Aflibercept with adjuvant micropulsed yellow laser versus aflibercept monotherapy in diabetic macular edema

  • Abeer M. Khattab
  • Sherein M. HagrasEmail author
  • AhmedHosni AbdElhamid
  • Magda A. Torky
  • Eman A. Awad
  • Ameera G. Abdelhameed
Retinal Disorders



To assess the impact of micropulsed laser (MPL) on modifying the number of aflibercept injections when used as an adjuvant therapy in diabetic macular edema (DME).


A prospective randomized interventional clinical study included patients with DME attending Al Hadi Clinic, Kuwait, during the period from May 2017 to December 2018. Patients were allocated in two groups; group A received aflibercept injections alone and group B received combined aflibercept injections followed by MPL within a week. The primary outcome was the number of Aflibercept injections in each group guided by the change in central macular thickness (CMT). All the patients were followed for 18 months. Secondary outcome measures included best corrected visual acuity (BCVA), contrast sensitivity (CS), and any recorded complications.


Fifty-four eyes of 51 patients were included (27 in each group). There was no statistically significant difference between the two groups in baseline characteristics except for the age that was statistically higher in group B (p = 0.001). The number of injections were significantly lower in group B (4.1 ± 1.1) than group A (7.3 ± 1.1) (p < 0.005). At 18th month, there was significant reduction in CMT in both groups (p < 0.005) with no statistical difference between the two groups (p = 0.989). Final BCVA in both groups showed statistically significant improvement (p < 0.005) without statistically significant difference between the two groups (p = 0.082). In both groups, the CS showed significant improvement from baseline (p < 0.005). No ocular or systemic adverse effects were observed in either group.


Supplemental MPL in eyes with DME may decrease the burden of the aflibercept injection frequency while resulting in comparable anatomical and visual outcomes.


Aflibercept Anti-VEGF Diabetic macular edema Micropulsed laser Subthreshold 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Abeer M. Khattab
    • 1
  • Sherein M. Hagras
    • 1
    • 2
    Email author
  • AhmedHosni AbdElhamid
    • 3
  • Magda A. Torky
    • 1
  • Eman A. Awad
    • 1
  • Ameera G. Abdelhameed
    • 1
  1. 1.Ophthalmology DepartmentMansoura UniversityMansouraEgypt
  2. 2.Ophthalmic Center, Faculty of MedicineMansoura UniversityMansouraEgypt
  3. 3.Ophthalmology DepartmentAin-Shams UniversityCairoEgypt

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