Comparative Study On The Efficacy Of Ranibizumab And Aflibercept Combined With Panretinal Photocoagulation In Diabetic Macular Edema

Objective: To compare and analyze the therapeutic effects of intravitreal injection of ranibizumab combined with and intravitreal injection of aflibercept combined with panretinal photocoagulation in diabetic macular edema(DME),and to explore the effects of intravitreal injection of ranibizumab and aflibercept on various indexes of diabetic macular edema(DME).Method: There were 94 patients with DME diagnosed by OCT and FFA in The Northern Theater Command General Hospital from January 2020 to January 2022 who were treated with intravitreal injection of anti-vascular endothelial growth factor(VEGF)combined with PRP.All 94 eyes were selected.They were divided into 2 groups according to the types of intravitreal injection drugs.3+PRN was used as the treatment regimen.In group Ⅰ,45 eyes were injected with aflibercept combined with PRP in vitreous cavity.In group Ⅱ,49 eyes were injected with ranibizumab combined with PRP in vitreous cavity.The time points of patient data observation were defined as before,1,3,6 and 12 months after vitreous cavity injection.BCVA values measured by ETDRS logarithmic visual acuity chart were recorded,and visual acuity values were expressed by log MAR recording method.Intraocular pressure and macular central thickness(CMT)were recorded.The number of intravitreal injections of the two drugs during treatment were collected.And the occurrence of related complications was recorded.The study data were statistically analyzed by IBM SPSS27.0 software.Kolmogorov-Smirnov was used to test whether the measurement indicators were in line with normal distribution.The measurement data in line with normal distribution were represented by mean ± standard deviation(x ± s),and the comparison between the two groups was conducted by independent sample t test.Non-parametric rank sum test was used to analyze measurement data inconsistent with normal distribution,and the median(P25,P75)was used to represent measurement data.Mann-Whitney U test was used to compare data between the two groups.Wilcoxon signed rank sum test was used to compare the data between the two groups.P<0.05 was considered statistically significant.Univariate analysis of variance was used to compare the changes of CMT and BCVA at different time points.Counting data were tested by x2.Count data were represented by relative number n,and P < 0.05 was considered statistically significant.Results: BCVA(Log MAR): The best BCVA(Log MAR)before surgery and 1,3,6,12 months after surgery were analyzed respectively in the two groups.BCVA in both groups was significantly improved compared with that before surgery,with both P values <0.001,the differences were statistically significant.A pairwise comparison of BCVA 1,3,6 and 12 months after surgery between the two groups showed that BCVA was correlated with time,with statistical differences.Both groups showed an overall trend of improvement over time,with a slight fluctuation in the middle.At 1,3,6,and 12 months after surgery,the BCVA(Log MAR)of aflibercept was slightly better than that of ranibizumab,with no statistical significance(P >0.05).CMT(μm)status: The CMT(μm)of the two groups were analyzed before surgery and 1,3,6 and 12 months after surgery.The postoperative CMT(μm)of the two groups was significantly decreased compared with that before surgery,and the P values were all <0.001,the differences were statistically significant.The overall trend of CMT decreases with the increase of time.A pin-to-pair comparison of the CMT values in 1,3,6,and 12 months after surgery between the two groups found that there were statistical differences in each month of the Aflibercept group,while there were statistical differences in the Ranibizumab group only in January,June,and December.Compared with the CMT(μm)at 1,3,6 and 12 months after surgery between the two groups,the CMT value of the Aflibercept group was slightly better than that of the Ranibizumab group at 1 and 3 months after surgery,the difference was not statistically significant(P > 0.05),the Aflibercept group was significantly better than the Ranibizumab group at 6 and 12 months after surgery,the difference was statistically significant(P< 0.05).At 12 months of treatment,37 patients(82.2%)in the Aflibercept group had CMT<250μm,higher than 15 cases(30.6%)in Ranibizumab group.Intraocular pressure: The intraocular pressure(mm Hg)of the two groups before and after 1,3,6 and 12 months were analyzed respectively,and the intraocular pressure of the two groups was stable before and after surgery,with no significant difference.The P values of the two groups were all>0.05 was not statistically significant.Compared with the intraocular pressure(mm Hg)at 1,3,6 and 12 months after operation between the two groups,the intraocular pressure in the Ranibizumab group was slightly higher than that in the Aflibercept group(P >0.05)was not statistically significant.Transient increase of intraocular pressure was observed in both groups after surgery.5 cases in the Aflibercept group,with an incidence of 11.1%,were slightly lower than 8 cases in the Ranibizumab group,with an incidence of 16.3%.The intraocular pressure in both groups recovered within 2-3 days.In terms of infusion times: 6(3,7)times of the aflibercept group was less than 7(6,8.5)times of the Ranibizumab group,and the difference was statistically significant(P < 0.05).In terms of the occurrence of adverse reactions: 9 cases(20%)of mild eye adverse reactions of Aflibercept group were slightly better than 11 cases(22.4%)of Ranibizumab group.No serious systemic and eye adverse reactions occurred in both groups.Conclusions: Vitreous cavity injection of aflibercept and ranibizumab combined with PRP in the treatment of DME can effectively improve patients’ visual acuity and CMT,and aflibercept is more effective in the improvement of CMT at the later stage of treatment,and the number of injections is slightly less than that of ranibizumab in the same time.