| Objective: To observe the clinical efficacy of micropulsion laser combined with Tangwang No.2 prescription in the treatment of diabetic macular edema.Methods: This study collected 110 DME patients accepted by the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from January 2020 to February 2022.These patients were were diagnosed with DME based on the tests for fluorescein fundusangiography(FFA)and optical coherence tomography(OCT)of slit lamp,SLO,and fundus.According to the treatment plans,the patients were divided into four groups,including the control group consisting of 24 cases(24 eyes),the experimental group I consisting of 28 cases(28 eyes),the experimental group II consisting of 28 cases(28 eyes)and the experimental group III consisting of 30 cases(30 eyes).The patients in the three groups were adopted three different treatments as follow:(1)Control group : the patients were treated with Conbercept vitreous injection.(2)Experimental group I: the patients were treated with Conbercept vitreous injection + Tangwang No.2 prescription treatment.(3)Experimental group II: the patients were treated with Conbercept vitreous injection + micropulse laser treatment.(4)Experimental group III : the patients were treated with Conbercept vitreous injection + micropulse laser + Tangwang No.2 prescription treatment.All groups were treated for 5 months,and the IOP,BCVA(Log MAR)and CRT were examined and recorded before and after the treatments.In addition,the total number of injections in 5 months was also counted.The data sets of three groups were statistically analyzed with R software to compare the efficacy of the four treatment methods.Results:(1)The comparisons of BCVA: After the treatments,the BCVA levels of the four groups were significantly improved comparing to the originial levels before treatment.The BCVA of the control group before treatment,2 months after treatment and 5 months after treatment were(0.84±0.43)、(0.75±0.33)、(0.59±0.22)respectively,the difference was statistically significant(P<0.05).The BCVA of experimental group 1 before treatment,2 months after treatment and 5 months after treatment were(0.81±0.34)、(0.68±0.28)、(0.55±0.32)respectively,the difference was statistically significant(P<0.05).The BCVA of experimental group 2 before treatment,2 months after treatment and 5 months after treatment were(0.81±0.37)、(0.65±0.27)、(0.55±0.32)respectively,the difference was statistically significant(P<0.05).The BCVA of experimental group 3 before treatment,2 months after treatment and 5 months after treatment were(0.76±0.28)、(0.52±0.22)、(0.38±0.21)respectively,the difference was statistically significant(P<0.05).Two months after treatment,there was no significant improvement in BCVA of experimental group 1 and experimental group 2 compared with the control group(P>0.05),the BCVA of experimental group 3 was significantly higher than that of the control group(P<0.05).In addition,the BCVA of experimental group 3 was significantly higher than that of test group 1(P<0.05),but there was no significant difference between experimental group 3 and experimental group 2(P>0.05).Five months after treatment,the BCVA of experimental group 1 and experimental group 2 was higher than that of the control group,but it was not significant(P>0.05),the BCVA of experimental group 3 was significantly higher than that of the control group(P<0.05),and the BCVA of experimental group 3 was significantly higher than that of test group 1 and experimental group 2(P<0.05).This shows that the effect of test group 3 is the best after 5 months of treatment.(2)The comparison of CRT: After the treatment,the CRT levels of the four groups were significantly reduced comparing with the original levels before treatment,The CRT of the control group before treatment,2 months after treatment and 5 months after treatment were(557.46±108.19)、(542.75±101.22)、(410.42±53.54)respectively,the difference was statistically significant(P<0.05).The CRT of experimental group 1 before treatment,2 months after treatment and 5 months after treatment were(547.89±146.40),(513.96±137.44),(377.79±136.24)respectively,the difference was statistically significant(P<0.05).The CRT of experimental group 2 before treatment,2 months after treatment and 5 months after treatment were(563.07±157.81),(525.14±140.45),(373.75±105.30)respectively,the difference was statistically significant(P<0.05).The CRT of experimental group 3 before treatment,2 months after treatment and 5 months after treatment were(582.80±141.08),(483.40±127.53),(298.63±125.82)respectively,the difference was statistically significant(P < 0.05).Two months after treatment,there was no significant difference in the improvement of CRT between several treatment schemes(P>0.05).Five months after treatment,the CRT of experimental group 1 and experimental group 2 were improved compared with the control group,but there was no significant difference(P>0.05).The treatment scheme of experimental group 3 had a very prominent effect on CRT(P<0.05).(3)The comparison of IOP:The effect of the four treatments on intraocular pressure in patients with DME is very limited.The IOP of the control group before treatment,2 months after treatment and 5 months after treatment were(15.25±1.33),(15.08±1.60),(14.94±1.75)respectively,the difference was statistically significant(P>0.05).The IOP of experimental group 1 before treatment,2 months after treatment and 5 months after treatment were(15.26±1.44),(15.51±1.51),(15.15±1.80)respectively,the difference was statistically significant(P>0.05).The IOP of experimental group 2 before treatment,2 months after treatment and 5 months after treatment were(15.38±1.92),(15.69±2.01),(15.15±1.80)respectively,the difference was statistically significant(P>0.05).The IOP of experimental group 3 before treatment,2 months after treatment and 5 months after treatment were(15.08±2.40),(15.63±2.23),(14.93±1.88)respectively,the difference was statistically significant(P>0.05).Two months after treatment,there was no significant change in IOP of the three experimental groups compared with the control group(P>0.05),and there was no significant difference in IOP between the three experimental groups(P>0.05).Five months after treatment,it was also found that there was no significant difference in IOP between the four groups(three experimental groups and one control group)(P>0.05).(4)The control group needs an average of(3.50 ± 1.02)injections,the experimental group 1 needs an average of(3.32 ± 0.86)injections,the experimental group 2 needs an average of(3.21 ± 0.92)injections,and the experimental group 3 needs an average of(2.97 ± 0.67)injections.It was found that the injection times of experimental group 1 and experimental group 2 were lower than those of the control group,but they were not significant(P>0.05).However,the number of injections in experimental group 3 was significantly lower than that in control group(P<0.05).In addition,the number of injections in experimental group 3 was lower than that in experimental group 1 and test group 2,but it was not significant(P>0.05).There was also no significant difference in the number of injections between experimental group 1 and experimental group 2(P>0.05).Conclusion:1.Conbercept can effectively treat diabetic macular edema.On the basis of the injection of Conbercept,adding micro-pulse laser or traditional Chinese medicine to improve vision and reduce macular edema thickness is better than the simple injection of Conbercept.Among them,there is no significant difference between the efficacy of Conbercept combined with micro-pulse laser and Conbercept combined with Tangwang No.2 prescription.On the basis of conbercept,micro-pulse laser combined with Tangwang No.2 prescription has the best curative effect in the treatment of DME,which can significantly improve the vision of patients and reduce the thickness of macular edema.It is the best treatment for DME.2.The intraocular pressure of the four treatment methods changed slightly after 2 months and 5 months,but there was no clinical significance.There was no significant difference in intraocular pressure between the four groups.The four treatment methods were safe and reliable in the treatment of DME.3.Based on the injection of Conbercept,the injection times of micro pulse laser combined with Tangwang No.2 are the least in the treatment process,which can significantly reduce the injection times of patients and reduce the potential risk of intravitreal injection. |
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