视网膜激光光凝治疗糖尿病性视网膜病变的疗效分析

Efficacy of retinal photocoagulation for diabetic retinopathy

目的 观察糖尿病性视网膜病变（DR）眼行视网膜激光光凝前后视力、无灌注区、视网膜新生血管及闪光视网膜电图（f-ERG）的变化.方法 前瞻性病例对照研究.2009年1月至2010年7月在新疆维吾尔自治区人民医院眼科行视网膜激光光凝的增殖前期糖尿病性视网膜病变（PPDR）72眼和增殖性糖尿病性视网膜病变（PDR）48眼纳入研究.在光凝前1周及之后1个月行视力、荧光素眼底血管造影及f-ERG检查.对患眼视力、视网膜新生血管及无灌注区消退情况进行计数,记录光凝前后患跟视杆反应b波、混合反应b波、震荡电位、视锥反应b波及30 Hz振幅.治疗前后的数据采用配对t检验进行分析.结果 视网膜激光光凝后,PPDR组中48眼视力保持不变,24眼下降;54眼无灌注区全部消退,16眼部分消退,2眼未消退.PDR组中12眼视力提高,26眼保持不变,10眼下降;24眼新生血管全部消退,16眼部分消退,8眼未消退.光凝前后患眼视杆反应b波振幅分别为（186.7±34.1）μV和（106.7±24.8）μV;混合反应b波振幅分别为（381.2±60.4）μV和（273.2±47.8）μV;振荡电位振幅分别为（66.6±12.4）μV和（86.6±18.7）μV;视锥反应b波振幅分别为（97.4±13.5）μV和（67.2±9.4）μV;30 Hz振幅分别为（24.1±8.4）μV和（20.1±6.4）μV,差异均有统计学意义（t=5.672、5.343、3.427、3.578、2.979,P均＜0.01）.结论 视网膜激光光凝后,大部分DR眼的视力提高或保持稳定,无灌注区及新生血管消退,明显改善了视网膜的血液循环,是治疗糖尿病性视网膜病变的有效方法.

Objective To analyze the changes in visual acuity, regression of retinal neovascularization and flash electroretinogram amplitude after retinal laser photocoagulation for diabetic retinopathy （DR）. Methods Prospective case-controlled study. The visual acuity, fundus fluorescein angiography, and f-ERG of 48 eyes with proliferative diabetic retinopathy （PDR） and 72 eyes with preproliferative diabetic retinopathy （PPDR） were analyzed and compared 1 week before retinal laser photocoagulation and 1 month after. Number of changes in visual acuity and retinal neovascularization and non-perfusion regression were counted. Amplitude of rod response b wave, mixed response b wave, oscillatory potentials, cone response b wave, and 30 Hz before and after retinal laser surgery were compared with a paired t test. Results For the visual acuity of PPDR patients, 48 eyes remained unchanged and 24 eyes decreased. For the same group, non-perfusion dissipated in 54 eyes, non-perfusion persisted in 16 eyes, and perfusion did not subside in 2 eyes. For the visual acuity of PDR patients, 12 eyes improved, 26 eyes remained unchanged, and 10 eyes decreased. For the same group, neovascular dissipated in 24 eyes, some neovascular persisted in 16 eyes, and did not changed in 8 eyes. Before retinal laser photocoagulation and post laser, the amplitude of rod response b wave of the eyes was （186.7±34.1）μV and （106.7±24.8）μV; the amplitude of photocoagulation mixed response b wave was （381.2±60.4）μV and （273.2±47.8）μV, the amplitude of oscillatory potentials was （66.6±12.4）μV and （86.6±18.7）μV, the amplitude of cone response b wave was （97.4±3.5）μV and （67.2±9.4）μV, the amplitude of 30 Hz was （24.1±8.4）μV and （20.1±6.4）μV, the difference was significant （t=5.672, 5.343, 3.427, 3.578, 2.979, P〈0.01 for all）. Conclusion After retinal laser photocoagulation, the visual acuity of DR patients improved or remain unchanged, non-perfusion or neovascular dissipate in some patients, amplitude of most f-ERG wave derease except oscillatory potentials. So retinal laser photoeoagulation is an effective treatment for DR patients.