El Matri Leila, Chebil Ahmed, El Matri Khaled, Falfoul Yousra, Chebbi Zouheir
Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Tunis, Tunisia.
Department B, Institut Hedi Rais d'ophtalmologie de Tunis, Boulevard 9 avril 1938, 1006 Tunis, Tunisia.
Ther Adv Ophthalmol. 2021 Sep 2;13:25158414211040887. doi: 10.1177/25158414211040887. eCollection 2021 Jan-Dec.
To compare the therapeutic impact of combining intravitreal injections of bevacizumab (IVB) with micropulse laser (MPL) in central diffuse diabetic macular edema (DME) versus IVB monotherapy during 12 months follow-up.
We conducted a retrospective comparative study of 98 treatment-naive eyes (63 patients) with central diffuse DME. The first group of patients (IVB + MPL group, = 49) was treated with 3 monthly IVB followed by MPL within 1 week after the third injection. Patients were then followed and treated on a pro re nata (PRN) basis, with MPL retreatment if necessary. The changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), number of IVB injections and MPL sessions were evaluated at 4, 8, and 12 months. A control group of diabetic patients with treatment-naive DME was treated with standard protocol of 3 monthly IVB as monotherapy then followed on a PRN basis (IVB group, = 49). Statistic comparaison of BCVA, CMT, and IVB number variation was interpreted at 12 months between both groups.
In IVB + MPL group, baseline BCVA improvement was not significant at 4 and 8 months ( = 0.90, = 0.08), and was statistically significant ( = 0.01) at 12 months. Mean CMT significantly decreased at 4, 8, and 12 months ( < 0.01) in IVB + MPL group. The difference in BCVA (p = 0.091) and CMT (p = 0.082) variation at 12 months between both groups was not significant but the number of injections was significantly lower in IVB + MPL group (4.1 ± 1.5 injections) compared to IVB group (7.2 ± 1.3 injections) ( < 0.005).
Combining intravitreal injections of bevacizumab and MPL in the treatment of DME is effective and safe. This protocol may decrease the number of IVB and its frequency. It offers the advantage of lasting therapeutic response with fewer recurrences.
比较玻璃体内注射贝伐单抗（IVB）联合微脉冲激光（MPL）治疗中心性弥漫性糖尿病性黄斑水肿（DME）与单纯IVB单药治疗在12个月随访期内的治疗效果。
我们对98只初治的中心性弥漫性DME患眼（63例患者）进行了一项回顾性对照研究。第一组患者（IVB + MPL组，n = 49）接受每月1次共3次的IVB注射治疗，在第3次注射后1周内接受MPL治疗。随后对患者进行随访，并根据需要进行MPL再次治疗。在4、8和12个月时评估最佳矫正视力（BCVA）、中心黄斑厚度（CMT）、IVB注射次数和MPL治疗次数的变化。另一组初治DME糖尿病患者对照组接受每月1次共3次的标准IVB单药治疗方案，随后根据需要进行随访（IVB组，n = 49）。在12个月时对两组间BCVA、CMT和IVB注射次数变化进行统计学比较。
在IVB + MPL组，4个月和8个月时基线BCVA改善不显著（P = 0.90，P = 0.08），12个月时具有统计学显著性（P = 0.01）。IVB + MPL组在4、8和12个月时平均CMT显著降低（P < 0.01）。两组在12个月时BCVA（P = 0.091）和CMT（P = 0.082）变化的差异不显著，但IVB + MPL组的注射次数（4.1 ± 1.5次注射）显著低于IVB组（7.2 ± 1.3次注射）（P < 0.005）。
玻璃体内注射贝伐单抗联合MPL治疗DME有效且安全。该方案可减少IVB的注射次数及其频率。它具有治疗反应持久、复发较少的优势。
