多波长激光对糖尿病视网膜病变患者神经纤维层的影响和疗效

Effect of Multi-Wavelength Laser on Nerve Fiber Layer in Patients with DR and Possible Mechanisms

目的分析多波长激光治疗糖尿病视网膜病变(diabetic retinopathy,DR)对患者神经纤维层(retinal nerve fiber layer,RNFL)的影响及可能的机制。方法选取2018年2月至2019年2月,DR患者72例80只眼,随机分成观察组和对照组,观察组患者36例41只眼,行4次多波长扫描激光全视网膜光凝(panretinal photocoagulation,PRP)治疗。对照组36例39只眼,使用577 nm多点扫描矩阵激光,进行2次PRP治疗。分别于治疗前、治疗后7 d、1和6个月比较两组患者最佳矫正视力(best corrected visual acuity,BCVA)、RNFL厚度,记录两组患者不良反应发生率。治疗前和治疗后1个月检测血流动力学指标(Hct、ESR、PV)、血液流变学指标(RI、EDV、PSV)、生长因子(FGF、EGF)水平变化。结果(1)两组患者BCVA改变。治疗前、治疗后7 d、治疗后1个月,两组患者BCVA随着时间的进展均显著升高,组内比较差异有统计学意义(P<0.05);治疗后6个月两组BCVA均稍高于治疗后1个月,但组内比较差异无统计学意义(P>0.05);治疗后1和6个月观察组BCVA高于对照组,组间差异具有统计学意义(P<0.05)。(2)两组患者RNFL厚度改变。对照组患者治疗前后RNFL厚度无明显改变;观察组治疗后RNFL厚度明显增加,治疗后7 d、治疗后1和3个月组间比较,差异具有统计学意义(P<0.05)。(3)血液学指标变化。治疗前两组血液流变学指标、血流动力学指标和生长水平比较,差异无统计学意义(P>0.05);治疗后1个月观察组患者各项指标改善均显著优于对照组(P<0.05)。两组患者均无严重不良反应发生。结论多波长PRP与多点扫描矩阵PRP治疗糖尿病性DR在视力改善上效果无明显差异,多波长PRP可以通过抑制生长因子水平、促进眼底微循环来恢复视乳头神经纤维层。

Objective To analyze the effect and possible mechanism of multi-wavelength laser treatment of diabetic retinopathy(DR)on patients’retinal nerve fiber layer(RNFL).Methods Totally 72 patients(80 eyes)with diabetes DR from Feb.2018 to Feb.2019 were randomly divided into two groups:the observation group and control group.All the 36 patients(41 eyes)in the observation group were given panretinal photocoagulation,(PRP)4 times with multi-wavelength scanning laser,and 36 patients(39 eyes)in the control group PRP twice with 577 nm multipoint scanning matrix laser.The best corrected visual acuity(BCVA)of the patients in both group were observed and compared before the treatment and 7 days and 1 and 6 months after the treatment respectively.The changes in the thickness of optic papillary nerve fiber layer(RNFL)were measured before the treatment and 7 days and 1 and 6 months after the treatment respectively.Results There was no significant difference in BCVA between the two groups after the treatment(P>0.05).Compared with that before treatment,the difference of BCVA between the two groups after the treatment was statistically significant(P>0.05)Conclusions Multi-wavelength PRP and multi-point scanning matrix PRP has no significant difference in visual acuity improvement in diabetic DR.Multi-wavelength PRP will restore the optic nerve layer of optic papilla by inhibiting growth factor levels and promoting fundus microcirculation.