The effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Wenqing ,  Song Yanping , Ding Qin

Department of Ophthalmology, Central Theater Command General Hospital, Clinical Research Center for Fundus Laser in Hubei Province, Wuhan 430070, China;

Corresponding author：

Song Yanping, Email: songyanping@medmail.com.cn

Keywords：

Diabetic retinopathy/complications; Macular edema/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Laser coagulation

DOI：

10.3760/cma.j.issn.1005-1015.2019.02.005

Video：

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ObjectiveTo observe the effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema (DME).MethodsA prospective randomized controlled clinical study. From June 2016 to June 2017, 68 eyes of 68 patients with DME diagnosed in Central Theater Command General Hospital were enrolled in the study. The patients were randomly assigned to two different treatment groups: 36 eyes (36 patients) in the conbercept combined with 577 nm subthreshold micropulse lase group (combined treatment group) and 32 eyes (32 patients) in conbercept group (drug treatment group). All patients received three initial intravitreous injection of conbercept and re-treatment was performed according to the criteria which has been disigned before. BCVA was measured by ETDRS charts. The central macular thickness (CMT), total macular volume (TMV) were measured by Topcon 3D-OCT 2000. The BCVA, CMT and TMV in the combined treatment group and the drug treatment group were 57.9±12.4 letters, 427.8±129.4 μm, 10.14±1.50 mm³ and 59.0±16.0 letters, 441.0 ±135.7 μm, 10.43±2.10 mm³, respectively. There was no significant difference (t=0.321, 0.410, 0.641; P=0.749, 0.683, 0.524). The follow-up period was more than 12 months. The changes of BCVA, CMT and TMV were compared between the two groups. Comparison of BCVA, CMT, TMV before and after treatment in and between groups using repeated measures analysis of variance.ResultsThe average annual injection times was 5.8±1.9 in the combined treatment group and 8.5±2.4 in the drug treatment group. The difference was statistically significant (t=5.12, P=0.000). The BCVA in the 3rd, 6th, 9th and 12th month were 64.9±11.1, 65.6±10.5, 67.0±10.8, 66.6±10.7 letters and 65.7±15.8, 66.9±15.7, 66.4±13.0, 67.3±16.4 letters, respectively, and there were significant differences compared with BCVA before treatment (F=34.234, 10.137; P=0.000, 0.000). The CMT were 335.2±105.9, 352.6±106.6, 336.2±120.8, 305.9±97.0 μm and 323.9±92.8, 325.5±90.2, 327.6±108.2, 312.2±106.8 μm, respectively. The TMV were 9.20±1.08, 9.26±1.20, 9.20±1.63, 9.05±1.18 mm³ and 9.19±1.21, 9.35±1.69, 9.09±1.20, 8.92±1.10 mm³, respectively. Compared with the CMT (F=12.152, 12.917; P=0.000, 0.000) and TMV (F=11.198, 11.008; P=0.000, 0.000) before treatment, the differences were statistically significant.ConclusionConbercept combined with 577 nm subthreshold micropulse laser and conbercept can effectively reduce CMT, TMV and improve BCVA in patients with DME, but combination therapy can reduce the injection times of conbercept.

Citation： Li Wenqing, Song Yanping, Ding Qin. The effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema. Chinese Journal of Ocular Fundus Diseases, 2019, 35(2): 129-134. doi: 10.3760/cma.j.issn.1005-1015.2019.02.005 Copy

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5.	Wang J, Quan Y, Dalal R, et al. Comparison of continuous-wave and micropulse modulation in retinal laser therapy[J]. Invest Ophthalmol Vis Sci, 2017, 58(11): 4722-4732. DOI: 10.1167/iovs.17-21610.
6.	Luttrull JK, Dorin G. Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review[J]. Curr Diabetes Rev, 2012, 8(4): 274-284. DOI: 10.2174/157339912800840523.
7.	Vujosevic S, Martini F, Longhin E, et al. Subthreshold micropulse yellow laser versus subthreshold micropulse infrared laser in center-involving diabetic macular edema: morphologic and functional safety[J]. Retina, 2015, 35(8): 1594-1603. DOI: 10.1097/IAE.0000000000000521.
8.	Vujosevic S, Martini F, Convento E, et al. Subthreshold laser therapy for diabetic macular edema: metabolic and safety issues[J]. Curr Med Chem, 2013, 20(26): 3267-3271. DOI: 10.2174/09298673113209990030.
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10.	孙光丽, 姜静, 王成虎, 等. 高密度微脉冲激光联合玻璃体内注射雷珠单抗治疗糖尿病性黄斑水肿[J]. 眼科新进展, 2017, 37(3): 279-281. DOI: 10.13389/j.cnki.rao.2017.0070.Sun GL, Jiang J, Wang CH, et al. High-density micropulse photocoagulation combined with intravitreal injection of ranibizumab for diabetic macular edema[J]. Rec Adv Ophthalmol, 2017, 37(3): 279-281. DOI: 10.13389/j.cnki.rao.2017.0070.
11.	Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial[J]. Ophthalmology, 2016, 123(6): 1351-1359. DOI: 10.1016/j.ophtha.2016.02.022.
12.	Bressler SB, Glassman AR, Almukhtar T, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema[J]. Am J Ophthalmol, 2016, 164: 57-68. DOI: 10.1016/j.ajo.2015.12.025.
13.	Elman MJ, Ayala A, Bressler NM, et al. Intravitreal Ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: 5-year randomized trial results[J]. Ophthalmology, 2015, 122(2): 375-381. DOI: 10.1016/j.ophtha.2014.08.047.
14.	Mansouri A, Sampat KM, Malik KJ, et al. Efficacy of subthreshold micropulse laser in the treatment of diabetic macular edema is influenced by pre-treatment central foveal thickness[J]. Eye (Lond), 2014, 28(12): 1418-1424. DOI: 10.1038/eye.2014.264.
15.	Li Z, Song Y, Chen X, et al. Biological modulation of mouse RPE cells in response to subthreshold diode micropulse laser treatment[J]. Cell Biochem Biophys, 2015, 73(2): 545-552. DOI: 10.1007/s12013-015-0675-8.
16.	Roider J, Michaud N, Flotte T, et al. Histology of retinal lesions after continuous irradiation and selective micro-coagulation of the retinal pigment epithelium[J]. Ophthalmologe, 1993, 90(3): 274-278.

