PASCAL激光联合玻璃体腔注药治疗糖尿病性黄斑水肿的短期疗效观察

The short-term efficacy of PASCAL laser combined with intravitreal injection of triamcinolone acetonide for treatment of diabetic macular edema

目的 观察Pattern Scan Laser（PASCAL）模式扫描激光联合玻璃体腔注药治疗糖尿病性黄斑水肿（DME）的短期疗效。设计 回顾性比较性病例系列。研究对象 2012年12月至2014年2月唐山市眼科医院收治的重度非增生性糖尿病视网膜病变（NPDR）及增生性糖尿病视网膜病变（PDR）合并DME患者80例（135眼）。方法 40例（70眼）采用PASCAL激光联合玻璃体腔注射曲安奈德（IVTA）2 mg，为治疗组；40例（65眼）采用传统多波长氪离子激光治疗，为对照组。两组患者术前DME病变程度无明显差异。通过诊断验光、相干光断层扫描（OCT）及微视野计（SLO）检查随访患者治疗前及治疗后3个月最佳矫正视力（BCVA）、黄斑中心厚度（CMT）及黄斑中心10°范围内平均光敏感度变化情况。主要指标 BCVA（logMAR）、CMT及黄斑中心10°范围内平均光敏感度。结果 治疗组治疗后3个月BCVA、CMT、黄斑区10°范围平均光敏感度的治疗有效及显效眼数总和较对照组多（治疗组分别为62眼、64眼、60眼，对照组分别为42眼、47眼、30眼）两组比较差异有统计学差异（χ2=10.60、8.42、38.83，P=0.010、0.005、0.023）。治疗组总有效率（分别为88.57%、91.40%、85.70%）均高于对照组（分别为64.30%、72.30%、46.15%）。治疗后3个月治疗组BCVA（logMAR）及黄斑区10°范围平均光敏感度分别为0.400±0.700、16.000±13.500，好于对照组（0.600±0.900、12.500±10.000），两组比较差异有统计学意义（t=0.612、0.695，P=0.010、0.005）。治疗组CMT（325±125） μm，与对照组（350±125） μm比较，差异无统计学意义（t=0.520，P=0.223）。结论 PASCAL激光联合IVTA治疗DME的疗效明显优于传统氪离子激光治疗模式，具有治疗后可快速提高中心视力，降低黄斑中心厚度，明显降低激光对黄斑区视敏度损害的优势。

Objective To observe the efficacy of pattern scan laser （PASCAL） combined with intravitreal injection of triamcinolone in treatment of diabetic macular edema （DME）. Design Retrospective and comparative study. Participants Eighty cases of patients with DME （135 eyes） with either severe non-proliferative diabetic retinopathy （NPDR） or proliferative diabetic retinopathy （PDR）, who were treated in Tangshan ophthalmologic hospital from December 2012 to February 2014. Method The treatment group included 40 cases （70 eyes） that were treated with PASCAL laser combined with intravitreal injection of triamcinolone acetonide （IVTA） 2 mg. The control group included 40 cases （65 eyes） that were treated with traditional different wavelength krypton lasers. The two groups had no significant difference in severity of DME before treatment. The patients were examined for best-corrected visual acuity （BCVA）, central macular thickness （CMT） and the mean light sensitivity within 10-degree range of the fovea with diagnostic optometry, optical coherence tomography （OCT） and micro-vision （SLO） before treatment and three months after treatment. Main Outcome Measures BCVA, CMT and the mean light sensitivity within 10-degree range of the fovea. Results The proportion of eyes with improvement in BCVA, CMT and the mean light sensitivity within 10-degree range of the fovea three months after treatment in the treatment group were significantly highger than those of control group （88.57%, 91.40% and 85.70% versus 64.30%, 72.30%, 46.15%, χ2=10.60, 8.42, 38.83; P=0.010, 0.005, 0.023 respectively）. The value of BCVA （logMAR） and the mean light sensitivity within 10 degree range of the fovea（dB） three months after treatment was significantly higher than in treatment group than in control group （0.400±0.700 and 16.000±13.500 versus 0.600±0.900 and 12.500±10.000, t=0.612,0.695,P=0.01 and 0.005）, the two groups＇ numerical value（standard deviation） of CMT （μm） after three months treatment, the treatment group ＇s numerical value was 325±125,the control group＇s numerical value was 350±125, they were compare with t test, the results had no statistically significant（t=0.520,P=0.223）. Conclusion IVTA combined with PASCAL laser treatment of DME is better than conventional laser treatment. The combined therapy not only can quickly improve central vision, reduced macular thickness, but also can reduce laser damage to macular visual function.