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A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
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Graefe's Archive for Clinical and Experimental Ophthalmology

Open Access 25-04-2024 | Laser | Review Article

Subthreshold micropulse laser combined with anti-vascular endothelial growth factor therapy for diabetic macular edema: a systematic review and meta-analysis

Authors: Hironori Hosoya, Takashi Ueta, Kazunori Hirasawa, Taku Toyama, Tomoyasu Shiraya

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology

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Abstract

Purpose

To evaluate the effects of subthreshold micropulse laser (SML) in addition to anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME).

Methods

MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for studies that compared anti-VEGF with SML and anti-VEGF monotherapy for DME. Outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of anti-VEGF injections.

Results

Eight studies including 493 eyes were selected. Four studies were randomized controlled, and the other four were retrospective. Meta-analysis showed that there was no significant difference in BCVA (mean difference [MD] -0.04; 95%CI -0.09 to 0.01 logMAR; P = 0.13;). CMT was thinner in the group of anti-VEGF with SML (MD -11.08; 95%CI -21.04 to -1.12 µm; P = 0.03); however, it was due to a single study that weighed higher, and the sensitivity and subcategory analyses did not support the finding. The number of anti-VEGF injections was significantly decreased in the group of anti-VEGF with SML (MD -2.22; 95%CI -3.02 to -1.42; P < 0.0001).

Conclusion

Current evidence indicates that adding SML to anti-VEGF therapy could significantly reduce the number of anti-VEGF injections compared to anti-VEGF monotherapy, while achieve similar BCVA and CMT.
Appendix
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Literature
1.
Lee R, Wong TY, Sabanayagam C (2015) Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond) 2:17CrossRefPubMed
2.
Sarohia GS, Nanji K, Khan M et al (2022) Treat-and-extend versus alternate dosing strategies with anti-vascular endothelial growth factor agents to treat center involving diabetic macular edema: A systematic review and meta-analysis of 2,346 eyes. Surv Ophthalmol 67:1346–1363CrossRefPubMed
3.
Early Treatment Diabetic Retinopathy Study research group (1985) Photocoagulation for diabetic macular edema. Early treatment diabetic retinopathy study report number 1. Arch Ophthalmol 103:1796–1806CrossRef
4.
Diabetic Retinopathy Clinical Research Network (2008) A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology 115:1447–1449CrossRef
5.
Friberg TR, Karatza EC (1997) The treatment of macular disease using a micropulsed and continuous wave 810-nm diode laser. Ophthalmology 104:2030–2038CrossRefPubMed
6.
Lois N, Campbell C, Waugh N et al; DIAMONDS Study Group (2023) Diabetic macular edema and diode subthreshold micropulse laser: A randomized double-masked noninferiority clinical trial. Ophthalmology 130:14–27
7.
8.
Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:i4898CrossRef
9.
10.
Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394CrossRefPubMed
11.
Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458CrossRefPubMed
12.
Moisseiev E, Abbassi S, Thinda S et al (2018) Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema. Eur J Ophthalmol 28:68–73CrossRefPubMed
13.
Khattab AM, Hagras SM, AbdElhamid A et al (2019) Aflibercept with adjuvant micropulsed yellow laser versus aflibercept monotherapy in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 257:1373–1380CrossRefPubMed
14.
Kanar HS, Arsan A, Altun A (2020) Can subthreshold micropulse yellow laser treatment change the anti-vascular endothelial growth factor algorithm in diabetic macular edema? A randomized clinical trial. Indian J Ophthalmol 68:145–151CrossRefPubMed
15.
Abouhussein MA, Gomaa AR (2020) Aflibercept plus micropulse laser versus aflibercept monotherapy for diabetic macular edema: 1-year results of a randomized clinical trial. Int Ophthalmol 40:1147–1154CrossRefPubMed
16.
Altınel MG, Acikalin B, Alis MG et al (2021) Comparison of the efficacy and safety of anti-VEGF monotherapy versus anti-VEGF therapy combined with subthreshold micropulse laser therapy for diabetic macular edema. Lasers Med Sci 36:1545–1553CrossRefPubMed
17.
El Matri L, Chebil A, El Matri K et al (2021) Subthreshold micropulse laser adjuvant to bevacizumab versus bevacizumab monotherapy in treating diabetic macular edema: one- year- follow-up. Ther Adv Ophthalmol 13:25158414211040890PubMedPubMedCentral
18.
Bıçak F, Kayıkçıoğlu ÖR, Altınışık M et al (2022) Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema. Int Ophthalmol 42:3829–3836CrossRefPubMed
19.
Koushan K, Eshtiaghi A, Fung P et al (2022) Treatment of diabetic macular edema with aflibercept and micropulse laser (DAM Study) Clin Ophthalmol 16:1109–1115
20.
Jørgensen MM, Vestergaard AH, Blindbaek SL et al (2022) Functional and structural efficacy of a novel combinational therapy of aflibercept and timely focal/grid photocoagulation in diabetic macular oedema: do clinical study results compare favourably with a standard-of-care treated real-world population? Acta Ophthalmol 100:e1624–e1629CrossRefPubMedPubMedCentral
21.
Solaiman KA, Diab MM, Abo-Elenin M (2010) Intravitreal bevacizumab and/or macular photocoagulation as a primary treatment for diffuse diabetic macular edema. Retina 30:1638–1645CrossRefPubMed
22.
Solaiman KA, Diab MM, Dabour SA (2013) Repeated intravitreal bevacizumab injection with and without macular grid photocoagulation for treatment of diffuse diabetic macular edema. Retina 33:1623–1629CrossRefPubMed
23.
Liegl R, Langer J, Seidensticker F et al (2014) Comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema. PLoS ONE 9:e113981CrossRefPubMedPubMedCentral
24.
Payne JF, Wykoff CC, Clark WL et al; TREX-DME Study Group (2017) Randomized trial of treat and extend ranibizumab with and without navigated laser for diabetic macular edema: TREX-DME 1 Year Outcomes. Ophthalmology 124:74–81
25.
Arevalo JF, Lasave AF, Wu L et al; Pan-American Collaborative Retina Study Group (PACORES) (2013) Intravitreal bevacizumab plus grid laser photocoagulation or intravitreal bevacizumab or grid laser photocoagulation for diffuse diabetic macular edema: results of the Pan-american Collaborative Retina Study Group at 24 months. Retina 33:403–413
26.
Mainster MA (1999) Decreasing retinal photocoagulation damage: principles and techniques. Semin Ophthalmol 14:200–209CrossRefPubMed
27.
Laursen ML, Moeller F, Sander B, Sjoelie AK (2004) Subthreshold micropulse diode laser treatment in diabetic macular oedema. Br J Ophthalmol 88:1173–1179CrossRefPubMedPubMedCentral
28.
Lavinsky D, Cardillo JA, Melo LA Jr et al (2011) Randomized clinical trial evaluating mETDRS versus normal or high-density micropulse photocoagulation for diabetic macular edema. Invest Ophthalmol Vis Sci 52:4314–4323CrossRefPubMed
29.
Citirik M (2019) The impact of central foveal thickness on the efficacy of subthreshold micropulse yellow laser photocoagulation in diabetic macular edema. Lasers Med Sci 34:907–912CrossRefPubMed
Metadata
Title
Subthreshold micropulse laser combined with anti-vascular endothelial growth factor therapy for diabetic macular edema: a systematic review and meta-analysis
Authors
Hironori Hosoya
Takashi Ueta
Kazunori Hirasawa
Taku Toyama
Tomoyasu Shiraya
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Keywords
Laser
Edema
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-024-06460-7