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

Abstract

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.

Yellow Subthreshold Micropulse Laser in Retinal Diseases: An In-Depth Analysis and Review of the Literature

“…Their combined use was demonstrated, in fact, to significantly reduce the number of anti-VEGF injections while preserving or even improving morpho-functional outcomes. BCVA improvement and a CMT decrease were illustrated in two thirds [ 55 , 56 , 58 – 61 , 63 ] and in half of the studies considered [ 55 , 58 – 61 ], respectively, and a stabilization of these features was described in the remaining cases throughout the entire follow-up [ 56 , 57 , 62 – 64 ].…”

Comparison of micropulse subthreshold laser plus anti-VEGF versus anti-VEGF alone in diabetic macular edema: Systematic review

“…Six studies were followed up for up to 1 year or 48 weeks, with a loading phase for 3 months, 1 dose each month, and followed by Pro Re Nata (PRN) injection of anti-VEGF until 12 month. [ 9 10 11 12 13 14 15 ] A study by Akhlaghi et al . [ 16 ] only followed up until the end of the loading phase, and followed up 1 month after (a fourth month) and a study by Khattab et al .…”

“…Different Anti-VEGF agents were used. Three of the studies used intravitreal aflibercept;[ 9 12 15 ] other three studies used intravitreal bevacizumab,[ 13 14 16 ] and two other studies used ranibizumab. [ 10 11 ]…”

“…A study by Altınel et al .,[ 13 ] Kanar et al .,[ 15 ] Khattab et al .,[ 12 ]and El Matri et al . [ 14 ] will give another session of MPSL based on patient presentation; meanwhile, studies by Abouhussein et al .,[ 9 ] Furashova et al .,[ 10 ] and Akhlaghi et al . [ 16 ] give fixed micropulse laser session.…”

Subthreshold Micropulse Laser for Diabetic Macular Edema: A Review

“…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.…”