Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema

Bıçak, Faruk; Kayıkçıoğlu, Özcan; Altınışık, Muhammed; Doğruya, Suzan; Kurt, Emin

doi:10.1007/s10792-022-02403-5

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…As a result, the retina is in a dry state, which provides ideal conditions for laser photocoagulation treatment, ensures good spot response under low laser energy state, and reduces the occurrence of bleeding and other related complications. 10,15,16 Mi et al 11 also confirmed that the combination of ranibizumab and micro pulse laser therapy can reduce the number of anti-VEGF drug injections and relieve the pain and psychological burden of patients.…”

Section: Discussionmentioning

confidence: 94%

“…The combination of the two methods, thus, can synergistically eliminate edema, achieving the goal of improving patients' visual function. 16,20 In addition, studies have shown that VEGF is an important endogenous mediating factor in the pathogenesis and progression of DME, which can affect the tight junction protein in endothelial cells, damage the internal retinal barrier, cause vascular leakage, and then exacerbate the disease of DME. 8,21 Nirtic Oxid Synthase (NOS) has vasoactive proprieties, and abnormal levels of NOS can lead to endothelial cell death and retinal blood flow reduction, thus causing local ischemia and hypoxia, and accelerating the occurrence and progress of ME.…”

Section: Discussionmentioning

confidence: 99%

“… 10 Antoszyk et al 15 used ranibizumab in patients with diabetes retinopathy with or without diabetes ME, and confirmed that it can improve patients’ vision and alleviate clinical symptoms. Kayıkçıoğlu et al 16 used a combination of subthreshold micro pulse laser and ranibizumab to treat patients with DME, and showed that it not only improves the treatment effect, but also reduces the risk of complications. The results of our study are consistent with these reports.…”

Section: Discussionmentioning

confidence: 99%

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Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema

Hu,

Liao,

Xia

et al. 2024

Pak J Med Sci

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Objective: To explore the clinical effect of ranibizumab combined with laser photocoagulation (LP) in treating diabetic macular edema (DME). Methods: We retrospectively reviewed the clinical data of 118 patients with DME admitted to The Affiliated Eye Hospital of Nanchang University from May 2021 to March 2023. Among them, 38 patients received LP alone (Laser-group), 39 patients received ranibizumab alone (Ranibizumab-group), and 41 patients received LP combined with ranibizumab (Combined-group). The improvement of macular edema (ME), visual acuity, and complications between the groups were compared. Results: The time of ME regression, exudation absorption and fundus hemorrhage absorption in the Combined-group was shorter than in the Laser-group and the Ranibizumab-group (P<0.05). After treatment, the CMT and RNV of the three groups decreased compared to pretreatment levels and were lower in the Combined-group compared to the Laser-group and the Ranibizumab-group (P<0.05). BCVA increased after the treatment in all groups, and was markedly higher in the Combined-group than in the Laser and the Ranibizumab-groups (P<0.05). NO were higher in the Combined-group compared to the Laser-group and the Ranibizumab-group. The post-treatment VEGF levels decreased in all groups, and were significantly lower in the Combined-group compared to the Laser-group and the Ranibizumab-group (P<0.05). The incidence of complications in the Combined-group was lower than in the Laser-group and the Ranibizumab-group (P<0.05). Conclusions: Compared to ranibizumab or LP alone, ranibizumab combined with LP is more effective in reducing ME in patients with DEM, and is associated with fewer complications. doi: https://doi.org/10.12669/pjms.40.6.9213 How to cite this: Hu J, Liao H, Xia H, Liao Y, Yuan D. Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema. Pak J Med Sci. 2024;40(6):1099-1104. doi: https://doi.org/10.12669/pjms.40.6.9213 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema

Hu,

Liao,

Xia

et al. 2024

Pak J Med Sci

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“… 67 There are also numerous reports of its additive effects as a combination therapy with anti-VEGFs, such as reducing the need for re-injection. 68 , 69 Therefore, although the gains in such a subgroup of patients are beyond the scope of this report, the use of micropulse laser as adjunctive therapy in this real-life DME treatment study (n=44, 3.2%) is worth mentioning.…”

Section: Discussionmentioning

confidence: 97%

Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1

Yayla,

Sevik,

Karabaş

et al. 2023

tjo

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Objectives: This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods: This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients’ baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, μm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results: The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 μm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 μm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion: This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.

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“…The patients qualified for micropulse therapy after receiving three initial loading anti-VEGF doses and with a CRT below 400 µm. It was suggested that additional laser treatment could decrease the burden of agent injection frequency with similar functional and anatomical outcomes [75,[78][79][80]82,83,[85][86][87]. However, the study by Akhlaghi et al [77] led to a different conclusion: adjuvant MPLT improved BCVA and CRT in eyes resistant to the bevacizumab therapy.…”

Section: Subthreshold Micropulse Laser Treatment and Intravitreal The...mentioning

confidence: 99%

Subthreshold Micropulse Laser for Diabetic Macular Edema: A Review

Sabal

Teper

Wylęgała

2022

JCM

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Diabetic macular edema (DME) is one of the main causes of visual impairment in patients of working age. DME occurs in 4% of patients at all stages of diabetic retinopathy. Using a subthreshold micropulse laser is an alternative or adjuvant treatment of DME. Micropulse technology demonstrates a high safety profile by selectively targeting the retinal pigment epithelium. There are no standardized protocols for micropulse treatment, however, a 577 nm laser application over the entire macula using a 200 μm retinal spot, 200 ms pulse duration, 400 mW power, and 5% duty cycle is a cost-effective, noninvasive, and safe therapy in mild and moderate macular edemas with retinal thickness below 400 μm. Micropulse lasers, as an addition to the current gold-standard treatment for DME, i.e., anti-vascular endothelial growth factor (anti-VEGF), stabilize the anatomic and functional retinal parameters 3 months after the procedure and reduce the number of required injections per year. This paper discusses the published literature on the safety and application of subthreshold micropulse lasers in DME and compares them with intravitreal anti-VEGF or steroid therapies and conventional grid laser photocoagulation. Only English peer-reviewed articles reporting research within the years 2010–2022 were included.

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Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema

Cited by 6 publications

References 21 publications

Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema

Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema

Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1

Subthreshold Micropulse Laser for Diabetic Macular Edema: A Review

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