中度非增殖期糖尿病视网膜病变个体化激光光凝术应用分析

Clinical study on the application of individualize d laser photocoagulation in Moderate Nonproliferative Diabetic Retinopathy

目的 探讨以FFA（眼底血管荧光造影）计算机图像信息为引导进行早期糖尿病视网膜病变个体化激光光凝术对视网膜功能的影响.方法 筛选出符合中度非增殖期糖尿病视网膜病变患者60例（110只眼）,根据激光治疗的方式不同随机分成两组,以FFA计算机信息为引导个体化治疗组（实验组）和传统FFA图片下行全视网膜光凝治疗组（对照组）,每组30例;随访24周.激光治疗后主要临床观察指标：术后视野光敏度变化、黄斑水肿、中心视力、毛细血管无灌注区、微血管瘤及新生血管等,以视网膜光敏度变化评价视网膜损害程度.结果 两组术后视网膜光敏度下降,实验组下降（1.23±0.47）Db,对照组下降（2.88±0.68）Db,下降程度试验组明显低于对照组（P＜0.05）;与激光术前相比实验组差异无统计学意义（P＞0.05）,对照组差异有统计学意义（P＜0.05）.随访24周,持续性黄斑水肿8眼其中实验组3眼,对照组5眼;中心视力改变、毛细血管无灌注区、微血管瘤消退、新生血管等两组差异均无统计学意义（P＞0.05）.结论 个体化激光治疗方案能有效达到视网膜光凝治疗目的,而视网膜功能损伤明显小于全视网膜光凝治疗组;应用个体化激光治疗方案短期内无明显增加中度非增殖期糖尿病视网膜病变视力丧失和其他并发症的风险.

Objective To explore the effects of retinal function with individualized diabetic retinopathy laser photocoagulation which guided by the FFA （Fundus fluorescein angiography） computer image information. Methods Sixty cases （110eyes） with indications of laser therapy moderate non-proliferative diabetic retinopathy according to the different methods were randomly divided into two groups, each group had 30 cases. Individualized laser photocoagulation with guided by the FFA computer image information was performed on the experimental group and pan retinal photocoagulation （PRP） by the traditional FFA image was performed on the control group. The follow-up was 24 weeks. Evaluation of degree of retinal damage was performed by retinal light sensitivity changes. Results Retinal light sensitivity was reduced by laser photocoagulation in the experimental group and control group. It was significantly lower in the experimental group that decreased 1.23± 0.47dB than in the control group （P〈0.05） that decreased 2.88± 0.68 dB. There was no significant difference on macular edema, neovascularization, visual acuity, capillary nonperfusion, postoperative complications between two groups in follow-up （P〉0.05）. Conclusions Individual methods can effectively achieve the purpose of retinal laser photocoagulation therapy and the retinal dysfunction significantly less than the PRP group. Application of individualized laser photocoagulation treatments has no significant increase the risk of visual loss and other complications in the short term in moderate nonproliferative diabetic retinopathy.