Clinical Observation Of Aflibercept Combined With Retinal Laser In The Treatment Of DME With Different OCT Types

Objective: according to the morphological characteristics of optical coherence tomography,to observe the effect of Aflibercept combined with retinal laser therapy on visual function and morphology of diabetic macular edema with different OCT types.Methods: This is a retrospective clinical study.From January 2020 to January2022,70 patients with DME were diagnosed for the first time in the Department of Ophthalmology,affiliated Hospital of Yan’an University.According to the morphological characteristics of optical coherence tomography,patients with DME were divided into diffuse retinal thickening(DRT)type(26 eyes),Cystoid macular edema(CME)type(24 eyes)and serous retinal detachment(SRD)type(20 eyes).All patients were treated with 3+PRN intravitreal injection of Aflibercept combined with laser.The Central macular thickness,best corrected visual acuity,times of injection,ellipsoid zoned,external limiting membrane and best corrected visual acuity were compared among the three groups before treatment,1 month,3 months,6 months and 12 months after treatment,and the complications during operation and follow-up were recorded.Result:one.There was no significant difference in BCVA among DRT,CME and SRD groups before operation(P=0.161),but it was significantly improved at1 month,3 months,6 months and 12 months after operation operation(P<0.05),and the benefit of BCVA was the best at 3 months after treatment,and then increased slightly at each time point,but it was still better than that before treatment.At each time point after treatment,BCVA in DRT group was better than that in SRD group,and the difference was statistically significant.(P<0.05)At 12 months after treatment,BCVA in CME group was significantly lower than that in SRD group(P<0.05).Two.There was no significant difference in CMT among DRT,CME and SRD groups before operation(P=0.509),but it decreased significantly at 1 month,3 months,6 months and 12 months after operation than that before operation(P<0.05),and the decrease of CMT was the lowest at 3 months after treatment,and increased slightly at each time point after treatment,but it was still lower than that before treatment.At all time points after treatment,CMT in DRT group was better than that in SRD group(P<0.05),and CMT in CME group was lower than that in SRD group 12 months after treatment(P<0.05).Three.There were significant differences in ellipsoid zone and external limiting membrane integrity at baseline among DRT,CME and SRD groups(P<0.05).After combined treatment,there was no significant difference in EZ integrity among the three groups except 1 month and 3 months(P>0.05),and there was no significant difference in ELM integrity among the three groups except 1month(P>0.05).The integrity of baseline photoreceptor was correlated with poor visual acuity(ZE:R=-0.686,P<0.001,ELM:(R=-0.509,P<0.001)Four.Within one year of follow-up,the times of injection of Aflibercept in DRT,CME and SRD groups were 3-8 times,with an average of(4.76 ±1.14).there was a significant difference in the average times of injection among the three groups(F=5.377,P = 0.007),and average injection times of DRT group was the least(4.38 ±1.02).Conclusion:Vitreous injection of Aflibercept combined with laser is effective for all three types of DEM,and can significantly improve the visual function and anatomical microstructure of eyes with DEM.Especially for DRT type,the number of injections was the least and the improvement of BCVA and CMT was the best within one year of follow-up.Different OCT types of DME may affect the therapeutic effect.The damage of ellipsoid zone and external limiting membrane continuity at baseline is related to poor visual effect,especially in SRD DME.