577 nm阈值下微脉冲激光联合抗VEGF药物治疗难治性糖尿病性黄斑水肿的疗效观察

Effect of 577 nm subthreshold micropulse laser photocoagulation combined with anti-VEGF on the treatment of refractory diabetic macular edema

目的探讨577 nm阈值下微脉冲激光(subthrehold micropulse laser photocoagulation,SMLP)联合玻璃体腔注射康柏西普(intravitreal conbercept,IVC)与单纯IVC治疗难治性糖尿病性黄斑水肿(diabetic macular edema,DME)的临床疗效。方法本研究为非随机对照研究。选取2022年1月至2022年12月在湖南省人民医院眼科就诊的难治性DME患者,将入选病例分为实验组(共10例,16眼)和对照组(共12例,17眼)。实验组采用577 nm SMLP联合IVC治疗,对照组采用单纯IVC治疗。收集两组治疗基线及随访6个月每月的最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心视网膜厚度(central macular thickness,CMT)、硬性渗出面积(hard exudates,HE)及微血管瘤数量(microangioma,MA)的变化情况以及玻璃体腔注药次数,观察两组患者治疗后并发症的发生情况。结果治疗6个月后,实验组、对照组LogMAR BCVA分别为0.300(0.100,0.400)、0.400(0.300,0.600),两者差异具有统计学意义(t=-2.575,P=0.015);CMT分别为237.00(230.75,254.75)μm、263.00(237.00,341.50)μm,两者差异具有统计学意义(t=-2.252,P=0.035);HE[411.50(72.25,8757.50)pixels^(2)]vs.[3000.00(10.00,6604.00)pixels^(2)]和MA[1.00(0.00,7.25)个]vs.[2.00(1.00,8.00)个]差异均无统计学意义(t=0.766,P=0.452;t=-0.861,P=0.400)。实验组、对照组的注药次数分别为(4.6±0.2)次、(5.3±0.2)次,差异具有统计学意义(t=-2.182,P=0.039)。实验组577 nm SMLP治疗6个月后患眼眼底检查无明显色素沉积和激光瘢痕。实验组与对照组在治疗6个月后均未见明显并发症发生。结论577 nm SMLP具有较好的安全性。577 nm SMLP联合IVC与单纯IVC治疗对比,在针对难治性DME患者的HE面积和出血点、MA的数量改善方面具有同等的效果,但联合治疗能在短期内更好地减轻部分患者的黄斑水肿,提升BCVA,并且延长玻璃体腔注药间隔时间,减少玻璃体腔注药频次,具有一定的临床应用前景。

Objective We compared the clinical efficacy of subthreshold micropulse laser photocoagulation(SMLP)with a threshold of 577 nm,combined with intravitreal injection of compacept(intravitreal conbercept,IVC),with that of IVC alone in the treatment of refractory diabetic macular edema(DME).Methods We designed and performed a non-randomized controlled study.Patients with refractory DME who were admitted to the Department of Ophthalmology,Hunan Provincial People's Hospital from January 2022 to December 2022 were selected and divided into an experimental group(10 cases,16 eyes)and a control group(12 cases,17 eyes).The experimental group received 577 nm SMLP combined with IVC treatment,and the control group received IVC alone.The changes in best corrected visual acuity(BCVA),central macular retinal thickness(CMT),hard exudates(HE)area,microangioma(MA),and the number of intravitreal injections were collected after 6 months of treatment in the two groups.The incidence of complications was recorded after treatment.Results After 6 months of treatment,the respective Log MAR BCVA values in the experimental and control groups were 0.300(0.100,0.400)and 0.400(0.300,0.600),respectively.The difference between these two groups was statistically significant(t=-2.575,P=0.015).The respective CMT values were 237.00(230.75,254.75)μm and 263.00(237.00,341.50)μm,and the difference was statistically significant(t=-2.252,P=0.035).No significant difference was observed between HE[411.50(72.25,8757.50)pixels^(2)]vs.[3000.00(10.00,6604.00)pixels^(2)]and MA[1.00(0.00,7.25)vs.(4.55±4.78)](t=0.766,P=0.452;t=-0.861,P=0.400).The numbers of injections in the experimental and control groups were(4.6±0.2)and(5.3±0.2),respectively.This difference was statistically significant(t=-2.182,P=0.039).After 6 months of treatment,no obvious pigment deposition or sign of laser scar was observed in the fundus examination of the affected eyes in the experimental group.No obvious complications were observed in the experimental group or the control group after 6 months of treatment.Conclusion SMLP at 577 nm demonstrated good safety.Compared with simple IVC treatment,577 nm SMLP combined with IVC treatment improves HE area,number of bleeding points,and MA with the same efficacy in patients with refractory DME.However,combined treatment can better reduce macular edema in some patients in the short term,improve BCVA,prolong the interval of intravitreal injection,and reduce the frequency of intravitreal injection,offering promising prospects for clinical application.