Observation on the efficacy of conbercept combined with subthreshold micropulsed laser photocoagulation in the treatment of diabetic macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

 Zhou Jinxiu , Zhang Jinghui

Shanxi Aier Eye Hospital, Taiyuan 030000, China;

Corresponding author：

Zhou Jinxiu, Email: owkgc158@163.com

Keywords：

Diabetic macular edema; Subthreshold micropulsed laser photocoagulation; Conbercept; Efficacy evaluation

DOI：

10.3760/cma.j.cn511434-20221222-00667

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observe the efficacy of intravitreal injection of conbercept (IVC) combined with subthreshold micropulse laser photocoagulation (SMLP) in the treatment of diabetic macular edema (DME). Methods A randomized controlled trial. From December 2020 to January 2022, 100 patients (100 eyes) with DME diagnosed by examination in Shanxi Aier Eye Hospital were included in the study. The patients were randomly divided into IVC group (50 eyes) and IVC+SMLP group (50 eyes). All the eyes were treated with IVC once a month for 3 times, and the eyes in IVC+SMLP group were treated with SMLP within 2 weeks after IVC. All affected eyes were examined by best corrected visual acuity (BCVA), which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by optical coherence tomography. Before the treatment, the logMAR BCVA of patients in IVC group and IVC+SMLP group were 0.56±0.04 and 0.55±0.03, respectively. The CMT were (437.36±11.35) μm and (434.58±10.88) μm, respectively. There was no significant difference in logMAR BCVA and CMT between the two groups (t= 0.476, 1.027; P＞0.05). The patients were followed up for 12 months after treatment. The times of IVC and the changes of BCVA and CMT were compared between the two groups. Independent sample t-test was used to compare the logMAR BCVA, CMT and times of IVC between groups. Results After 12 months treatment, the logMAR BCVA of IVC group and IVC+SMLP group were (241.63±29.79) μm and (240.47±30.46) μm, respectively. Compared with those before treatment, 12 months after treatment, the BCVA of the two groups increased significantly (t=7.014, 5.608; P＜0.001), while CMT decreased significantly (t=8.126, 6.013; P＜0.001). There was no significant difference in BCVA and CMT between the two groups (t=0.835, 0.764; P＞0.05). The number of IVC in IVC group and IVC+SMLP group were (8.15±2.04) times and (5.91±1.80) times, respectively, and the difference was statistically significant (t=5.210, P＜0.001). Conclusions Both IVC+SMLP and IVC alone can effectively reduce CMT and increase BCVA in patients with DME. Combination therapy can reduce the number of IVC.

Citation： Zhou Jinxiu, Zhang Jinghui. Observation on the efficacy of conbercept combined with subthreshold micropulsed laser photocoagulation in the treatment of diabetic macular edema. Chinese Journal of Ocular Fundus Diseases, 2023, 39(2): 132-136. doi: 10.3760/cma.j.cn511434-20221222-00667 Copy

