| Objective:In this study,the effect of intravitreal injection of anti-vascular endothelial growth factor（anti-VEGF）drugs combined with 577nm subthreshold yellow micropulse laser and intravitreal injection of anti-VEGF drugs in patients with diabetic macular edema（DME）after pars plana vitrectomy（PPV）in type 2 diabetic proliferative retinopathy（PDR）was observed and analyzed,providing a new clinical treatment for DME.Methods:A prospective randomized controlled study was conducted in 28 patients（28 eyes）with DME diagnosed as PDR and treated with PPV.The patients were divided into intravitreal injection of anti-VEGF drugs combined with 577nm subthreshold yellow micropulse laser treatment group（combined treatment group）and simple intravitreal injection of anti-VEGF drugs group（simple drug injection treatment group）.There were 11 cases in the combined treatment group and 17 cases in the simple anti-VEGF treatment group.Visual acuity,optical coherence tomography（OCT）and other examinations were improved in all patients.Combination therapy group received intravitreal injection of anti-VEGF drug 1-2 weeks before micropulse laser therapy,while the control group received only intravitreal injection anti-VEGF drug.All patients were assessed for anti-VEGF therapy every month after initial treatment according to pre-set retreatment criteria,and the follow-up period was three months.The differences of BCVA,central macular thickness（CMT）and retinal volume（CV）between the two groups before and after treatment were comprehensively analyzed and statistically analyzed.Results:1.We compared changes in DME before and after intravitreal injection of anti-VEGF combined with 577nm subthreshold yellow micropulse laser:The logmar BCVA before treatment was 0.8±0.5.After treatment,the Logmar BCVA was 0.9±0.8 in the first month,0.7±0.4 in the second month,and 0.6±0.5 in the third month.There was no significant difference in logmar BCVA before and first、second month after treatment（P=0.974,0.921）.There were significant difference in logmar BCVA before and third month after treatment（P=0.016）.The CMT of combined treatment group before treatment was（426.3±124.7）μm.After treatment,the CMT was（420.0±138.7）μm in the first month,（383.5±116.4）μm in the second month,and（403.3±157.4）μm in the third month.CMT values?before and after treatment were no statistically different（P=0.718,0.375,0.491）.The 6mm*6mm CV of the combined treatment group before treatment was（12.0±1.9）mm~3.After treatment,the CV was（11.1±1.8）mm~3in the first month,（11.1±1.7）mm~3in the second month,and（11.0±2.4）mm~3in the third month.CV values??before and after treatment were statistically different（P=0.009,0.023,0.004）.2.We compared changes in DME before and after intravitreal injection of anti-VEGF.:The logmar BCVA before treatment was 1.0±0.7.After treatment,the logmar BCVA was 1.0±0.7 in the first month,0.9±0.7 in the second month,and 1.0±0.7 in the third month.There was no significant difference in logmar BCVA before and after treatment（P=0.928、0.505、0.672）.The CMT of injection-only drug treatment group before treatment was（476.8±194.1）μm.After treatment,the CMT was（335.8±123.5）μm in the first month,（352.3±175.8）μm in the second month,and（352.4±175.8）μm in the third month.CMT values before and after treatment were statistically different（P=0.017、0.020、0.019）.The 6mm*6mm CV of injection-only drug treatment group before treatment was（12.1±2.8）mm~3.After treatment,the CV was（10.0±2.3）mm~3in the first month,（10.3±3.4）mm~3in the second month,and（10.0±3.2）mm~3in the third month.CV values?before and after treatment were statistically different（P=0.020,0.037,0.033）.3.The pathological changes and complications of ocular fundus after 577nm subthreshold yellow micropulse laser were observed:Fundus examination showed that there was no obvious pigmentation in macular area,and no obvious laser scar was observed.After treatment,choroidal neovascularization,subretinal fibrosis and other complications were not found in macular area.Conclusion:1.The therapy of intravitreal injection of anti-VEGF drugs combined with 577nm subthreshold yellow micropulse laser and simple anti-VEGF therapy can effectively reduce the CV of DME patients with PDR after PPV treatment in the short term,and reduce macular edema.2.Compared with anti-VEGF alone,the BCVA of DME treated with 577nm subthreshold yellow micropulse laser combined with anti-VEGF drugs can be significantly improved and the visual function of patients can be improved in the short term.3.For patients with DME after PPV treatment for PDR,577nm subthreshold yellow micropulse laser treatment did not find the occurrence of macular-related complications.it was safe. |
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