微脉冲激光及传统激光治疗糖尿病性黄斑水肿效果比较

Comparison of therapeutic effect of micro-pulse laser and conventional laser on diabetic macular edema

目的比较微脉冲激光、单点激光及多点扫描激光光凝术治疗糖尿病性黄斑水肿的效果。方法将确诊为糖尿病视网膜病变增生前期或增生期Ⅳ期合并黄斑水肿60例（120眼）纳入研究。随机分为微脉冲激光组、单点激光组和多点扫描激光组，每组20例（40眼）。黄斑区分别采用微脉冲激光、单点激光及多点扫描激光光凝治疗。治疗前后所有患眼均查最佳矫正视力（BCVA）、黄斑中心区视网膜厚度（central macular thickness，CMT）及视网膜平均光敏感度（mean sensitivity，MS）。治疗后6个月比较3组患者以上观察指标的变化及在各组间的差异。结果治疗后6个月，微脉冲激光组BCVA提高；单点激光组、多点扫描激光组BCVA降低，与光凝前差异有统计学意义（P〈0．05），但3组间比较差异无统计学意义（P〉0．05）。治疗后6个月，3组CMT均降低，与光凝前差异有统计学意义（P〈0．05），但3组间比较差异无统计学意义（P〉0．05）。治疗后6个月，微脉冲激光组MS提高，单点激光组、多点扫描激光组MS均降低，与光凝前差异有统计学意义（P〈0．05），3组间比较差异有统计学意义（P〈0．05）。结论三种激光治疗糖尿病性黄斑水肿均能降低黄斑中心区视网膜厚度，减轻黄斑水肿，但微脉冲激光同时能改善视功能：提高最佳矫正视力，提高视网膜平均光敏感度；而单点激光和多点扫描激光不能改善视功能。

Objective To compare the therapeutic effect of micro-pulse laser, single-spot laser and pattern scan laser for diabetic macular edema（DME）. Methods Total of 120 eyes of 60 patients who were confirmed as preproliferative diabetic retinopathy or IV phase proliferative diabetic retinopathy complicated with clinically significant macular edema were included. These patients were randomized divided into the micro-pulse group with 40 eyes of 20 patients, the single-spot laser group with 40 eyes of 20 patients and the pattern scan laser group with 40 eyes of 20 patients. The patients in micro-pulse group underwent micro-pulse laser therapy in macular region , the single-spot laser group underwent maeular laser grid photoeoagulation therapy by single-spot laser, the pattern scan laser group underwent macular laser grid photocoagulation therapy by pattern scan laser. The BCVA, central macular thickness（CMT） and mean sensitivity（MS） of all patients were examined before and after the treatment. The changes in BCVA, CMT and MS at 6 months after treatment were observed and compared among the groups. Results At 6 months after the treatment, the BCVA of micro-pulse group increased more significantly compared to that before treatment （ P 〈 0.05 ）, the BCVA of single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment（P 〈 0.05）, the BCVA of the three groups showed no statistical difference （P 〉 0.05）. At 6 months after the treatment, the CMT of micro-pulse group, single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment（ P 〈 O. 05 ）, the CMT of the three groups showed no statistical difference （ P 〉 0.05 ）. At 6 months after the treatment, the MS of micro-pulse group increased significantly compared to that before treatment（ P 〈 0.05 ）, the MS of single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment（ P 〈 0. 05 ） , the MS of the three groups showed statistical difference （ P 〈 0.05 ）. Conclusion Micro-pulse laser,single-spot laser and pattern scan laser therapies on DME can effectively reduce CMT and alleviate macular edema, micro-pulse laser therapy on DME also increase BCVA and MS, and improve visual function. Single-spot laser and pattern scan laser therapies can not improve visual function.