1.	Cheung CMG, Pearce E, Fenner B, et al. Looking ahead: visual and anatomical endpoints in future trials of diabetic macular ischemia[J]. Ophthalmologica, 2021, 244(5): 451-464. DOI: 10.1159/000515406.
2.	邵毅, 王珊珊, 袁晴. 糖尿病黄斑水肿诊治规范—2018欧洲视网膜专家协会指南解读[J]. 国际眼科杂志, 2020, 20(1): 1-3. DOI: 10.3980/j.issn.1672-5123.2020.1.01.Shao Y, Wang SS, Yuan Q. European Society of Retina Specialists guidelines for management of diabetic macular edema[J]. Int Eye Sci, 2020, 20(1): 1-3. DOI: 10.3980/j.issn.1672-5123.2020.1.01.
3.	邵毅, 李乐妍, 魏红. 糖尿病黄斑水肿的诊断和治疗进展[J]. 眼科新进展, 2022, 42(11): 841-846. DOI: 10.13389/j.cnki.rao.2022.0174.Shao Y, Li LY, Wei H. Progress in diagnosis and treatment of diabetic macular edema[J]. Rec Adv Ophthalmol, 2022, 42(11): 841-846. DOI: 10.13389/j.cnki.rao.2022.0174.
4.	Passos RM, Malerbi FK, Rocha M, et al. Real-life outcomes of subthreshold laser therapy for diabetic macular edema[J]. Int J Retina Vitreous, 2021, 7(1): 4. DOI: 10.1186/s40942-020-00268-3.
5.	Inagaki K, Ohkoshi K, Ohde S, et al. Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema[J]. Jpn J Ophthalmol, 2015, 59(1): 21-28. DOI: 10.1007/s10384-014-0361-1.
6.	Kwon YH, Lee DK, Kwon OW. The short-term efficacy of subthreshold micropulse yellow (577-nm) laser photocoagulation for diabetic macular edema[J]. Korean J Ophthalmol, 2014, 28(5): 379-385. DOI: 10.3341/kjo.2014.28.5.379.
7.	Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy preferred practice pattern®[J]. Ophthalmology, 2020, 127(1): 66-145. DOI: 10.1016/j.ophtha.2019.09.025.
8.	中国医师协会中西医结合医师分会内分泌和代谢病学专业委员会. 糖尿病视网膜病变病证结合诊疗指南(2021-09-24)[J]. 世界中医药, 2021, 16(22): 3270-3277. DOI: 10.3969/j.issn.1673-7202.2021.22.002.Professional Committee of Endocrinology and Metabolism, Chinese Medical Doctor Association Branch of Integrative Chinese and Western Medicine Physicians. Guidelines for the integrated diagnosis and treatment of diabetic retinopathy(2021-09-24)[J]. World Chinese Medicine, 2021, 16(22): 3270-3277. DOI: 10.3969/j.issn.1673-7202.2021.22.002.
9.	赵芳, 杨兰, 韩媛, 等. 阈值下微脉冲激光在糖尿病黄斑水肿中机制及应用的研究进展[J]. 临床眼科杂志, 2022, 730(5): 464-467. DOI: 10.3969/j.issn.1006-8422.2022.05.020.Zhao F, Yang L, Han Y, et al. Research progress on the mechanism and application of threshold micropulse laser in diabetic macular edema[J]. J Clin Ophthalmol, 2022, 730(5): 464-467. DOI: 10.3969/j.issn.1006-8422.2022.05.020.
10.	Hirabayashi K, Kakihara S, Tanaka M, et al. Investigation of the therapeutic mechanism of subthreshold micropulse laser irradiation in retina[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(5): 1039-1047. DOI: 10.1007/s00417-020-04638-3.
11.	Bıçak F, Kayıkçıoğlu ÖR, Altınışık M, et al. Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema[J]. Int Ophthalmol, 2022, 42(12): 3829-3836. DOI: 10.1007/s10792-022-02403-5.
12.	刘路宏, 李敏, 曾思明, 等. 577 nm波长微脉冲激光二次治疗与单次治疗重度糖尿病黄斑水肿的临床效果比较[J]. 中国临床新医学, 2022, 15(10): 961-965. DOI: 10.3969/j.issn.1674-3806.2022.10.13.Liu LH, Li M, Zeng SM, et al. Comparison of clinical effects between secondary and single treatment of severe diabetic macular edema with micropulse laser at 577 nm wavelength[J]. Chinese Journal of New Clinical Medicine, 2022, 15(10): 961-965. DOI: 10.3969/j.issn.1674-3806.2022.10.13.
13.	赵晶, 蔡小会, 马文霞. 577 nm微脉冲激光治疗糖尿病重度黄斑水肿的效果及对黄斑厚度的影响[J]. 临床医学研究与实践, 2022, 7(33): 138-140. DOI: 10.19347/j.cnki.2096-1413.202233038.Zhao J, Cai XH, Ma WX. Effect of 577 nm micropulse laser on severe diabetic macular edema and macular thickness[J]. Clinical Research and Practice, 2022, 7(33): 138-140. DOI: 10.19347/j.cnki.2096-1413.202233038.
14.	Işık MU, Değirmenci MFK, Sağlık A. Factors affecting the response to subthreshold micropulse laser therapy used in center-involved diabetic macular edema[J]. Lasers Med Sci, 2022, 37(3): 1865-1871. DOI: 10.1007/s10103-021-03441-8.
15.	Lai FHP, Chan RPS, Lai ACH, et al. Comparison of two-year treatment outcomes between subthreshold micropulse (577 nm) laser and aflibercept for diabetic macular edema[J]. Jpn J Ophthalmol, 2021, 65(5): 680-688. DOI: 10.1007/s10384-021-00846-4.
16.	Chang DB, Luttrull JK. Comparison of subthreshold 577 and 810 nm micropulse laser effects on heat-shock protein activation kinetics: implications for treatment efficacy and safety[J]. Transl Vis Sci Technol, 2020, 9(5): 23. DOI: 10.1167/tvst.9.5.23.
17.	Ueda K, Shiraya T, Araki F, et al. Changes in entropy on polarized-sensitive optical coherence tomography images after therapeutic subthreshold micropulse laser for diabetic macular edema: a pilot study[J/OL]. PLoS One, 2021, 16(9): e0257000[2021-09-13]. https://pubmed.ncbi.nlm.nih.gov/34516553/. DOI: 10.1371/journal.pone.0257000.

