改良糖尿病视网膜病变早期治疗研究组格栅样光凝与轻度黄斑格栅样光凝在治疗糖尿病黄斑水肿中的疗效比较

Comparison of modified-ETDRS and mild macular grid laser photocoagulation strategies for diabetic macular edema

目的比较改良糖尿病视网膜病变早期治疗研究组（ETDRS）格栅样光凝及轻度格栅样光凝在糖尿病视网膜病变黄斑水肿治疗中的疗效。方法选取2008年1月至2010年1月于我院眼科门诊就诊及内分泌科会诊的伴有糖尿病黄斑水肿（DME）的轻至中度非增殖性糖尿病视网膜病变（NPDR）患者为研究对象，共72例97眼，其中男40例55眼、女32例42眼。入选患者均进行全面眼科检查，采用随机化分组表将患者分为改良ETDRS格栅样光凝组（36例48眼）及轻度格栅样光凝组（36例49眼）进行激光治疗，治疗后随访24个月。观察2组患者治疗前后视力、黄斑中心凹视网膜厚度等变化情况，数据采用SPSS16．0软件进行统计分析。统计学方法采用One．wayANOVA检验，两两比较采用t检验。结果改良ETDRS格栅样光凝组和轻度格栅样光凝组患者治疗后24个月均可见视力明显提高，与治疗前比较差异具有统计学意义（改良ETDRS格栅样光凝组：初始值55．4-21，治疗24个月后59±21；轻度格栅样光凝组：初始值544-11，治疗24个月后584-13，均P〈0．05），但2组患者视力改善程度在各随访时间点差异均无统计学意义（P〉0．05）。改良ETDRS光凝组和轻度格栅样光凝组患者治疗后24个月内黄斑中心凹视网膜厚度均有所下降，与治疗前比较差异具有统计学意义（改良ETDRS格栅样光凝组：初始值395±174，治疗24个月后2044-16；轻度格栅样光凝组：初始值464±204，治疗24个月后2414-13，均P〈0．05）。但2组在各时间截点黄斑中心凹视网膜厚度改变差异均无统计学意义（均P〉0．05）。结论对轻、中度NPDR合并DME患者采用改良ETDRS光凝或轻度格栅样光凝治疗并随访24个月后发现2种光凝方法均在改善黄斑水肿患者远期视力方面具有一定疗效且无明显差异。

Objective To compare the efficacy of modified-ETDRS with mild macular grid laser photocoagulation for treatment of diabetic maeular edema. Methods 72 patients （97 eyes） with mild or moderate non-proliferative diabetic retinopathy （NPDR） and diabetic macular edema （DME） were randomly assigned to receive laser photocoagulation of modified-ETDRS （ n = 36 patients, 48 eyes） or mild macular grid （MMG） （ n = 36 patients, 49 eyes ） from January 2008 to January 2010. All subjects received 24- month follow-up. General clinical examinations, including blood pressure and glyeated hemoglobin, and comprehensive standardized ophthalmic examinations were performed. One-way analysis of variance was used between groups compared. Results From baseline to 24 months, there was a significant improvement of best corrected visual acuity （BCVA） both in modified-ETDRS group and MMG group （modified-ETDRS group ： baseline 55 ± 21,24 month 59 ± 21 ; MMG： baseline 54 ± 11,24 month 58 ± 13 ） , however, there was no signifcant difference in BCVA improvement between the two groups. Central macular thickness （CMT） was significantly decreased in both groups within 24 months after treatment （ modified-ETDRS group ： baseline 395 ± 174,24 month 204 ± 16 ; MMG ： baseline 464 ± 204,24 month 241 ± 13, P 〈 0.05 ）, but no significant difference in CMT improvement between the two groups. Conclusions After 24 months follow-up, both modified-ETDRS and mild maeular grid laser photoeoagulation are effective to improve BCVA of patients with diabetic macular edema.