Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, 34752, Istanbul, Turkey.
Department of Ophthalmology, Faculty of Medicine, Bahcesehir University, 34734, Kadikoy, Istanbul, Turkey.
Lasers Med Sci. 2021 Sep;36(7):1545-1553. doi: 10.1007/s10103-021-03306-0. Epub 2021 Apr 4.
The purpose of this study is to compare the efficacy and safety of 577-nm subthreshold micropulse laser (SML) and intravitreal bevacizumab injection (IVB) combined therapy with IVB monotherapy in the treatment of diabetic macular edema (DME). This retrospective study included 80 eyes of 80 patients; 40 eyes were treated with IVB monotherapy, and 40 eyes were treated with SML-IVB combined therapy. The mean number of required IVB injections and changes of best corrected visual acuity (BCVA) and central macular thickness (CMT) values were compared between the groups. The mean age of the patients was 60.19±7.43 years. The baseline characteristics of the patients were similar between the groups. In the SML-IVB combined group, the mean number of required SML sessions was 2.1±0.81. The mean number of required IVB injections was 4.38±0.81 in the SML-IVB combined group and 5.65±1.51 in the IVB monotherapy group (p<0.05). The increase of the BCVA was significant in the SML-IVB combined group at the 3rd, 6th, 9th, and 12th months; however, in the IVB monotherapy group, it was only significant at the 3rd month (p<0.05). The mean CMT values of the 3rd, 9th, and 12th months were similar between the groups (p>0.05); only at the 6th month was it significantly lower in the SML-IVB combined group (p<0.05). When compared with baseline, the decrease of the CMT was statistically significant in both groups at the 3rd, 6th, 9th, and 12th months (p<0.05). In this study, a significant benefit of adding SML to IVB therapy was found with less IVB need, although a very significant increase in BCVA could not be achieved. The use of SML-IVB combined treatment may be an effective and safe alternative for DME.
本研究旨在比较 577nm 亚阈值微脉冲激光（SML）和玻璃体腔内注射贝伐单抗（IVB）联合治疗与 IVB 单药治疗糖尿病黄斑水肿（DME）的疗效和安全性。本回顾性研究纳入 80 例 80 眼患者；其中 40 眼接受 IVB 单药治疗，40 眼接受 SML-IVB 联合治疗。比较两组间所需 IVB 注射次数及最佳矫正视力（BCVA）和中心黄斑厚度（CMT）值的变化。患者平均年龄为 60.19±7.43 岁。两组患者的基线特征相似。在 SML-IVB 联合组中，所需 SML 治疗次数的平均值为 2.1±0.81。SML-IVB 联合组所需 IVB 注射次数为 4.38±0.81，IVB 单药组为 5.65±1.51（p<0.05）。SML-IVB 联合组在第 3、6、9 和 12 个月时 BCVA 增加显著，而 IVB 单药组仅在第 3 个月时显著（p<0.05）。第 3、9 和 12 个月时两组的 CMT 值平均值相似（p>0.05）；仅在第 6 个月时 SML-IVB 联合组的 CMT 值显著降低（p<0.05）。与基线相比，两组在第 3、6、9 和 12 个月时 CMT 值降低均有统计学意义（p<0.05）。本研究发现，与 IVB 治疗相比，联合 SML 治疗可减少 IVB 的使用，尽管不能显著提高 BCVA。因此，SML-IVB 联合治疗可能是 DME 的一种有效且安全的替代治疗方法。
