Diabetic macular edema (DME) is a common ocular complication of diabetes patients. It mainly involve macular which is closely related with visual function, thus DME is one of the major reasons causing visual impairment or blindness for diabetes patients. How to reduce the visual damage of DME is always a big challenge in the ophthalmic practice. In the past three decades, there are tremendous developments in DME treatments, from laser photocoagulation, antiinflammation drugs to antivascular endothelial growth factor therapy. However, the mechanism of DME development is not yet completely clear; every existing treatment has its own advantages and weaknesses. Therefore DME treatment still challenges us to explore further to reduce the DME damages.
Objective To compare the clinical results of yellow micro-pulse laser and traditional laser grid (MLG) photocoagulation for diabetic macular edema (DME). Methods Seventy-eight patients (106 eyes) with DME diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in this study. The patients were divided into micro-pulse group (39 patients, 51 eyes) and MLG group (39 patients, 55 eyes). The patients of micropulse group underwent 577 nm yellow micro-pulse laser therapy, while the patients of MLG group underwent continuous wavelength laser photocoagulation with a 561 nm yellow green laser. All the patients were examined documenting corrected visual acuity, macular retinal thickness (CMT) and mean sensitivity within macular 10 deg; examination before and after treatment. Six months after treatment was considered as the judgment time for the therapeutic effects. The mean corrected visual acuity, CMT and MS were comparatively analyzed. Results Six months after treatment, the mean corrected visual acuity of micropulse group and MLG group were 0.45plusmn;0.20 and 0.42plusmn;0.20, which increased significantly compared to those before treatment (t=3.404,2.316; P＜0.05). The difference of mean corrected visual acuity between before and after treatment of micro-pulse group and MLG group were 0.08plusmn;0.02 and 0.06plusmn;0.03, the difference was statistically significant between two groups (t=0.532, P＞0.05). The mean CMT of micropulse group and MLG group were (323.94plusmn;68.30) and (355.85plusmn;115.88) mu;m, which decreased significantly compared to those before treatment (t=4.028, 2.039; P＜0.05). The difference of mean CMT between before and after treatment of micro-pulse group and MLG group were (55.12plusmn;13.68) and (22.25plusmn;10.92) mu;m. The difference was not statistically significant between two groups (t=1.891,P＞0.05). The mean MS of micro-pulse group and MLG group were (6.63plusmn;2.65) and (4.53plusmn;1.81) dB. The mean MS of micro-pulse group increased significantly compared to that before treatment(t=3.335,P＜0.05). The mean MS of MLG group decreased significantly compared to that before treatment (t=3.589,P＜0.05). The difference of mean MS between before and after treatment of micro-pulse group and MLG group were (1.10plusmn;0.33) and (-0.91plusmn;0.25) dB.The difference was statistically significant between groups (t=4.872，P＜0.05). Conclusions In the treatment of DME, yellow micro-pulse laser therapy and MLG can improve visual acuity, and reduce CMT. In addition, yellow micro-pulse laser therapy can improve the MS, but MLG reduces MS.
Intravitreal injection of antiangiogenic agents is widely used to treat retinal vascular disease. This therapy can induce regression of neovascular vessels; reduce intraocular inflammation and retinal vascular permeability, and control macular edema. However the action period of these agents is short, and thus this therapy need repeated injections which cause higher operation risk and cost. Retinal laser photocoagulation therapy can close retinal capillary non-perfusion area and neovascular vessels, reduce macular edema caused by vascular leakage. However, as its therapeutic effect is based on the destruction of the retinal tissues in the lesion area, this therapy need longer time to show its effects. When the disease is controlled by this method, it may already induce some structural irreversible damages to the retina, especially the macular. This is why the visual acuity is not satisfactory in some patients, even though the disease get controlled, macular edema gets disappeared and anatomical structure of retina get improved. Properly evaluating all the pros and cons of retinal photocoagulation and intravitreal injection of antiangiogenic agents, will allow us to explore a better way to combine these two therapies to treat retinal vascular diseases.
Objective To observe the efficacy and safety of laser photocoagulation on highrisk prethreshold versus threshold retinopathy of prematurity (ROP). Methods Ninety-seven ROP infants (186 eyes)， which included 88 high-risk prethreshold ROP eyes and 98 threshold ROP eyes, were enrolled in this study. Among the 186 eyes, 70 eyes were zone one and 116 eyes were zone two. Laser photocoagulation with 810 nm wavelength using binocular indirect ophthalmoscopy was used in all the infants under general anesthesia. Follow-up ranged from 35 to 852 days with a mean of (316±274) days. The degree of retinopathy alleviation and progress were observed. ResultsAmong the 186 eyes, complete abatement of retinopathy was found in 168 eyes (90.3%), local retinal detachment was found in eight eyes (4.3%). The complete abatement of retinopathy was found in 84 eyes both in high-risk prethreshold group (95.5%) and threshold group (85.7%), while progressive retinopathy was found in four eyes in the high-risk prethreshold group (4.5%) and 14 eyes in threshold group (14.3%). The difference in recovery rate was statistically significant between two groups (χ2=3.98,P＜0.05). The abatement of retinopathy was found in 56 eyes in zone one group (80.0%) and in 112 eyes in zone two group (96.6%), while progression of retinopathy was found in 14 eyes in zone one group (20.0%), and 14 eyes in zone two group (3.4%). The number of eyes with progressive retinopathy in zone one group was obviously higher than that in zone two group. The difference was statistically significant (χ2=11.86，P＜0.01). No treatmentrelated complications were observed during the follow-up period. ConclusionsLaser photocoagulation is effective in treating high-risk prethreshold and threshold ROP. Early intervention could improve prognosis. There was no treatment-related complication during the follow-up duration.