Abstract:AIM: To explore the efficacy of intravitreal injection of aflibercept combined with modified macular grid laser photocoagulation and panretinal photocoagulation for treating diabetic macular edema(DME).
METHODS: This study was a retrospective study. The clinical data of DME patients admitted to the hospital from February 2022 to February 2025 were collected. According to different treatment methods, patients were divided into control group(treated with modified macular grid laser photocoagulation and panretinal photocoagulation alone)and combined group(treated with single intravitreal injection of aflibercept preoperative 3 d preoperatively on the basis of the control group). All patients were followed up for at least 6 mo after treatment. Changes in best-corrected visual acuity(BCVA), intraocular pressure(IOP)and retinal microcirculation parameters were compared between the two groups pre- and postoperatively. The postoperative complications of the two groups were recorded, and the quality of life of the two groups before and after treatment was observed.
RESULTS: Totally 300 DME patients(300 eyes)were enrolled, including 150 patients(150 eyes)in the combined group(80 males and 70 females, with a mean age of 58.89±6.19 y)and 150 patients(150 eyes)in the control group(86 males and 64 females, with a mean age of 57.88±5.91 y). At 1, 3, and 6 mo after surgery, BCVA of both groups was better than before surgery(all P<0.01), and the BCVA of the combined group was better than that of the control group at all time points after surgery(P<0.001). The IOP of the control group was higher than that of the combined group at 1 mo after surgery(P<0.001), while there was no statistical significant difference in IOP between the two groups at other postoperative time points(all P>0.05). At 1, 3, and 6 mo after surgery(all P<0.01), the resistance index(RI)of the central retinal artery in both groups of affected eyes was lower than before surgery. The end-diastolic velocity(EDV)and peak systolic velocity(PSV)of blood flow in both groups were higher than before surgery. The leakage area of retinal neovascularization(RNV), parafoveal macular thickness(PMT), foveal macular thickness(FMT), central retinal thickness(CRT), and foveal avascular zone area(FAZ)in both groups were lower than before surgery(all P<0.01), and the RI of the combined group was lower than that of the control group at all time points after surgery. The EDV and PSV of the combined group were higher than those of the control group at all time points after surgery(all P<0.001). The RNV leakage area, PMT, FMT, CRT, and FAZ were all smaller than those in the control group(all P<0.01). After surgery, the scores of the National Eye Institute Visual Function Related Quality of Life Questionnaire(NEI-VFQ-25)in both groups were increased, and the combined group was higher than the control group(P<0.001). The postoperative macular edema elimination rate and visual acuity improvement or retention rate of the combined group were higher than those of the control group, and the incidence of postoperative complications was lower than control group(P<0.05).
CONCLUSION:Intravitreal aflibercept combined with modified macular grid laser photocoagulation and panretinal photocoagulation achieves significant efficacy in the treatment of DME patients, which can promote the improvement of retinal microcirculation, enhance the visual acuity, effectively stabilize postoperative IOP, reduce the occurrence of postoperative complications, and ultimately improve the quality of life.
