Table 5.
MPLT and intravitreal therapy.
| Article | Design | Evaluated on | Results |
|---|---|---|---|
| Inagaki et al., 2019 [75] |
Retrospective ranibizumab or aflibercept + 577 nm MPLT 100 μm/200 ms/5% DC titrated to 0.5–0.6× CWL power |
34 eyes DME FU = 12 |
Significant improvement in BCVA (logMAR from 0.52 ± 0.34 to 0.43 ± 0.33). Significant decrease in CRT (from 491.1 to 354.8 μm). Mean no. of injections 3.6 ± 2.1. |
| Akkaya et al., 2020 [76] |
Retrospective ranibizumab or aflibercept vs. 577 nm MPLT 100 μm/200 ms/10% DC titrated to 0.5× CWL power |
76 eyes CI-DMI ≤ 350 μm BCVA > 0.7 Snellen FU = 12 |
BVCA significantly better in laser group (logMAR 0.054 ± 0.07 vs. 0.095 ± 0.08). The decrease in CRT was non-significant, but it was higher in laser group. Mean no. of injections 5.85 ± 1.38; mean no. of laser treatments 3.64 ± 0.76. |
| Bevacizumab | |||
| Akhlaghi et al., 2019 [77] |
Prospective, randomized bevacizumab + 532 nm MPLT vs. bevacizumab 200 μm/5% DC titrated to 4× CWL power |
42 eyes refractory DME FU = 3 |
Significant improvement in BCVA (logMAR 0.81 ± 0.33 to 0.62 ± 0.26) and significant decrease in CRT (from 513 ± 126.29 to 408.1 ± 95.28 μm) only in combination group. |
| Altınel et al., 2021 [78] |
Retrospective bevacizumab + 577 nm MPLT vs. bevacizumab 160 μm/200 ms/5% DC titrated to 0.5 × visible MPLT power |
80 eyes CI-DME FU = 12 |
Significant increase in BVCA in combined group. Significant decrease in CRT, which was similar in both groups. Mean no. of injections significantly lower in combined group (4.38 ± 0.81 vs. 5.65 ± 1.51). |
| El Matri et al., 2021 [79] |
Retrospective bevacizumab + 577 nm MPLT vs. bevacizumab 200 μm/200 ms/5% DC fixed 400 mW, 2 × 2 or 4 × 4 pattern |
98 eyes naïve CI-DME ≤ 500 μm FU = 12 |
Significant improvement in BCVA (logMAR from 0.692 ± 0.35 to 0.501 ± 0.37) and decrease in CRT (from 479.1 ± 14.3 to 289.6 ± 15) in combined group. The difference is not significant between groups. Significantly lower no. of injections in combined group (4.1 ± 1.5 vs. 7.2 ± 1.3) per year. |
| Ranibizumab | |||
| Moisseiev et al., 2018 [80] |
Retrospective 577 nm MPLT vs. ranibizumab 200 μm/200 ms/5% DC/fixed 400 mW |
38 eyes DME FU = 12 |
Comparable improvement in BCVA. Change in CRT greater in ranibizumab group. Significantly fewer injections required in MPLT group (1.7 ± 2.3 vs. 5.6 ± 2.1). |
| Abdelrahman et al., 2020 [81] |
Prospective, randomized 532 nm MPLT vs. ranibizumab vs. control 200 μm/200 ms/5% DC fixed 400 mW, 7 × 7 pattern |
120 eyes naïve DME CRT ≤ 400 μm FU = 6 |
Significant improvement in BCVA (93% vs. 31%) and decrease in CRT (34.66% vs. 11.69%) in both groups; significantly higher in ranibizumab group. Significant improvement in mfERG only in ranibizumab group. |
| Furashova et al., 2020 [82] |
Prospective, randomized ReCaLL clinical trial 810 nm MPLT 200 ms/15% DC titrated to 2× CWL power, without fovea |
17 eyes DME CRT > 300 μm FU = 12 |
Significant increase in BCVA with significant decrease in CRT in both groups. No significant differences between groups. Significantly lower no. of injections in combined group (7.5 vs. 9). |
| Bıçak et al., 2022 [83] |
Retrospective ranibizumab + 577 nm MPLT vs. ranibizumab 165 μm/200 ms/5% DC titrated to 0.5× visible MPLT power, grid pattern |
97 eyes DME CRT ≤ 350 μm FU = 9 |
Significant increase in BCVA in both groups with significant decrease in CRT. No significant differences between groups. Significantly lower no. of injections in combined group (4.19 ± 1.01 vs. 5.53 ± 1.14). |
| Mi et al., 2022 [84] |
Prospective, randomized, double-blind ranibizumab + sham 577 nm MPLT vs. sham ranibizumab + 577 nm MPLT 200 μm/200 ms/5% DC fixed 400 mW, 7 × 7 pattern |
72 patients DME CRT > 300 μm |
This study is currently recruiting participants. The results are not yet available. |
| Aflibercept | |||
