Clinical Efficacy Study Of Aflibercept Combined With Subthreshold Micropulse Laser In The Treatment Of Diabetic Macular Edema

Objective:To compare the clinical efficacy of aflibercept combined with subthreshold micropulse laser and aflibercept monotherapy in the treatment of diabetic macular edema（DME）,analyze whether the combined medication group can reduce the number of extra injections,and explore a more economical and effective treatment plan.Methods:This study was a prospective randomized controlled study.60 cases（60 eyes）patients were diagnosed with DME who were admitted to Yunnan University Affiliated Hospital between January 2021 and December 2021.According to the random number table method,the patients were divided into group A:aflibercept monotherapy group,group B:aflibercept combined with subthreshold micropulse laser treatment group.Group A and group B were treated with 3+PRN（3+pro re nata）scheme.In the group B,patients received subthreshold micropulse laser therapy for 2 weeks after the 3-needle loading doses,and repeated subthreshold micropulse laser therapy was performed at least 2 months apart.The CMT、BCVA、the average number of injections and the occurrence of adverse reactions were recorded in before treatment,3 months after treatment,6 months after treatment and12 months after treatment.The two groups were compared and analyzed.Results:1.The average number of injections in group A（monotherapy group）was 5.43±1.07,and the average number of injections in group B（combined treatment group）was 4.43±0.90.The difference between the two groups was statistically significant（P<0.05）.2.CMT in group A（monotherapy group）decreased from484.83±68.83μm at baseline to 329.27±25.62μm,323.03±26.56μm,311.97±22.31μm after 3,6,and 12 months of treatment.Compared with baseline,the differences were statistically significant（all P<0.05）.CMT of group B（combined treatment group）decreased from 462.50±74.63μm at baseline to 319.67±24.52μm,295.27±23.69μm,283.37±23.01μm after 3,6,and 12 months of treatment.Compared with baseline,the differences were statistically significant（all P<0.05）.There was no significant difference between groups A and B at baseline and 3 months after treatment（P baseline,P₃>0.05）,but there was significant difference between groups 6 months and 12 months after treatment(P₆,P₁₂<0.05).3.BCVA in group A（monotherapy group）improved from 0.52±0.11 log MAR at baseline to 0.34±0.12log MAR,0.28±0.11 log MAR,and 0.27±0.11 log MAR after 3,6,and 12 months of treatment.Compared with baseline,the differences were statistically significant（all P<0.05）.BCVA in group B（combined treatment group）improved from 0.53±0.10 log MAR at baseline to 0.38±0.13 log MAR,0.28±0.11 log MAR,0.27±0.11 log MAR after 3,6 and 12 months of treatment.Compared with baseline,the differences were statistically significant（all P<0.05）.There was no significant difference between groups A and B at baseline and after 3,6,and 12 months of treatment（all P>0.05）.Conclusions:1.Aflibercept combined with subthreshold micropulse laser in the treatment of DME can reduce the number of additional injections in the short term.2.Both aflibercept combined with subthreshold micropulse laser therapy and aflibercept monotherapy can reduce macular edema in patients with DME in a short time.3.Both aflibercept combined with subthreshold micropulse laser therapy and aflibercept monotherapy can improve vision in patients with DME in a short term.