帕斯卡短脉冲加阈下终点管理激光疗法治疗糖尿病性黄斑水肿：“三明治技术”
Pascal short-pulse plus subthreshold endpoint management laser therapy for diabetic macular edema: the "sandwich technique".
作者信息
Cardillo J A, Rodrigues M W, Oliveira R C, Messias A M V, Jorge R
机构信息
Department of Ophthalmology, CRESEP- Eye Hospital public service, Araraquara, SP, Brazil.
Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Preto, SP, 14049-900, Brazil.
出版信息
Int J Retina Vitreous. 2022 Jun 2;8(1):32. doi: 10.1186/s40942-022-00381-5.
BACKGROUND
Diabetic macular edema (DME) is the main cause of visual loss in diabetic patients. Despite the use of anti-VEGF therapy as first-line treatment, there are many patients whose response to treatment is poor or transient at best. Sophisticated laser techniques have emerged aiming at low-intensity retinal damage, avoiding excessive heat that causes tissue necrosis and related collateral effects.
OBJECTIVE
To evaluate the effect of combined sublethal laser modalities from short-pulse duration (SPD) with endpoint management (EpM) subthreshold laser [named the "sandwich technique" (SWiT)] on central subfield thickness (CST) and best-corrected visual acuity (BCVA) in patients with DME.
MATERIAL AND METHODS
In this consecutive retrospective study, 37 patients (37 eyes) with center-involved (CI) DME were treated with SWiT laser therapy from April 2017 to June 2021. The technique consisted of a mean number of 200 (range number 50-400) SPD laser burns OCT-guided thickened area performed on the juxta- and perifoveal area 500 µm away from the foveal center, overlapping with a mean number of 1000 (range number 800-1200) EpM laser burns focused on 6 mm macular diameter area but saving 300 µm toward the foveal center. All patients underwent ophthalmological evaluations, including BCVA and CST measurement by spectral-domain optical coherence tomography (SD-OCT), before and after SWiT laser therapy. The mean follow-up time was 19.2 months (range 2-60 months).
RESULTS
Thirty-five out of 37 cases showed an improvement in CST and BCVA following treatment. At baseline, mean CST (µm) ± standard error (SE) and mean BCVA (logMAR) ± SE was 456.95 ± 37.00 and 0.71 ± 0.29, respectively. After a mean follow-up of 19.2 months, mean CST (µm) ± SE and BCVA (logMAR) ± SE were 272.09 ± 9.10 (p < 0.0001) and 0.54 ± 0.26 (p = 0.003), respectively. A statistically significant reduction in CST and improvement in BCVA was noted after laser therapy application. The anti-VEGF injection frequency was reduced during the mean 19.2 months of the study period.
CONCLUSIONS
The novel "sandwich" laser therapy aid reduced CST and improved BCVA in this retrospective case series. Further prospective studies are warranted.
背景
糖尿病性黄斑水肿（DME）是糖尿病患者视力丧失的主要原因。尽管抗血管内皮生长因子（VEGF）疗法被用作一线治疗，但仍有许多患者对治疗的反应不佳或充其量只是短暂有效。旨在造成低强度视网膜损伤的精密激光技术应运而生，避免了导致组织坏死及相关附带影响的过多热量。
目的
评估短脉冲持续时间（SPD）联合终点管理（EpM）阈下激光的亚致死性激光模式（称为“三明治技术”（SWiT））对DME患者中心子野厚度（CST）和最佳矫正视力（BCVA）的影响。
材料与方法
在这项连续性回顾性研究中，2017年4月至2021年6月期间，对37例（37只眼）累及中心的（CI）DME患者采用SWiT激光疗法进行治疗。该技术包括平均200次（范围50 - 400次）SPD激光烧灼，在距黄斑中心500 µm的黄斑旁和黄斑周围区域，根据光学相干断层扫描（OCT）引导对增厚区域进行烧灼，同时平均1000次（范围800 - 1200次）EpM激光烧灼，聚焦于直径6 mm的黄斑区域，但向黄斑中心保留300 µm。所有患者在SWiT激光治疗前后均接受眼科评估，包括通过光谱域光学相干断层扫描（SD - OCT）测量BCVA和CST。平均随访时间为19.2个月（范围2 - 60个月）。
结果
37例患者中有35例在治疗后CST和BCVA有所改善。基线时，平均CST（µm）±标准误（SE）和平均BCVA（logMAR）±SE分别为456.95±37.00和0.71±0.29。平均随访19.2个月后，平均CST（µm）±SE和BCVA（logMAR）±SE分别为272.09±9.10（p < 0.0001）和0.54±0.26（p = 0.003）。激光治疗后，CST有统计学意义的降低，BCVA有所改善。在研究期间平均19.2个月内，抗VEGF注射频率降低。
结论
在这个回顾性病例系列中，新型“三明治”激光疗法有助于降低CST并改善BCVA。有必要进行进一步的前瞻性研究。
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