全视网膜光凝术对糖尿病视网膜病变视网膜神经纤维层及黄斑区视网膜的影响

Effects of panretinal photocoagulation on retinal nerve fiber layer and macular retina in patients with diabetic retinopathy

目的探讨全视网膜光凝术(panretinal photocoagulation,PRP)对糖尿病视网膜病变(diabetic retinopathy,DR)视网膜神经纤维层(retinal nerve fiber layer,RNFL)及黄斑区视网膜的影响。方法选取2010年6月至2013年12月于我院行PRP治疗的120例(120眼)DR患者,其中非增生性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)60例(NPDR组),增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)60例(PDR组),同时选取同期于我院健康体检的60例(60眼)正常志愿者作为正常对照组。PRP手术前后使用OCT横向扫描视盘旁RNFL厚度和黄斑区,将视盘旁RNFL和黄斑区分为上方、鼻侧、下方和颞侧4个象限进行扫描,获取各象限及全周平均视盘旁RNFL厚度及黄斑区视网膜厚度,并对结果进行统计分析。结果与正常对照组相比,NPDR和PDR组PRP前视盘上方、下方、鼻侧象限、全周平均RNFL厚度均降低(均为P<0.05),但颞侧象限RNFL厚度差异均无统计学意义(均为P>0.05);NPDR组和PDR组PRP前不同象限及全周平均RNFL厚度相比,差异均无统计学意义(均为P>0.05)。与PRP前相比,NPDR、PDR组PRP后各象限及全周平均RNFL厚度均变薄,但只有上方、下方及全周平均RNFL厚度差异均有统计学意义(均为P<0.05);与NPDR组相比,PDR组上方、下方、鼻侧及全周平均RNFL厚度变薄更明显,差异均有统计学意义(均为P<0.05)。与正常对照组相比,NPDR和PDR组PRP前各象限及平均黄斑区视网膜厚度均增加,差异均有统计学意义(均为P<0.05),且PDR组较NPDR组增加更为明显,差异均有统计学意义(均为P<0.05)。与PRP前相比,NPDR、PDR组PRP后各象限及平均黄斑区视网膜厚度均增加,差异均有统计学意义(均为P<0.05),且PDR较NPDR组增加更为明显,差异均有统计学意义(均为P<0.05)。结论 PRP对DR患者RNFL有一定损伤,应选择适当的激光能量与曝光时间,最大限度地降低对RNFL的影响。

Objective To discuss the effects of panretinal photocoagulation（ PRP） on retinal nerve fiber layer（ RNFL） and macular retina in patients with diabetic retinopathy（ DR）.Methods A total of 120 patients（ 120 eyes） with DR underwent PRP in our hospital from June 2010 to December 2013 were chosen and studied,including 60 cases with non-proliferative diabetic retinopathy（ NPDR group） and 60 cases with proliferative diabetic retinopathy（ PDR group）. In addition,60 healthy persons were chosen as normal control group. The RNFL thickness（ anterior,nasal,temple,inferior,average） and macular retinal thickness（ anterior,nasal,temple,inferior,all quarters） were detected by OCT before and after PRP,the results were compared and analyzed. Results Compared with normal control group,the RNFL thickness at superior,inferior and nasal quarter before PRP of NPDR and PDR groups were all decreased（ all P〉0. 05）,but the difference at temple quarter was not different（ all P〈0. 05）,and there was no statistical difference in each quarter and average before PRP between NPDR group and PDR group（ all P〉0. 05）.Compared with before PRP,the RNFL thickness at each quarter and average thickness after PRP of NPDR and PDR groups were all decreased,but the differences at superior,inferior quarter and average were significant（ all P〈0. 05）,and the differences between NPDR group and PDR group were significant（ all P〈0. 05）. Compared with normal control group,the macular retinal thickness at each quarter before PRP of NPDR and PDR groups were all increased（ all P〈0. 05）,and the differences between NPDR group and PDR group were significant（ all P〈0. 05）. Compared with before PRP,the macular retinal thickness at each quarter and average thickness after PER of NPDR and PDR groups were all increased（ all P〈0. 05）,and the differences between NPDR group and PDR group were significant（ all P〈0. 05）. Conclusion PRP can damage the RNFL,and we should choose the proper laser energy and photocoagulation time to reduce the damages utmostly.