p value < 0.05). Fas Ligand (FasL), Macrophage Inflammatory Proteins (MIP)-1α, Regulated on Activation Normal T Cell Expressed and Secreted (RANTES) and Vascular Endothelial Growth Factor (VEGF) were increased in DME at baseline versus controls and decreased after SMPL treatments (p < 0.05). CRT reduction and visual acuity improvement were also found. Inflammatory cytokines, mainly produced by the retinal microglia, were significantly reduced after treatments, suggesting that SMPL may act by de-activating microglial cells, and reducing local inflammatory diabetes-related response.
亚阈微脉冲激光（SMPL）是一种组织保护技术，其疗效已被证明可用于治疗糖尿病性黄斑水肿（DME）。然而，其作用机制尚不清楚。本研究对接受 SMPL 治疗的初治 DME 患者进行了前瞻性观察研究，以评估治疗后房水（AH）炎症和血管活性生物标志物的变化。采集了 18 只 DME 眼的 AH 样本，在 SMPL 治疗前后进行了采集。10 个非糖尿病 AH 样本作为对照。在 DME 组中进行了全面眼科评估、光谱域光学相干断层扫描（SD-OCT）和荧光素血管造影。使用玻璃芯片蛋白芯片定量了 58 种炎症分子。还监测了中央视网膜厚度（CRT）和视力。与对照组相比，DME 眼的几种分子浓度不同（p 值<0.05）。Fas 配体（FasL）、巨噬细胞炎症蛋白（MIP）-1α、调节激活正常 T 细胞表达和分泌（RANTES）和血管内皮生长因子（VEGF）在基线时在 DME 眼中升高，而在 SMPL 治疗后降低（p<0.05）。还发现 CRT 降低和视力改善。治疗后炎症细胞因子，主要由视网膜小胶质细胞产生，明显减少，表明 SMPL 可能通过使小胶质细胞失活并减少局部炎症性糖尿病相关反应而起作用。
