Efficacy Analysis Of Different Combination Sequences Of Laser And Anti-VEGF In The Treatment Of Diabetic Macular Edema

Objective:To investigate the optimal combined sequence of laser and intravitreal conbercept injection in patients with diabetic macular edema（DME）,and analyze the prognostic factors of DME patients.Methods:A prospective study was conducted on 160 eyes of 160 patients with DME diagnosed.According to the size of baseline central macular thickness（CMT）,they were divided into two groups,52 eyes with CMT≤360μm were mild DME group,and 108 eyes with CMT>360μm were severe DME group.The patients in the mild DME group were randomdly divided into A₁group（received laser photocoagulation followed by intravitreal injection of conbercept,25 cases with 25 eyes）,B₁group（received intravitreal injection of conbercept followed by laser photocoagulation treatment,27 cases with 27eyes）;patients in the severe DME group were divided into A₂group（received laser photocoagulation followed by intravitreal injection of conbercept,50 cases with 50 eyes）,B₂group（received intravitreal injection of conbercept followed by laser photocoagulation treatment,58cases with 58 eyes）.All four groups of patients received best-corrected visual acuity（BCVA）,intraocular pressure（IOP）,and CMT before treatment.The four groups of patients were followed up for 6mo after the completion of treatment,and the BCVA,IOP,and CMT were measured at 1wk,1mo,3mo,and 6mo after treatment.During the follow-up,95 cases and 95 eyes were excluded for various reasons.Finally,65cases and 65 eyes participated in the statistical analysis and discussion,including 8 cases and 8 eyes in group A₁,8 cases and 8 eyes in group A₂,20 cases and 20 eyes in group B₁and 29 cases and 29 eyes in group B₂.The BCVA,IOP,and CMT at baseline and follow-up after treatment in each group were compared,and the parameters and times required for laser photocoagulation,the times of intravitreal injection,postoperative adverse reactions and DME recurrence were observed and compared.Results:1.There was no significant difference in BCVA,IOP and CMT before treatment in mild ME group（P>0.05）;there was no significant difference in BCVA,IOP and CMT in severe ME group before treatment（P>0.05）.2.In each group,1wk,1,3,and 6mo after treatment,BCVA and CMT were improved compared with baseline（P<0.05）.3.Severe ME group:（1）The improvement of BCVA in group B2 at 1wk,1,3,and 6mo after operation was higher than that in group B₁（P<0.05）,and the improvement trend of BCVA after operation was higher in group B2 than in group B₁（P<0.05）.（2）At each time point of follow-up after treatment,the improvement of CMT in group B₂was better than that in group B₁（P<0.05）,but there was no significant difference in the improvement trend of CMT between the two groups（P>0.05）.4.Mild ME group:（1）There was no significant difference in the level of BCVA and the trend of improvement at each time point of postoperative follow-up between group A₁and group A₂（P>0.05）.（2）There was no significant difference in the improvement of CMT compared with the baseline and the improvement trend of CMT at each time point of postoperative follow-up in group A₁and group A₂（P>0.05）.5.Laser treatment and intravitreal Conbercept injection:（1）Severe ME group:（1）The laser energy and laser number required for treatment in group B₂were lower than those in group B₁（P<0.05）.（2）The times of laser and drug injection in group B₂were lower than those in group B₁,but the difference was not statistically significant（P>0.05）.（2）Mild ME group:（1）The laser energy and laser number required for treatment in group A₂were lower than those in group A₁（P<0.05）.（2）The times of laser and drug injection in group A₂were lower than those in group A₁,but the difference was not statistically significant（P>0.05）.6.During the follow-up period,there was no significant difference in the incidence of postoperative adverse reactions among the four groups.Conclusion:1.we found that among the combined treatments of laser photocoagulation a nd anti-vascular endothelial growth factor（VEGF）,the outcomes of DME were sig nificantly better after intravitreal injection of conifercept than after laser photocoag ulation followed by intravitreal injection of conifercept.2.For the severe DME,laser photocoagulation after first conifercept intravitre al injection resulted in better outcomes,and its tendency to improve BCVA and C MT was also significantly better than that after laser photocoagulation intravitreal i njection.3.For the mild DME group,although there is not much difference in recent treatment outcomes regardless of the combination regimen,laser photocoagulation after first conifercept intravitreal injection may benefit patients long.4.In addition,laser therapy after antecedent intravitreal drug injection is expe cted to reduce the number of injections and lasers and reduce the risk and cost of treatment.