The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
Int Ophthalmol. 2024 Feb 3;44(1):3. doi: 10.1007/s10792-024-02973-6.
To introduce the treatment of diabetic macular edema (DME) with subthreshold micropulse diode laser (SMPL), to summarize the biological impact, therapeutic effects, and safety of this treatment, and to discuss the response to DME when SMPL is combined with anti-vascular endothelial growth factor (anti-VEGF) or steroid.
The literature search was performed on the PubMed database, with a selection of English-language articles published from 2000 to 2023 with the following combinations of search terms: diabetes macular (o) edema, micropulse laser or subthreshold micropulse laser, anti-vascular endothelial growth factor, and steroid.
SMPL is a popular, invisible retinal laser phototherapy that is inexpensive, safe, and effective in the treatment of DME. It can selectively target the retinal pigment epithelium, reduce the expression of pro-inflammatory factors, promote the absorption of macular edema, and exert a similar and lasting clinical effect to traditional lasers. No significant difference was found in the therapeutic effects of SMPL between different wavelengths. However, HbA1c level and pretreatment central macular thickness (CMT) may affect the therapeutic outcomes of SMPL.
SMPL has a slow onset and produces lasting clinical effects similar to conventional photocoagulation. It has been reported that SMPL combined with the intravitreal anti-VEGF injection can significantly reduce the number of injections without influencing the therapeutic effect, which is essential for clinical applications and research. Although 577 nm SMPL is widely used clinically, there are no standardized protocols for SMPL. Additionally, some important problems regarding the treatment of SMPL require further discussion and exploration.
介绍次阈值微脉冲二极管激光（SMPL）治疗糖尿病性黄斑水肿（DME）的方法，总结该治疗方法的生物学影响、疗效和安全性，并探讨 SMPL 联合抗血管内皮生长因子（anti-VEGF）或类固醇治疗 DME 的反应。
在 PubMed 数据库中进行文献检索，选择 2000 年至 2023 年发表的英语文献，使用以下搜索词组合进行检索：糖尿病性黄斑（o）水肿、微脉冲激光或次阈值微脉冲激光、抗血管内皮生长因子和类固醇。
SMPL 是一种受欢迎的、不可见的视网膜激光光疗方法，价格低廉、安全有效，可用于治疗 DME。它可以选择性地靶向视网膜色素上皮，减少促炎因子的表达，促进黄斑水肿的吸收，并产生与传统激光相似且持久的临床效果。不同波长的 SMPL 治疗效果没有显著差异。然而，HbA1c 水平和预处理中心黄斑厚度（CMT）可能会影响 SMPL 的治疗效果。
SMPL 起效缓慢，产生持久的临床效果，与传统光凝相似。有报道称，SMPL 联合玻璃体内抗 VEGF 注射可以显著减少注射次数，而不影响治疗效果，这对临床应用和研究至关重要。尽管 577nm SMPL 在临床上得到广泛应用，但目前尚无 SMPL 的标准化方案。此外，SMPL 治疗的一些重要问题需要进一步讨论和探索。
