Clinical Observation of Micropulse Laser Combined with Conbercept in the Treatment of Neovascular Age-related Macular Degeneration with Pigment Epithelial Detachment (PED)
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v5i3.2636
Abstract
The aim of this study is to observe the efficacy of micropulse laser combined with Conbercept in the treatment of neovascular age-related macular degeneration (nAMD) complicated with PED. Thirty patients (30 eyes) diagnosed with nAMD and PED at our hospital in 2023 were randomly divided into two groups: the Conbercept treatment (IVC) group with 15 cases (15 eyes) and the Conbercept combined with 577 nm threshold micropulse laser treatment (IVC+SMLP) group with 15 cases (15 eyes). Anti-VEGF treatment was administered according to the 3+PRN regimen, and the combined treatment group received 577 nm threshold micropulse laser treatment within 2 weeks after anti-VEGF injection. Follow-up observed the best-corrected visual acuity (BCVA), central macular thickness (CMT), PED height (PEDH), number of injections, and related complications at 1 month, 3 months, 6 months, and 12 months after Conbercept intravitreal injection. The average BCVA, CMT, and PEDH in both groups improved significantly from baseline at all time points (P < 0.05). At 12 months of follow-up, PEDH in the IVC+SMLP group decreased significantly from baseline (293.57±82.59 vs 184.84±33.95) and was significantly lower than in the IVC group (P < 0.05). The number of IVC injections in the IVC group was significantly higher than in the IVC+SMLP group (8.04±0.3 vs 5.29±1.26) with a significant difference (t=4.290, P=0.016). No treatment-related adverse events were observed during the study. The 577 nm threshold micropulse laser combined with Conbercept effectively improves or stabilizes visual function and anatomical morphology in nAMD with PED, reduces the number of intravitreal injections, and alleviates the patient's economic burden to some extent.
Keywords
neovascular age-related macular degeneration; intravitreal Conbercept (IVC); threshold micropulse laser photocoagulation (SMLP); pigment epithelial detachment height (PEDH)
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[4] Long H, Liu M, Hu Q, et al. 577 nm subthreshold micropulse laser treatment foracute central serous chorioretinopathy: Acomparative study. BMC Ophthalmol 2022;22: 105-112.
[5] Kumar A, Kumar P, Ambiya V, et al.Subthreshold micropulse laser for adultonset Coats’ associated exudative maculopathy. Eur J Ophthalmol 2022; 32: NP29-31.
[6] Luttrull JK,Margolis BW. Functionally guided retinal protective the rapy for dry age-related macular and inherited retinal degenerations:a pilot study[J].Invest Ophthalmol Vis Sci, 2016,57:265-275.
[7] Hirabayashi K, Kakihara S, Tanaka M,et al. Investigation of the therapeutic mechanism of subthreshold micropulse laserirradiation in retina. Graefes Arch Clin ExpOphthalmol 2020; 258: 1039-1047
[8]Lian, H., Chen, X., Yan, M., et al. Research status and progress of subthreshold micropulse laser photocoagulation for macular diseases. Chin. J. Retina Vitreous, 2019, 35(2):206-210.
[9]Ophthalmology Branch, Chinese Medical Association. Clinical diagnosis and treatment pathway for age-related macular degeneration in China. Chin. J. Retina Vitreous, 2013, 29(4):343-355.
[10] Midena E, Bini S, Martini F, et al. Changes of aqueous humor Mu¨ller cells’ biomarkers
in human patients affected by diabetic macular edema after subthreshold micropulse
laser treatment. Retina 2020; 40: 126-134.
[11] BAKRI S J, THORNE J E, HO A C, EHLERS J P, SCHOENBERGER S D, YEH S, et al. Safety and efficacy of anti-vascular endothelial grow th factor therapies for neovascular age-related macular degeneration[J].Ophthalm ology,2019,26( 1) : 55-63.
[12] Tenbrock, L.Wolf, J.Boneva, S.Schlecht, A.Agostini, H.Wieghofer, P.Schlunck, G.Lange, C. Subretinal fibrosis in neovascular age-related macular degeneration: Current concepts, therapeutic avenues, and future perspectives. Cell Tissue Res. 2022, 387,361-375.
[13] Bıçak F, Kayıkçıoğlu ÖR, Altınışık M, et al. Efficacy of subthreshold micropulse laser combined with ranibizumab in the treatment of diabetic macular edema[J]. Int Ophthalmol, 2022, 42(12): 3829-3836.
[14] Li, H., Song, Y., Yan, M., et al. Observation on the efficacy of 577 nm subthreshold micropulse laser in the treatment of dry age-related macular degeneration. Chin. Laser Med. J., 2017, 26(6):293-297.
[15] Li, W., Song, Y., Ding, Q. Efficacy observation of conbercept intravitreal injection combined with subthreshold micropulse laser for diabetic macular edema. Chin. J. Retina Vitreous, 2019, 35(2):129-134.
[16]Terashima H, Hasebe H, Okamoto F, et al. Combination therapy of intravitreal ranibizumab and subthreshold micropulse photocoagulation for macular edema secondary to branch retinal vein occlusion: 6-month result. Retina 2019; 39: 1377-1384.
[17] Kauppinen, A.Paterno, J.J.Blasiak, J.Salminen, A.Kaarniranta, K. Inflammation and its role in age-related macular degeneration. Cell Mol. Life Sci. 2016, 73, 1765-1786.
[18] Kaarniranta, K.Uusitalo, H.Blasiak, J.Felszeghy, S.Kannan, R.Kauppinen, A.Salminen, A.Sinha, D.Ferrington, D. Mechanisms of mitochondrial dysfunction and their impact on age-related macular degeneration. Prog. Retin. Eye Res. 2020, 79, 1008-1018.
[19]Abdin AD, Suffo S, Asi F, et al. Intravitreal ranibizumab versus aflibercept following treat and extend protocol for neovascular agerelated macular degeneration[J]. Graefe's Arch Clin Exp Ophthalmol, 2019, 257(8): 1671-1677.
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