弥漫性糖尿病黄斑水肿光凝后黄斑区视野和视网膜厚度变化

Alteration of macular visual field and retinal thickness after photocoagulation in diffuse diabetic macular edema

目的 探讨Ⅳ期糖尿病视网膜病变 (DR)合并弥漫性糖尿病性黄斑水肿 (DME)患者行全视网膜联合黄斑格栅状光凝后黄斑结构和功能的变化。方法 对 12例Ⅳ期DR合并DME患者15眼全视网膜联合黄斑格栅状光凝术前、术后 3天、 7天、 3 0天、 90天OCT、视力、黄斑光敏感度检查结果进行对比分析。结果 术后 2 8天、 90天视力较术前均明显提高 (WilcoxonranksumtestP <0 0 5、P <0 0 1) ;术后 3天黄斑中心厚度比术前有显著增加 (P <0 0 5 ) ,术后 7天与术前无差别 (P>0 0 5 ) ,术后 3 0天和术后 90天比术前均显著降低 (P <0 0 1) ;术后 3天黄斑中心 10°光敏感度较术前显著降低 (P <0 0 1) ,术后 7天与术前相比无明显变化 (P >0 0 5 ) ,术后 3 0天与术后 7天相比明显提高 (P <0 0 5 ) ,术后 90天与术前和术后 3 0天相比无明显变化 (P >0 0 5 )。结论 Ⅳ期DR合并弥漫性DME患眼行黄斑格栅样光凝联合全视网膜光凝术后 3月视力保持稳定或提高 ;术后早期原有黄斑水肿加重或引起黄斑水肿 ,随后逐渐减轻 ,至术后 1月、 3月黄斑视网膜厚度较术前显著下降 ;黄斑中心 10°光敏感度早期下降 。

Objective To investigate alteration of macular structure and function after panretinal associated with grid macular photocoagulation in the Ⅳ-phase diabetic retinopathy accompanied with diffuse diabetic macular edema.Methods Optical coherence tomography(OCT),visual acuity,macular light sensitivity were used for comparative analyses in 12 cases(15 eyes)with Ⅳ-phase diabetic retinopathy accompanied with diffuse diabetic macular edema before,and on the 3rd day,7th day,28th day,90th day after panretinal and grid macular photocoagulation.Results The visual acuity on the 28th day and 90th day after photocoagulation increased significantly compared to the one before operation.(Wilcoxon rank sum test P <0 05、 P <0 01).Three days after photocoagulation,obvious thickening of retina was observed in the fovea macula( P <0 05).There was no significant difference in macular central thickness before,and on the 7th day after photocoagulation( P >0 05).Matching macular central thickness before operation,the ones on the28th day and 90th day after photocoagulation both decreased statistically( P <0 01).Three days after photocoagulation,light sensitivity in macular central 10° zone declined significantly.Subsequently,there was no significant difference in light sensitivity before and on the 7th day after photocoagulation( P >0 05).Wheras,the amount increased evidently on the 30th day after photocoagulation( P <0 05).Comparing with macular light sensitivity before operation,the ones on the 28th day and 90th day after photocoagulation both had no statistically significance( P >0 05).Conclusions The visual acuity kept stable or improved after panretinal and grid macular photocoagulation in the Ⅳ-phase diabetic retinopathy accompanied with diffuse diabetic macular edema.Macular edema which was caused or aggravated in the early phase after operation gradually decreased until the 28th day and 90th day after photocoagulation when macular retinal thickness declined statistically in comparison with that before photocoagulation.Light sensitivity in macular central 10°zone decreased in the early phase.Then it gradually restored and improved.