糖尿病视网膜病变患者视网膜光凝术后近期调节力的变化

Accommodative change after retinal photocoagulation for diabetic retinopathy

目的观察视网膜光凝术后糖尿病视网膜病变(DR)患者眼近期调节力的变化。设计前瞻性病例系列。研究对象15例(30眼)确诊须行眼底激光治疗的DR患者,平均年龄(57.4±13.4)岁。方法由同一操作者进行视网膜光凝术,观察患者同一只眼激光前、激光后第1、3、7、14天的调节功能指标和视力。主要指标调节幅度、正相对调节、负相对调节、最佳矫正远视力、近视力。结果激光后各时间点的单眼调节幅度、正相对调节均较激光前有所下降(F=34.19,P=0.00;F=23.68,P=0.00),差异有统计学意义。下降规律是从激光后第1天开始,第3天幅度最大,第7天稍有恢复,第14天的观察时间内未恢复到激光前。负相对调节在激光前后的比较差异无统计学意义(F=0.569,P=0.686)。激光后的近视力较激光前有所下降(F=5.54,P=0.00),且变化规律与单眼调节幅度、正相对调节相似。结论在激光后14天的观察时间内,视网膜光凝术会导致DR患眼近期调节力下降。

Objective To observe the accommodative change in patients with diabetic retinopathy after retinal photocoagulation.Design Prospective case series. Participants 15 patients （30 eyes） treated with retinal photocoagulation for diabetic retinopathy, with average age 57.4±13.4 years. Methods Accommodative indexes and visual acuity of the same eyes of all the patients were measured before treatment and on 1st, 3rd, 7th, 14th day after treatment. Main Outcome Measures Amplitude of accommodation （AA）, positive and negative relative accommodation （PRA/NRA）, best corrected visual acuity （BCVA）, near visual acuity （VA-N）. Results The AA and PRA of post-treatment were lower than pre-treatment （all P〈0.05）. The post-treatment change happened from the 1st day, reached peak on 3rd day, and partially recovered on 7tb day, but could not recovery to the pre-treatment on ldth day. There was no significant difference between pretreatment and post-treatment NRA （P〉0.05）. The VA-N of post-pretreatment was lower than pre-treatment （P〈0.05）, and the change trend was similar with AA and PRA. There was no significant difference between pretreatment and post-treatment BCVA （P〉0.05）. Conclusion In post-treatment 14 days, retinal photocoagulation can cause decline of accommodative amplitude in patients with diabetic retinopathy.