Peroni Renato, Cardillo José Augusto, Memória Rafael, Castro Teixeira Pinto Tomas de Oliveira, Albieri Lucélia, Scott Ingrid U, Jorge Rodrigo
Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
Int J Retina Vitreous. 2024 Sep 30;10(1):69. doi: 10.1186/s40942-024-00585-x.
To investigate the effects of two laser treatment procedures combined, short pulse grid laser (SP) and subthreshold micropulse laser (MP) (the sandwich grid [SWG] technique), plus intravitreal ranibizumab (IVR) on central subfield thickness (CSFT), best-corrected visual acuity (BCVA) and macular sensitivity in patients with diabetic macular edema (DME).
Forty-five eyes (of 33 patients) with center-involving DME were treated with the SWG laser technique plus IVR and followed for 12 months. Laser treatment was performed at baseline: SP laser spots were placed in a grid pattern in the macular area (500 µm from the fovea) according to the extension of DME; subsequently, MP laser was delivered up to the edge of the fovea. MP laser re-treatment sessions could be performed every 3 months if DME was present and CSFT was ≥ 300 μm on SD-OCT. IVR injection was performed at baseline and repeated monthly if CSFT > 300µm. Preoperatively and monthly, ophthalmological examination was performed including measurements of BCVA, CSFT, and macular sensitivity.
One-year follow-up data is available for 37 eyes of 27 patients. Mean ± SE CSFT (µm) was 509.36 ± 25.14 and 325.76 ± 15.34 at baseline and 12 months, respectively. A significant reduction in mean CSFT was observed at all study visits compared to baseline (p < 0.001). Mean ± SE BCVA (logMAR) was 0.62 ± 0.04 and 0.45 ± 0.04 at baseline and 12 months, respectively. A significant improvement in mean BCVA was observed at all study visits compared to baseline (p < 0.001). Mean ± SE macular sensitivity (dB) was 17.85 ± 0.80 and improved to 19.05 ± 0.59 after one year of follow-up (p = 0.006). The mean number of IVR injections was 8.29 ± 0.63. The mean number of MP laser procedures including the initial SWG laser session was 3.67 ± 0.22. No ocular or systemic adverse effects were observed.
The SWG laser technique plus IVR was associated with significant improvement in macular edema, BCVA, and macular sensitivity in patients with center-involving DME.
CLINICAL TRIAL NUMBER (CAAE): 22969019.4.0000.5440.
探讨短脉冲格栅激光（SP）和阈下微脉冲激光（MP）联合（三明治格栅[SWG]技术）加玻璃体腔内注射雷珠单抗（IVR）对糖尿病性黄斑水肿（DME）患者中心子野厚度（CSFT）、最佳矫正视力（BCVA）和黄斑敏感度的影响。
对33例患者的45只累及中心的DME眼采用SWG激光技术联合IVR治疗，并随访12个月。在基线时进行激光治疗：根据DME的范围，在黄斑区（距黄斑中心凹500μm）以格栅模式放置SP激光光斑；随后，向黄斑中心凹边缘发射MP激光。如果存在DME且SD-OCT上的CSFT≥300μm，可每3个月进行一次MP激光再治疗。在基线时进行IVR注射，若CSFT>300μm，则每月重复注射。术前及每月进行眼科检查，包括测量BCVA、CSFT和黄斑敏感度。
27例患者的37只眼有1年的随访数据。基线时和12个月时的平均±标准误CSFT（μm）分别为509.36±25.14和325.76±15.34。与基线相比，在所有研究访视中均观察到平均CSFT显著降低（p<0.001）。基线时和12个月时的平均±标准误BCVA（logMAR）分别为0.62±0.04和0.45±0.04。与基线相比，在所有研究访视中均观察到平均BCVA显著改善（p<0.001）。平均±标准误黄斑敏感度（dB）为17.85±0.80，随访1年后提高到19.05±0.59（p=0.006）。IVR注射的平均次数为8.29±0.63。包括初始SWG激光治疗在内的MP激光治疗的平均次数为3.67±0.22。未观察到眼部或全身不良反应。
SWG激光技术联合IVR可使累及中心的DME患者的黄斑水肿、BCVA和黄斑敏感度得到显著改善。
临床试验编号（CAAE）：22969019.4.0000.5440。
