缺血型视网膜静脉阻塞出血多眼光凝探讨

Laser treatment of the ischemic retinal vein occlusion with more hemorrhage

目的探封出血偏多的缺血型视网膜静脉阻塞光凝方法及其疗效。方法采用Zeiss Lumenis NOVUSOMNI多波长激光仪，利用红光、大光斑、低能量、长时间对视网膜出血偏多的缺血型分支、半侧或中央静脉阻塞并黄斑水肿患者49人52只眼实施局部或全视网膜光凝。参数：黄斑区：0．1～0．3秒，光斑大小50—100μm，能量100～200mw，中心凹1000μm外开始，Ⅰ级光斑反应；其余区域：0．3-0．7s，200～500μm，150～300mw，Ⅲ级光斑轻一中强度反应，如光斑反应不足，则以增长时间为主，增加能量为辅；分2-4次完成，间隔2-3周。观察视网膜出血水肿消退及视力改变等情况，随访3～30个月。结果（1）18只眼（34．62％）首次光凝2-3周后视网膜出血水肿明显消退，其中9只眼（17．31％）视力提高，8只眼（15．39％）视力不变，1只眼（1．92％）视力下降。激光后3个月FFA证实治疗有效。（2）31只眼（59．62％）首次光凝2-3周后视网膜出血水肿部分消退，全部光凝完成后3月，眼底出血水肿完全消退，FFA证实治疗有效。其中8只眼（15．38％）视力提高；20只眼（38．46％）视力保持不变；3只眼（5．77％）视力下降。（3）3只眼新生血管性青光眼患者，病情部分改善稳定。其余患者随访期内未新发生玻璃体出血及新生血管性青光眼。结论对出血偏多的缺血型视网膜静脉阻塞，可选用红光，使用大光斑、低能量、长时间的光凝方法，获得足够数量和强度的有效光斑，促进视网膜出血水肿吸收，减少病情恶化可能。

Objective To discuss the laser treatment method to the ischemic retinal vein occlusion （RVO） with more hemorrhage. Methods Fifty-two eyes in 49 cases suffering from ischemic RVO with more hemorrhage were treated with local or panretinal photocoagulation in red light, big spot size, long pulse duration and lower power. Results The hemorrhage and edema in the retina disap peared quickly in the 2-3 weeks after laser in 18 eyes （34.62%） and the visual acuity improved in 9 eyes （17.31%）, no changes in 8 eyes （15.38%） and declined in 1 eye （1.92%）. In 31 eyes （59.62%）, the hemorrhage and edema disappeared partly in the 2-3 weeks after laser and it disappeared completely after 3 months and the visual acuity improved in 8 eyes （15.38%）,no change in 20 eyes （38.46%） and declined in 3 eyes （5.77%）. FFA verified that most of the nonperfusion areas covered over by photocoagulation and did not enlarged, the neovascular disappeared completely or partly. There were no new bleeding in vitreous and neovascular glaucoma in these patients during the follow up. In the 3 eyes with neovascular glaucoma, the condition had been controlled and stabilized in some extent. Conclusion In the ischemic retinal vein occlusion with more hemorrhage, the laser of red light, big spot size, long pulse duration and lower power can make effective photocoagulation and help the absorb of the hemorrhage and edema in the retina, reduce the incidence of serious complication such as vitreous bleeding and neovascular glaucoma.