1. Cheung CMG, Pearce E, Fenner B, et al. Looking ahead: visual and anatomical endpoints in future trials of diabetic macular ischemia[J]. Ophthalmologica, 2021, 244(5): 451-464. DOI: 10.1159/000515406.
2. 邵毅, 王珊珊, 袁晴. 糖尿病黄斑水肿诊治规范—2018欧洲视网膜专家协会指南解读[J]. 国际眼科杂志, 2020, 20(1): 1-3. DOI: 10.3980/j.issn.1672-5123.2020.1.01.Shao Y, Wang SS, Yuan Q. European Society of Retina Specialists guidelines for management of diabetic macular edema[J]. Int Eye Sci, 2020, 20(1): 1-3. DOI: 10.3980/j.issn.1672-5123.2020.1.01.
3. 邵毅, 李乐妍, 魏红. 糖尿病黄斑水肿的诊断和治疗进展[J]. 眼科新进展, 2022, 42(11): 841-846. DOI: 10.13389/j.cnki.rao.2022.0174.Shao Y, Li LY, Wei H. Progress in diagnosis and treatment of diabetic macular edema[J]. Rec Adv Ophthalmol, 2022, 42(11): 841-846. DOI: 10.13389/j.cnki.rao.2022.0174.
4. Passos RM, Malerbi FK, Rocha M, et al. Real-life outcomes of subthreshold laser therapy for diabetic macular edema[J]. Int J Retina Vitreous, 2021, 7(1): 4. DOI: 10.1186/s40942-020-00268-3.
5. Inagaki K, Ohkoshi K, Ohde S, et al. Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema[J]. Jpn J Ophthalmol, 2015, 59(1): 21-28. DOI: 10.1007/s10384-014-0361-1.
6. Kwon YH, Lee DK, Kwon OW. The short-term efficacy of subthreshold micropulse yellow (577-nm) laser photocoagulation for diabetic macular edema[J]. Korean J Ophthalmol, 2014, 28(5): 379-385. DOI: 10.3341/kjo.2014.28.5.379.
7. Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy preferred practice pattern®[J]. Ophthalmology, 2020, 127(1): 66-145. DOI: 10.1016/j.ophtha.2019.09.025.
8. 中国医师协会中西医结合医师分会内分泌和代谢病学专业委员会. 糖尿病视网膜病变病证结合诊疗指南(2021-09-24)[J]. 世界中医药, 2021, 16(22): 3270-3277. DOI: 10.3969/j.issn.1673-7202.2021.22.002.Professional Committee of Endocrinology and Metabolism, Chinese Medical Doctor Association Branch of Integrative Chinese and Western Medicine Physicians. Guidelines for the integrated diagnosis and treatment of diabetic retinopathy(2021-09-24)[J]. World Chinese Medicine, 2021, 16(22): 3270-3277. DOI: 10.3969/j.issn.1673-7202.2021.22.002.
9. 赵芳, 杨兰, 韩媛, 等. 阈值下微脉冲激光在糖尿病黄斑水肿中机制及应用的研究进展[J]. 临床眼科杂志, 2022, 730(5): 464-467. DOI: 10.3969/j.issn.1006-8422.2022.05.020.Zhao F, Yang L, Han Y, et al. Research progress on the mechanism and application of threshold micropulse laser in diabetic macular edema[J]. J Clin Ophthalmol, 2022, 730(5): 464-467. DOI: 10.3969/j.issn.1006-8422.2022.05.020.