| Khattab et al., 2019 [85] |
Prospective, randomized aflibercept + 577 nm MPLT vs. aflibercept 200 μm/200 ms/5% DC fixed 400 mW, 7 × 7 pattern |
54 eyes DME CRT > 250 μm FU = 18 |
Significant increase in BCVA and contrast sensitivity; significant decrease in CRT in both groups. No significant differences between groups. Significantly lower no. of injections in combined group (4.1 ± 1.1 vs. 7.3 ± 1.1). |
| Abouhussein et al., 2020 [86] |
Prospective, randomized aflibercept + 577 nm MPLT vs. aflibercept 200 μm/200 ms/5% DC fixed 400 mW, 5 × 5 pattern |
40 eyes naïve DME CRT > 300 μm FU = 12 |
Significant increase in BCVA and significant decrease in CRT in both groups. No significant differences between groups. Significantly lower no. of injections in combined group (4.5 ± 1.4 vs. 5.4 ± 1.7) after the loading dose of aflibercept. |
| Kanar et al., 2020 [87] |
Prospective, randomized aflibercept + 577 nm MPLT vs. aflibercept 160 μm/200 ms/5% DC titrated to 0.5× visible MPLT power |
56 eyes naïve DME CRT > 300 μm FU = 12 |
Significant increase in BCVA and significant decrease in CRT in both groups. No significant differences between groups. Significantly lower no. of injections in combined group (3.21 ± 0.41 vs. 5.39 ± 1.54). |
| Lai et al., 2021 [88] |
Retrospective 577 nm MPLT + focal laser of microaneurysms vs. aflibercept 200 μm/200 ms/5% DC fixed 400 mW, 5 × 5 pattern, 0.25 spacing |
164 eyes DME CRT > 300 μm FU = 24 |
Significant increase in BCVA and significant decrease in CRT in both groups. Significantly greater improvement in BCVA at 6 months, as well as in CTR at 6 and 12 months in aflibercept group; no significant differences between groups at 12 and 24 months. Rescue aflibercept required in 24% of MLPT eyes. |
| Koushan et al., 2022 [89] |
Prospective, randomized, single-blind DAM Study aflibercept + 532 nm MPLT vs. aflibercept + sham 532 nm MPLT 200 μm/200 ms/10% DC titrated to 0.9× visible MPLT power, 3 × 3 pattern |
30 eyes CI-DME CRT ≥ 315 μm FU = 12 |
Significant increase in BCVA and significant decrease in CRT in both groups. No significant differences between groups. Similar no. of injections in both groups. |
| Dexamethasone | |||
| Elhamid 2017 [9] |
Prospective 577 nm MPLT + IDI 200 μm/200 ms/5% DC fixed 400 mW, 7 × 7 pattern |
20 eyes refractory CI-DME CRT ≥ 300 μm FU = 12 |
Significant improvement in BCVA (Snellen from 0.45 ± 0.14 to 0.6 ± 0.1) and significant decrease in CRT (from 420.7 ± 38.74 to 285.2 ± 14.99 μm). Retreatment was performed in 40% of eyes. |
| Toto et al., 2022 [90] |
Prospective 577 nm navigated MPLT + IDI vs. IDI 100 μm/100 ms/5% DC titrated to 0.3× visible MPLT power |
60 eyes naïve CI-DME CRT > 300 μm FU = 6 |
Significant improvement in BCVA and decrease in CRT in both groups; significantly higher in MPLT+ IDI group. Significantly higher no. of second injections in IDI group (73.3% vs. 56.7% of patients). Shorter time before the second injection in IDI group (83.5 vs. 137.4 days). |
| Vitrectomy | |||
| Bonfiglio et al., 2022 [91] |
Prospective PPV+ 577 nm MPLT vs. PPV 200 μm/200 ms/5% DC titrated to 2× CWL power, 7 × 7 pattern |
95 eyes Persistent DME CRT ≥ 300 μm FU = 6 |
Significant improvement in BCVA (EDTRS letters from 51.54 ± 13.81 to 57.83 ± 13.95) and decrease in CRT (from 410.59 ± 129.91 to 283.39 ± 73.45 μm) in MPLT group. Second MPLT required in 67% of eyes. Parafoveal VD significantly higher and FAZ significantly smaller in OCTA in MPLT group. |
MPLT, micropulse laser treatment; CWL, continuous-wave laser; DME, diabetic macular edema; FU, follow-up (in months); BCVA, best corrected visual acuity; CRT, central retinal thickness; CI, center involved; mfERG, multifocal electroretinography; IDI, intravitreal dexamethasone implant; PPV, pars plana vitrectomy; FAZ, foveal avascular zone; VD, vessel density; OCTA, optical coherent tomography angiography.