目的:介绍亚阈值微脉冲半导体激光(SMPL)治疗糖尿病性黄斑水肿(DME)。为了总结生物影响,治疗效果,以及这种治疗的安全性,并讨论SMPL与抗血管内皮生长因子(抗VEGF)或类固醇联合对DME的反应。
方法:在PubMed数据库中进行文献检索,选择2000年至2023年发表的英语文章,其中包含以下搜索词的组合:糖尿病黄斑(o)水肿,微脉冲激光或亚阈值微脉冲激光,抗血管内皮生长因子,和类固醇。
结果:SMPL很受欢迎,廉价的隐形视网膜激光光疗,安全,对DME的治疗有效。它可以选择性地靶向视网膜色素上皮,减少促炎因子的表达,促进黄斑水肿的吸收,并发挥与传统激光相似和持久的临床效果。SMPL在不同波长之间的治疗效果没有发现显着差异。然而,HbA1c水平和治疗前中央黄斑厚度(CMT)可能会影响SMPL的治疗效果。
结论:SMPL起效缓慢,产生与常规光凝相似的持久临床效果。据报道,SMPL联合玻璃体腔注射抗VEGF可显著减少注射次数,且不影响治疗效果。这对于临床应用和研究至关重要。尽管577nmSMPL在临床上被广泛使用,SMPL没有标准化的协议。此外,关于SMPL治疗的一些重要问题需要进一步讨论和探索。
OBJECTIVE: To introduce the treatment of diabetic macular edema (DME) with subthreshold micropulse diode laser (SMPL), to summarize the biological impact, therapeutic effects, and safety of this treatment, and to discuss the response to DME when SMPL is combined with anti-vascular endothelial growth factor (anti-VEGF) or steroid.
METHODS: The literature search was performed on the PubMed database, with a selection of English-language articles published from 2000 to 2023 with the following combinations of search terms: diabetes macular (o) edema, micropulse laser or subthreshold micropulse laser, anti-vascular endothelial growth factor, and steroid.
RESULTS: SMPL is a popular, invisible retinal laser phototherapy that is inexpensive, safe, and effective in the treatment of DME. It can selectively target the retinal pigment epithelium, reduce the expression of pro-inflammatory factors, promote the absorption of macular edema, and exert a similar and lasting clinical effect to traditional lasers. No significant difference was found in the therapeutic effects of SMPL between different wavelengths. However, HbA1c level and pretreatment central macular thickness (CMT) may affect the therapeutic outcomes of SMPL.
CONCLUSIONS: SMPL has a slow onset and produces lasting clinical effects similar to conventional photocoagulation. It has been reported that SMPL combined with the intravitreal anti-VEGF injection can significantly reduce the number of injections without influencing the therapeutic effect, which is essential for clinical applications and research. Although 577 nm SMPL is widely used clinically, there are no standardized protocols for SMPL. Additionally, some important problems regarding the treatment of SMPL require further discussion and exploration.