光凝预防视网膜中央静脉阻塞新生血管性青光眼

Laser photocoagulation for prevention ofneovascular glaucoma due to central retinal vein occlusion

目的 评价广泛视网膜光凝预防缺血刊视网膜中央静脉阻塞新生血管性青光眼的临床效果。方法为前瞻性随机对照临床研究，共60例（60只眼）经眼底荧光素血管造影证实的缺血型视网膜中央静脉阻塞患者，随机分组．A组30例（30只眼）用药物治疗；B组30例（30只眼）除用药物治疗外，还用氪靖激光进行广泛视网膜光凝（激光波长568nm，功率100～300mw．光斑直径300～500μzm，曝光时间0．1s，光凝872、1207点，光斑反应Ⅲ级），随访时间为治疗后1个月、3个月、半年、1年、2年和3年。结果A组失访7例，B组失访9例；A组23倒（23只限）治疗前平均视力为0．097±0．038，治疗后平均视力为0．102±0．066，两者比较无显著差异（t=0．901，P＞0．05）；B组21例（21只眼）治疗前平均视力为0．094±0．034，治疗后平均视力为0．101±0．043，两者比较无屁著差异（t=0．887，P〉0．05）；A组和B组的治疗前平均视力比较无显著差异（t=0．672．P＞0．05）；A组和B组的治疗后平均视力比较也无显著差异（t=0．488，P〉0．05）；A组发生新生血管性青光眼7例，占30-4％，B组发生新生血管性青光眼1例，占4．8％，两组比较有显著差异（x^2=4．864，P＜0．05）？结论氪黄激光广泛视网膜光凝能有效预防缺血型视网膜中央静脉阻塞新生血管性青光眼的发生，但不能提高视力。

Objective To evaluate the clinical effect of krypton yellow laser pan-retinal photocoagulation （PRP）for prevention ofneovascular glaucoma due to central retinal vein occlusion.Methods This was a prospective randomized clinical trial.Sixty eyes （60 cases）of ischemic central retinal vein occlusion confirmed by FFA were randomly classified to Group A, which were treated with oral drugs, and Group B,which were treated with krypton yellow laser PRP along with oral drugs.The patients were followed-up at one month, three months, six months, one year, two and three years after treatment.Results Seven and nine patients were lost in Group A and Group B respectively at the end of follow-up.The mean visual acuity of Group A（23 eyes）was 0.097±0.038 before treatment and 0.102＋ 0.066 after treatment（t =0.901 ,P 〉0.05 ）.The mean visual acuity of Group B （21 eyes）was 0.094± 0.034 before treatment and 0.101 ±0.043 after treatment （t =0.887, P 〉0.05 ）. There was no significant difference between the two groups if compared with the mean visual acuity before treatment （ t =0.672, P 〉0.05 ）, neither after treatment （ t =0.488, P 〉0.05 ）.Seven eyes developed neovascular glaucoma in Group A（30.4% ）and only one in Group B（4.8% ）.There was a significant difference between the two groups（x^2=4.864,P〈0.05 ）.Conclusion Krypton yellow laser PRP was effective for preventing neovascular glaucoma secondary to ischemic central retinal vein occlusion, but could not improve visual acuity.