The Study Of The Optimized Method For Treatment Of Diabetic Macular Edema

ObjectiveDiabetic retinopathy is one of the serious complications in Diabetes. The diabetic macular edema is the leading cause of decreased vision or blindness in Diabetes. This research is to study optimized Chinese and Western treatment on diabetic macular edema by comparing different treatment methods.MethodsWe used retrospective case-control study by choosing 160 cases (285 eyes) of diagnosed diabetic retinopathy patients from January,2009 to October,2014 in our hospital. The patients were divided into Chinese medicine differentiation treatment group(A group), Chinese differentiation therapy integrated with bevacizumab/ranibizumab intravitreal injection group (group B), Chinese medicine differentiation treatment integrated with laser photocoagulation therapy(group C),and Chinese medicine differentiation treatment integrated with retinal laser photocoagulation and bevacizumab/ ranibizumab intravitreal injection group (group D). To evaluate the efficacy of these four groups by comparing the best corrected visual acuity, foveal thickness, the average thickness of the retina, retinal volume, regression of retinal neovascularization and vitreous hemorrhage.Results1. Best corrected visual acuityGroup A:In 4 weeks after treatment, BCVA was significantly higher than that before treatment (P<0.05), BCVA did not obvious increase between 4w and 8w. BCVA decreased in 12w after treatment.Group B and Group C:BCVA was gradually increasing in 4w,8w, and 12w after treatment. It had significantly differences compared with that before treatment (P<0.05). Group D showed the significantly best efficacy data in 4 groups(P<0.05). The improvement of BCVA in group D which patients with proliferative diabetic retinopathy and macular edema was significantly higher than that with non-proliferative diabetic retinopathy and macular edema.2. Macular edema and the macular area seepageGroup A、B、C、D showed that the central macular thickness, retinal average thickness and retinal volume descended in 12 weeks after treatment. Group D showed it declined significantly greater than that of other 3 groups (P <0.05).12 week after treatment in the macular area leakage situation D group were better than other groups. The differences among the groups is statistically significant (P<0.05).3. Macular exudation12 weeks after treatment:the exudation of 30 eyes in group A(39%) increased,30 eyes were unchanged(39),17 eyes decresed(22%). The exudation of 16 eyes in group B(23%) increased,15 eyes were unchanged(21%),25 eyes decresed(35%),15 eyes were disappeared(21%). The exudation of 17 eyes in group A(24%) increased,18 eyes were unchanged,20 eyes decresed(28%),16 eyes were disappeared(23%). The exudation in 8 eyes of group A(39%) increased,6 eyes were unchanged(9%),29 eyes decresed(44%),23 eyes disappeared(35%). The differences in two groups were significant (P<0.05.4. The mean intravitreal injection anti-VEGF therapy in group B was 3.6, and was 2.7 in group D. The average injection number in group D was less than group B. The injection number were both less than that mentioned in the related articles published.5. The incidence of vitreous hemorrhage20 eyes in group A occured(26%) vitreous hemorrhage in six months after treatment.14 eyes in group B (19.7%) occurred vitreous hemorrhage in six months after treatment.18 eyes in group C (25.4%) occurred vitreous hemorrhage in six months after treatment.9 eyes in group D(13.6%) occurred vitreous hemorrhage in six months after treatment. The differences among the groups is statistically significant (P<0.05) 6. There were no severe ocular and systemic complications in the treatment process.Conelusion:Chinese medicine differentiation treatment integrated with retinal laser photocoagulation and bevacizumab/ranibizumab intravitreal injection can improve patients visual acuity, reduce macular edema and incidence of vitreous hemorrhage, so as to cure diabetic macular edema.