1. Brown DM, Schmidt-Erfurth U, Do DV, et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the VISTA and VIVID Studies[J]. Ophthalmology, 2015, 122(10): 2044-2052. DOI: 10.1016/j.ophtha.2015.06.017.
2. Heier JS, Korobelnik JF, Brown DM, et al. Intravitreal aflibercept for diabetic macular edema: 148-week results from the VISTA and VIVID Studies[J]. Ophthalmology, 2016, 123(11): 2376-2385. DOI: 10.1016/j.ophtha.2016.07.032.
3. Brown DM, Nguyen QD, Marcus DM, et al. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase Ⅲ trials: RISE and RIDE[J]. Ophthalmology, 2013, 120(10): 2013-2022. DOI: 10.1016/j.ophtha.2013.02.034.
4. Rajendram R, Fraser-Bell S, Kaines A, et al. A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3[J]. Arch Ophthalmol, 2012, 130(8): 972-979.
5. Wang J, Quan Y, Dalal R, et al. Comparison of continuous-wave and micropulse modulation in retinal laser therapy[J]. Invest Ophthalmol Vis Sci, 2017, 58(11): 4722-4732. DOI: 10.1167/iovs.17-21610.
6. Luttrull JK, Dorin G. Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: a review[J]. Curr Diabetes Rev, 2012, 8(4): 274-284. DOI: 10.2174/157339912800840523.
7. Vujosevic S, Martini F, Longhin E, et al. Subthreshold micropulse yellow laser versus subthreshold micropulse infrared laser in center-involving diabetic macular edema: morphologic and functional safety[J]. Retina, 2015, 35(8): 1594-1603. DOI: 10.1097/IAE.0000000000000521.
8. Vujosevic S, Martini F, Convento E, et al. Subthreshold laser therapy for diabetic macular edema: metabolic and safety issues[J]. Curr Med Chem, 2013, 20(26): 3267-3271. DOI: 10.2174/09298673113209990030.
9. Moisseiev E, Abbassi S, Thinda S, et al. Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema[J]. Eur J Ophthalmol, 2018, 28(1): 68-73. DOI: 10.5301/ejo.5001000.
10. 孙光丽, 姜静, 王成虎, 等. 高密度微脉冲激光联合玻璃体内注射雷珠单抗治疗糖尿病性黄斑水肿[J]. 眼科新进展, 2017, 37(3): 279-281. DOI: 10.13389/j.cnki.rao.2017.0070.Sun GL, Jiang J, Wang CH, et al. High-density micropulse photocoagulation combined with intravitreal injection of ranibizumab for diabetic macular edema[J]. Rec Adv Ophthalmol, 2017, 37(3): 279-281. DOI: 10.13389/j.cnki.rao.2017.0070.
11. Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial[J]. Ophthalmology, 2016, 123(6): 1351-1359. DOI: 10.1016/j.ophtha.2016.02.022.
12. Bressler SB, Glassman AR, Almukhtar T, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema[J]. Am J Ophthalmol, 2016, 164: 57-68. DOI: 10.1016/j.ajo.2015.12.025.
13. Elman MJ, Ayala A, Bressler NM, et al. Intravitreal Ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: 5-year randomized trial results[J]. Ophthalmology, 2015, 122(2): 375-381. DOI: 10.1016/j.ophtha.2014.08.047.
14. Mansouri A, Sampat KM, Malik KJ, et al. Efficacy of subthreshold micropulse laser in the treatment of diabetic macular edema is influenced by pre-treatment central foveal thickness[J]. Eye (Lond), 2014, 28(12): 1418-1424. DOI: 10.1038/eye.2014.264.
15. Li Z, Song Y, Chen X, et al. Biological modulation of mouse RPE cells in response to subthreshold diode micropulse laser treatment[J]. Cell Biochem Biophys, 2015, 73(2): 545-552. DOI: 10.1007/s12013-015-0675-8.
16. Roider J, Michaud N, Flotte T, et al. Histology of retinal lesions after continuous irradiation and selective micro-coagulation of the retinal pigment epithelium[J]. Ophthalmologe, 1993, 90(3): 274-278.

Chinese Journal of Ocular Fundus Diseases

The effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema

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