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激光光凝在眼内药物治疗时代治疗糖尿病性黄斑水肿的作用:描述性综述。

The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review.

机构信息

Department of Ophthalmology, Laser Eye Center, Nagoya City University East Medical Center, Nagoya 464-8547, Japan.

Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.

出版信息

Medicina (Kaunas). 2023 Jul 17;59(7):1319. doi: 10.3390/medicina59071319.

Abstract

: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with, the first-line treatment, anti-vascular endothelial growth factor (VEGF). : A comprehensive literature search to identify studies that evaluated the efficacy of laser photocoagulation therapy in the management of DME was performed. The relevant findings of the efficacy of focal/grid laser therapy from data in randomized, controlled trials were synthesized, and the potential of new laser technologies, such as navigated laser systems, pattern scan lasers, and subthreshold lasers, was explored. The usefulness of multimodal imaging-guided laser therapy was also evaluated, with a focus on the potential contribution to anti-VEGF therapy. : Focal laser photocoagulation targeting microaneurysms remains an effective therapeutic approach to chronic refractory edema, despite the widespread use of anti-VEGF therapy. To achieve the best possible treatment outcomes, precise identification of microaneurysms is essential. This requires the use of multimodal imaging-guided, highly accurate, minimally invasive coagulation techniques. Subthreshold laser therapy can also reduce the frequency of anti-VEGF injections and minimize treatment burden. : Further studies are needed to determine the optimal timing and settings for laser photocoagulation therapy and the potential of new laser technologies in the management of DME. Nevertheless, laser photocoagulation therapy plays an important role in the management of DME, in conjunction with anti-VEGF therapy.

摘要

本研究旨在阐明激光光凝疗法在治疗糖尿病性黄斑水肿(DME)中的作用,可作为一线治疗(抗血管内皮生长因子[VEGF])的替代或联合治疗方法。我们进行了全面的文献检索,以确定评估激光光凝疗法在 DME 管理中的疗效的研究。综合了来自随机对照试验数据的关于局灶/格栅激光治疗疗效的相关发现,并探讨了新的激光技术(如导航激光系统、模式扫描激光和亚阈值激光)的潜力。还评估了多模态成像引导激光治疗的实用性,重点关注其对抗 VEGF 治疗的潜在贡献。尽管抗 VEGF 治疗广泛应用,但针对微动脉瘤的局灶性激光光凝仍然是治疗慢性难治性水肿的有效方法。为了获得最佳的治疗效果,必须精确识别微动脉瘤。这需要使用多模态成像引导的、高度精确的、微创的凝固技术。亚阈值激光治疗也可以减少抗 VEGF 注射的频率,并最大限度地减少治疗负担。需要进一步研究来确定激光光凝疗法的最佳时机和设置以及新的激光技术在 DME 管理中的潜力。尽管如此,激光光凝疗法在 DME 的管理中与抗 VEGF 治疗联合应用具有重要作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1d/10385537/3594c62c04d1/medicina-59-01319-g001.jpg

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