Ma Ching-Chih, Chen Po-Huang, Hsieh Yun-Hsiu
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
J Clin Med. 2024 Aug 14;13(16):4782. doi: 10.3390/jcm13164782.
Diabetic macular edema (DME) is the primary cause of visual impairment in individuals with diabetes. Anti-vascular endothelial growth factor (VEGF) is the current first-line treatment for DME owing to its effectiveness. However, frequent anti-VEGF injections may be inconvenient for patients. Therefore, this study aimed to investigate whether the addition of subthreshold micropulse laser (SML) to anti-VEGF therapy could reduce the requirement for anti-VEGF injections while maintaining the treatment efficacy for DME. Clinical trials retrieved from the databases of PubMed, EMBASE, and the Cochrane Library were evaluated to determine the effectiveness of combination treatment with SML and anti-VEGF medication compared with that of anti-VEGF treatment alone. The primary outcome measures were the changes in CMT, best-corrected visual acuity (BCVA), and the total number of intravitreal injections (IVIs). The IVI + SML group revealed a substantial increase in the logarithm of the minimum angle of the resolution BCVA and a reduction in CMT at the 12-month follow-up (BCVA: random-effects; mean difference [MD], -0.05; 95% confidence interval [CI]: -0.10 to -0.01; -value = 0.28, and CMT: random-effects; MD, -18.27; 95% confidence interval, -27.36 to -9.18; -value = 0.20). The number of required IVIs in the IVI + SML group was lower than that in the IVI only group (random-effects; MD, -2.22; 95% CI: -3.13 to -1.31; -value < 0.01). Combining SML therapy with anti-VEGF injections may reduce the total number of injections required, improve VA, and reduce CMT at the 12-month follow-up. Although the included studies used different SML regimens and anti-VEGF agents, this review indicates that the application of additional SML therapy results in positive clinical outcomes.
糖尿病性黄斑水肿（DME）是糖尿病患者视力损害的主要原因。抗血管内皮生长因子（VEGF）因其有效性，是目前DME的一线治疗方法。然而，频繁注射抗VEGF对患者来说可能不方便。因此，本研究旨在探讨在抗VEGF治疗中添加阈下微脉冲激光（SML）是否能减少抗VEGF注射的需求，同时维持DME的治疗效果。对从PubMed、EMBASE和Cochrane图书馆数据库检索到的临床试验进行评估，以确定与单独抗VEGF治疗相比，SML与抗VEGF药物联合治疗的有效性。主要结局指标是中心凹视网膜厚度（CMT）、最佳矫正视力（BCVA）的变化以及玻璃体内注射（IVI）的总数。IVI+SML组在12个月随访时最佳矫正视力最小分辨角对数有显著增加，CMT降低（BCVA：随机效应；平均差[MD]，-0.05；95%置信区间[CI]：-0.10至-0.01；P值=0.28，CMT：随机效应；MD，-18.27；95%置信区间-27.36至-9.18；P值=0.20）。IVI+SML组所需的IVI次数低于仅接受IVI组（随机效应；MD，-2.22；95%CI：-3.13至-1.31；P值<0.01）。在12个月随访时，SML治疗与抗VEGF注射联合使用可能会减少所需的注射总数，改善视力，并降低CMT。尽管纳入的研究使用了不同的SML方案和抗VEGF药物，但本综述表明，额外应用SML治疗可产生积极的临床结果。
