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Supplementary Material for: Comparative Efficacy of Subthreshold Micropulse Laser Photocoagulation vs. Conventional Laser Photocoagulation for Diabetic Macular Edema: A Meta-analysis

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posted on 2023-01-20, 13:17 authored by Hu X.-Y., Cao L., Gao Y., Luan J., Xu X.-D.
Background Laser photocoagulation is an effective procedure for the treatment of diabetic macular edema (DME). However, the beneficial effects of conventional laser photocoagulation (CLP) are accompanied by the destruction of retinal photoreceptors. Therefore, subthreshold micropulse laser photocoagulation (SMLP) was proposed for DME. Objectives This meta-analysis study was performed to evaluate the efficacy and safety of SMLP compared with CLP for the management of DME. Methods The PubMed, Embase, Web of Science, Cochrane, SinoMed,, Wanfang and China National Knowledge Infrastructure (CNKI) databases, published until Dec 2021, were searched to identify studies evaluating the clinical outcomes of SMLP for DME. Results 8 randomized controlled trials (RCTs) were selected for this meta-analysis involving a total of 546 eyes (275 eyes in SMLP group and 271 eyes in CLP group). SMLP of different wavelengths (577nm and 810nm) and duty cycles (5% and 15%) were applied. The pooled outcomes showed that SMLP group, especially 577nm and 810nm 15% duty cycle parameter settings, had a statistically significant higher efficacy than CLP group in terms of BCVA(MD = -0.02, 95% CI: -0.03 to -0.01, P<0.01; MD = -0.09, 95% CI: -0.09 to -0.09, P<0.01) and showed more significant advantages than CLP group in resolving macular edema assessed by reduction of CMT (MD = -32.87, 95% CI: -37.61 to -28.13, P<0.01; MD = -8.01, 95% CI: -9.06 to -6.96, P<0.01), whereas the efficacy of 577nm and 810nm 5% duty cycle SMLP subgroups remained numerically superior to CLP group, but non-significantly (P>0.05); In the field of CS, SMLP group (no matter parameter settings) resulted in better preservation of CS compared to CLP group (MD = 1.96, 95% CI: 1.47 to 2.46, P<0.01). Conclusions Compared with CLP, SMLP may get superior efficacy and safety on improvement of BCVA, reduction of CMT and preservation of CS. In clinical, SMLP can be considered as a safe and effective therapy in the management of DME.