Ahrabi Behnaz, Omidvari Samareh, Mollazadeh Ghomi Shamim, Ahmady Roozbahany Navid, Vafaei-Nezhad Saeed, Shirazi Tehrani Atefeh, Abbaszadeh Hojjat Allah, Darabi Shahram
Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Lasers Med Sci. 2022 Sep 4;13:e36. doi: 10.34172/jlms.2022.36. eCollection 2022.
Many systemic and ocular diseases cause macular edema (ME). Macular edema is seen in two primary forms; the first is diffuse thickening of the macula, and the other is a macula with a distinct petaloid (cloverleaf) appearance called cystoid macular edema. Macular edema has a known role in the reduction of visual equity, and many options have been proposed for the reversal of this condition. Articles on the effects of macular laser grid photocoagulation on diabetic macular edema (DME) or cystoid macular edema published between 2000 and 2022 were collected from PubMed, Google Scholar, and Web of Science. The following keywords were used for the search: "macular laser photocoagulation", "macular edema", "cystoid macular edema", "intravitreal pharmacotherapies", and "antivascular endothelial growth factor". Two hundred nineteen articles were found in google scholar and 165 articles in PubMed, and a total of 58 articles were included in the study after applying the exclusion criteria. We investigated the effects of various lasers photocoagulation such as Focal and/or grid macular laser, subthreshold micropulse laser (SMPL), as well as intravitreal pharmacotherapies with triamcinolone acetonide, and fluocinolone, and extended released intraocular implants such as Ozurdex, Retisert, Iluvien, and anti-vascular endothelial growth factors such as bevacizumab (Avastin), Eyela, and Lucentis. Corticosteroids were more effective than lasers, although some researchers have found that lasers and combined lasers and corticosteroids are more effective. In addition, some studies have shown that the frequency and concentrations of intravitreal pharmacotherapies are effective in increasing visual outcomes. The results of the studies showed that the combined intravitreal corticosteroids are much more effective in improving visual acuity (VA) than a single corticosteroid, and the low concentration of the drug is safer. Still, corticosteroids have side effects such as increased intraocular pressure and glaucoma. Therefore, combining the medication with a laser is much more reasonable than each alone. Also, the subthreshold photocoagulation laser (670 nm) is better at reducing the central macular thickness (CMT) and improving VA than the micro pulse yellow laser and pan-retinal photocoagulation (PRP).
许多全身性和眼部疾病都会导致黄斑水肿（ME）。黄斑水肿有两种主要形式：第一种是黄斑弥漫性增厚，另一种是具有明显花瓣样（三叶草叶形）外观的黄斑，称为黄斑囊样水肿。黄斑水肿在降低视觉质量方面有明确作用，人们已经提出了许多逆转这种情况的方法。从PubMed、谷歌学术搜索和科学网收集了2000年至2022年间发表的关于黄斑激光格栅光凝对糖尿病性黄斑水肿（DME）或黄斑囊样水肿影响的文章。搜索使用了以下关键词：“黄斑激光光凝”、“黄斑水肿”、“黄斑囊样水肿”、“玻璃体内药物治疗”和“抗血管内皮生长因子”。在谷歌学术搜索中找到219篇文章，在PubMed中找到165篇文章，应用排除标准后，共有58篇文章纳入本研究。我们研究了各种激光光凝的效果，如局灶性和/或格栅状黄斑激光、阈下微脉冲激光（SMPL），以及玻璃体内注射曲安奈德、氟轻松等药物治疗，还有Ozurdex、Retisert、Iluvien等缓释眼内植入物，以及贝伐单抗（阿瓦斯汀）、Eyela和雷珠单抗等抗血管内皮生长因子。皮质类固醇比激光更有效，尽管一些研究人员发现激光以及激光与皮质类固醇联合使用更有效。此外，一些研究表明，玻璃体内药物治疗的频率和浓度对提高视觉效果有效。研究结果表明，玻璃体内联合使用皮质类固醇在提高视力（VA）方面比单一皮质类固醇有效得多，且低浓度药物更安全。然而，皮质类固醇有眼压升高和青光眼等副作用。因此，将药物与激光联合使用比单独使用每种方法更合理。此外，阈下光凝激光（670纳米）在降低中心黄斑厚度（CMT）和提高视力方面比微脉冲黄色激光和全视网膜光凝（PRP）更好。
