Bonfiglio Vincenza, Rejdak Robert, Nowomiejska Katarzyna, Zweifel Sandrine Anne, Justus Wiest Maximilian Robert, Romano Giovanni Luca, Bucolo Claudio, Gozzo Lucia, Castellino Niccolò, Patane Clara, Pizzo Corrado, Reibaldi Michele, Russo Andrea, Longo Antonio, Fallico Matteo, Macchi Iacopo, Vadalà Maria, Avitabile Teresio, Costagliola Ciro, Jonak Kamil, Toro Mario Damiano
Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy.
Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland.
Front Pharmacol. 2022 Apr 6;13:832448. doi: 10.3389/fphar.2022.832448. eCollection 2022.
To examine the effect of subthreshold micropulse yellow laser (SMYL) on best-corrected visual acuity (BCVA), central macular thickness (CMT), and optical coherence tomography angiography (OCT-A) changes in eyes with persistent diabetic macular edema (DME) after pars plana vitrectomy (PPV) for tractional DME (TDME). In a comparative study, 95 eyes of 95 consecutive patients with persistent DME were prospectively enrolled. The SMYL group (54 eyes) was treated with SMYL 6 months after PPV, while the control group (41 eyes) was followed up without treatment. BCVA and CMT by OCT were analyzed at baseline and 3 and 6 months. Additionally, parameters such as the vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), respectively, and the area of the foveal avascular zone (FAZ) were also evaluated on OCT-A. There were no significant differences between both groups in demographic data. In the SMYL group, mean BCVA was significantly increased [F(2,106) = 17.25; < 0.001; = 0.246] from 51.54 ± 13.81 ETDRS letters at baseline to 57.81 ± 12.82 ETDRS letters at 3 months ( < 0.001) and 57.83 ± 13.95 EDTRS letters at 6 months ( < 0.001), respectively. In comparison to the control group, BCVA values were statistically significantly higher in the SMYL group at 3 and 6 months, respectively. Mean CMT significantly decreased [F(2,106) = 30.98; < 0.001; = 0.368] from the baseline value 410.59 ± 129.91 μm to 323.50 ± 89.66 μm at 3 months ( < 0.001) and to 283.39 ± 73.45 μm at 6 months ( < 0.001). CMT values were significantly lower in the SMYL group ( < 0.001), especially at 6 months follow-up time ( < 0.001) compared with the control group. Parafoveal VD in the SCP and DCP was significantly higher in the SMYL group in comparison to the control group, respectively, at 3-month (SCP < 0.001; DCP < 0.001) and 6-month follow-up (SCP < 0.001; DCP < 0.001). FAZ area was also significantly smaller in the SMYL group at 6-month follow-up ( = 0.001). There were no adverse SMYL treatment effects. SMYL therapy may be a safe and effective treatment option in eyes with persistent macular edema following PPV for TDME.
为研究阈下微脉冲黄色激光（SMYL）对牵拉性糖尿病性黄斑水肿（TDME）行玻璃体切割术（PPV）后持续性糖尿病性黄斑水肿（DME）患者的最佳矫正视力（BCVA）、中心黄斑厚度（CMT）及光学相干断层扫描血管造影（OCT - A）变化的影响。在一项对比研究中，前瞻性纳入95例连续患有持续性DME患者的95只眼。SMYL组（54只眼）在PPV术后6个月接受SMYL治疗，而对照组（41只眼）未接受治疗，仅进行随访。在基线、3个月和6个月时分析OCT测量的BCVA和CMT。此外，还通过OCT - A评估了浅表毛细血管丛（SCP）和深部毛细血管丛（DCP）中的血管密度（VD）以及黄斑无血管区（FAZ）面积等参数。两组患者的人口统计学数据无显著差异。在SMYL组中，平均BCVA从基线时的51.54±13.81 ETDRS字母显著提高[F(2,106)=17.25；P<0.001；η² = 0.246]，3个月时达到57.81±12.82 ETDRS字母（P<0.001），6个月时达到57.83±13.95 EDTRS字母（P<0.001）。与对照组相比，SMYL组在3个月和6个月时的BCVA值在统计学上显著更高。平均CMT从基线值410.59±129.91μm显著降低[F(2,106)=30.98；P<0.001；η² = 0.368]，3个月时降至323.50±89.66μm（P<0.001），6个月时降至283.39±73.45μm（P<0.001）。SMYL组的CMT值显著更低（P<0.001），尤其是在6个月随访时与对照组相比（P<0.001）。与对照组相比，SMYL组在3个月（SCP：P<0.001；DCP：P<0.001）和6个月随访时（SCP：P<0.001；DCP：P<0.001），SCP和DCP中的旁中心VD分别显著更高。在6个月随访时，SMYL组的FAZ面积也显著更小（P = 0.001）。SMYL治疗没有不良影响。对于TDME行PPV术后持续性黄斑水肿的眼睛，SMYL治疗可能是一种安全有效的治疗选择。
