Aflibercept with adjuvant micropulsed yellow laser versus aflibercept monotherapy in diabetic macular edema

Khattab, Abeer; Hagras, Sherein M; Abdelhamid, A M E; Torky, Magda A; Awad, Eman; Abdelhameed, Ameera G

doi:10.1007/s00417-019-04355-6

Cited by 25 publications

(27 citation statements)

References 25 publications

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“…The studies compared in Table 1 consist of four studies covering DME [ 10 , 11 , 12 , 13 ] and one study concerning ME secondary to branch retinal vein occlusion (BRVO) [ 14 ]. Among those studies, there were two randomized clinical trials on DME by Khattab et al [ 12 ] and Kanar et al [ 13 ], respectively. The results of combined anti-VEGF plus SDM treatment were compared with the outcomes of anti-VEGF.…”

Section: Resultsmentioning

confidence: 99%

“…A description of these trials is presented in Table 1. The studies compared in Table 1 consist of four studies covering DME [10][11][12][13] and one study concerning ME secondary to branch retinal vein occlusion (BRVO) [14]. Among those studies, there were two randomized clinical trials on DME by Khattab et al [12] and Kanar et al [13], respectively.…”

Section: Resultsmentioning

confidence: 99%

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Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Gawęcki¹

2021

JCM

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Objective: intravitreal therapy for macular edema (ME) is a common clinical approach to treating most retinal vascular diseases; however, it generates high costs and requires multiple follow-up visits. Combining intravitreal anti–vascular endothelial growth factor (VEGF) or steroid therapy with subthreshold diode micropulse laser (SDM) application could potentially reduce the burden of numerous intravitreal injections. This review sought to explore whether this combination treatment is effective in the course of ME secondary to retinal vascular disease, and in particular, determine whether it is comparable or superior to intravitreal therapy alone. Materials and methods: the following terms and Boolean operators were used to search the PubMed literature database: subthreshold micropulse laser, subthreshold diode micropulse OR micropulse laser treatment AND anti-VEGF, anti-VEGF treatment, intravitreal steroids, OR combined therapy.This analysis included all studies discussing the combination of SDM and intravitreal anti-VEGF or steroid treatment. Results: the search revealed nine studies that met the inclusion criteria, including five comparing combined treatment and anti-VEGF treatment alone, four covering diabetic ME, and one covering ME secondary to branch retinal vein occlusion. All of these five studies suggested that combination therapy results in fewer intravitreal injections than anti-VEGF monotherapy with non-inferior functional and morphological outcomes. The remaining four studies report functional and morphological improvements after combined treatment; however, SDM alone was never superior to intravitreal-alone or combined treatment. There were substantial differences in treatment protocols and inclusion criteria between the studies. Conclusions: the available material was too scarce to provide a reliable assessment of the effects of combined therapy and its relation to intravitreal monotherapy in the treatment of ME secondary to retinal vascular disease. One assumption of note is that it is possible that SDM plus anti-VEGF might require fewer intravitreal injections than anti-VEGF monotherapy with equally good functional and morphological results. However, further randomized research is required to confirm this thesis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Gawęcki¹

2021

JCM

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“…More recent studies evaluated the results of combined anti-VEGF treatment with MPL. 32 – 34 Khattab and colleagues showed that this combined treatment may be effective and safe. It decreased the burden of aflibercept injection frequency with comparable anatomical and visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…It decreased the burden of aflibercept injection frequency with comparable anatomical and visual outcomes. 32 Abouhussein and colleagues 33 showed that 577 nm micropulse laser adjuvant to Aflibercept was effective for treatment-naive DME and was associated with decreased number of injections. The combined treatment compared to intravitreal injections alone allows reduction of annual injections frequency.…”

Section: Discussionmentioning

confidence: 99%

“…The combined treatment compared to intravitreal injections alone allows reduction of annual injections frequency. 32 – 34 Recently, Gawecki published a systematic review about subthreshold MPL combined with intravitreal injections in macular edema treatment. 35 Analysing different studies about MPL and anti-VEGF in DME, 32 , 34 , 36 – 39 author concluded that combining MPL would reduce the number of required intravitreal injections in cases of limited macular edema with non-inferior functional and morphological outcomes to those of anti-VEGF monotherapy, as observed in our study.…”

Section: Discussionmentioning

confidence: 99%

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Subthreshold micropulse laser adjuvant to bevacizumab versus bevacizumab monotherapy in treating diabetic macular edema: one- year- follow-up

et al. 2021

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Purpose: To compare the therapeutic impact of combining intravitreal injections of bevacizumab (IVB) with micropulse laser (MPL) in central diffuse diabetic macular edema (DME) versus IVB monotherapy during 12 months follow-up. Methods: We conducted a retrospective comparative study of 98 treatment-naive eyes (63 patients) with central diffuse DME. The first group of patients (IVB + MPL group, n = 49) was treated with 3 monthly IVB followed by MPL within 1 week after the third injection. Patients were then followed and treated on a pro re nata (PRN) basis, with MPL retreatment if necessary. The changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), number of IVB injections and MPL sessions were evaluated at 4, 8, and 12 months. A control group of diabetic patients with treatment-naive DME was treated with standard protocol of 3 monthly IVB as monotherapy then followed on a PRN basis (IVB group, n = 49). Statistic comparaison of BCVA, CMT, and IVB number variation was interpreted at 12 months between both groups. Results: In IVB + MPL group, baseline BCVA improvement was not significant at 4 and 8 months ( p = 0.90, p = 0.08), and was statistically significant ( p = 0.01) at 12 months. Mean CMT significantly decreased at 4, 8, and 12 months ( p < 0.01) in IVB + MPL group. The difference in BCVA (p = 0.091) and CMT (p = 0.082) variation at 12 months between both groups was not significant but the number of injections was significantly lower in IVB + MPL group (4.1 ± 1.5 injections) compared to IVB group (7.2 ± 1.3 injections) ( p < 0.005). Conclusion: Combining intravitreal injections of bevacizumab and MPL in the treatment of DME is effective and safe. This protocol may decrease the number of IVB and its frequency. It offers the advantage of lasting therapeutic response with fewer recurrences.

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Lasers in Diabetic Retinopathy

Gawęcki¹,

Luttrull

Grzybowski³

2023

Retina Lasers in Ophthalmology

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Aflibercept with adjuvant micropulsed yellow laser versus aflibercept monotherapy in diabetic macular edema

Cited by 25 publications

References 25 publications

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

Subthreshold micropulse laser adjuvant to bevacizumab versus bevacizumab monotherapy in treating diabetic macular edema: one- year- follow-up

Lasers in Diabetic Retinopathy

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