10. Hirabayashi K, Kakihara S, Tanaka M, et al. Investigation of the therapeutic mechanism of subthreshold micropulse laser irradiation in retina[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(5): 1039-1047. DOI: 10.1007/s00417-020-04638-3.
11. Bıçak F, Kayıkçıoğlu ÖR, Altınışık M, et al. Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema[J]. Int Ophthalmol, 2022, 42(12): 3829-3836. DOI: 10.1007/s10792-022-02403-5.
12. 刘路宏, 李敏, 曾思明, 等. 577 nm波长微脉冲激光二次治疗与单次治疗重度糖尿病黄斑水肿的临床效果比较[J]. 中国临床新医学, 2022, 15(10): 961-965. DOI: 10.3969/j.issn.1674-3806.2022.10.13.Liu LH, Li M, Zeng SM, et al. Comparison of clinical effects between secondary and single treatment of severe diabetic macular edema with micropulse laser at 577 nm wavelength[J]. Chinese Journal of New Clinical Medicine, 2022, 15(10): 961-965. DOI: 10.3969/j.issn.1674-3806.2022.10.13.
13. 赵晶, 蔡小会, 马文霞. 577 nm微脉冲激光治疗糖尿病重度黄斑水肿的效果及对黄斑厚度的影响[J]. 临床医学研究与实践, 2022, 7(33): 138-140. DOI: 10.19347/j.cnki.2096-1413.202233038.Zhao J, Cai XH, Ma WX. Effect of 577 nm micropulse laser on severe diabetic macular edema and macular thickness[J]. Clinical Research and Practice, 2022, 7(33): 138-140. DOI: 10.19347/j.cnki.2096-1413.202233038.
14. Işık MU, Değirmenci MFK, Sağlık A. Factors affecting the response to subthreshold micropulse laser therapy used in center-involved diabetic macular edema[J]. Lasers Med Sci, 2022, 37(3): 1865-1871. DOI: 10.1007/s10103-021-03441-8.
15. Lai FHP, Chan RPS, Lai ACH, et al. Comparison of two-year treatment outcomes between subthreshold micropulse (577 nm) laser and aflibercept for diabetic macular edema[J]. Jpn J Ophthalmol, 2021, 65(5): 680-688. DOI: 10.1007/s10384-021-00846-4.
16. Chang DB, Luttrull JK. Comparison of subthreshold 577 and 810 nm micropulse laser effects on heat-shock protein activation kinetics: implications for treatment efficacy and safety[J]. Transl Vis Sci Technol, 2020, 9(5): 23. DOI: 10.1167/tvst.9.5.23.
17. Ueda K, Shiraya T, Araki F, et al. Changes in entropy on polarized-sensitive optical coherence tomography images after therapeutic subthreshold micropulse laser for diabetic macular edema: a pilot study[J/OL]. PLoS One, 2021, 16(9): e0257000[2021-09-13]. https://pubmed.ncbi.nlm.nih.gov/34516553/. DOI: 10.1371/journal.pone.0257000.

Chinese Journal of Ocular Fundus Diseases

Observation on the efficacy of conbercept combined with subthreshold micropulsed laser photocoagulation in the treatment of diabetic macular edema

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content