多点扫描矩阵激光对重度非增殖性糖尿病性视网膜病变的疗效观察

Therapeutic Effect of Multi-Spot Panretinal Photocoagulation on Severe Nonproliferative Diabetic Retinopathy

目的探讨多点扫描矩阵激光对重度非增殖性糖尿病性视网膜病变(nonproliferative diabetic retinopathy,NPDR)的疗效及优势。方法重度NPDR患者40例40只眼,根据光学相干断层扫描(optical coherence tomography,OCT)检查结果分为两大组,分别为重度NPDR伴有临床意义黄斑水肿组(clinical significant macular edema,CSME)(A组)和重度NPDR不伴有黄斑水肿组(non-macular aredema,NE)(B组),每组20只眼。A组内又随机分为2个小组,实验组(A1组)采用多点扫描矩阵激光完成全视网膜光凝,10只眼;对照组(A2组)采用传统单点扫描激光完成全视网膜光凝,10只眼;B组也以同样的方法分为实验组(B1组)和对照组(B2组)。所有患者均于治疗开始前以及治疗结束后1个月、3个月、6个月接受眼压、最佳矫正视力、OCT和微视野仪(microperimetry-1,MP-1)的检查;术后1年时接受眼底荧光素血管造影(fluorescein fundus angiography,FFA)检查。结果 CSME组(A组)中:实验组(A1组)的黄斑厚度、最佳矫正视力、黄斑区光敏度较治疗前无明显变化(P>0.05);对照组(A2组)的黄斑厚度较治疗前明显增加(P<0.05),A2组最佳矫正视力较治疗前明显下降(P<0.05),A2组黄斑区光敏度较治疗前无明显变化(P>0.05)。NE组(B组)中:实验组(B1组)的最佳矫正视力、黄斑厚度和黄斑区光敏度较治疗前均无明显变化(P>0.05);对照组(B2组)的最佳矫正视力、黄斑区光敏度较治疗前均有不同程度的下降(P<0.05),黄斑厚度较治疗前有增加(P<0.05)。术后1年时,所有患眼均未发现视网膜新生血管。结论多点扫描矩阵激光能有效的减轻传统单点扫描激光对黄斑视功能的影响,在远期疗效上具有一致的有效性。

Objective To investigate the clinical efficacy and benefit of multi-spot panretinal photocoagulation for severe nonproliferative diabetic retinopathy. Methods Forty patients （40 eyes） with severe nonproliferative diabetic retinopathy were divided into two groups by the examination result of optical coherence tomography： one consisting of twenty patients （20 eyes） with significant macular edema and the other twenty patients（20 eyes） without macular edema. In the group with clinically significant macular edema, patients were randomly divided into the experimental group （ 10 eyes） and control group （ 10 eyes）. The patients in the experimental group were given multi-spot panretinal photoeoagulation, and those in the control group single-spot panretinal photocoagulation. The patients in the group without maeular edema were divided and treated in the same way. The intraoeluar pressure, best corrected visual acuity, OCT and MP-1 microperimetry were measured respectively before the treatment and one month, three months and six months after the treatment. The FFA was measured one year after the treatment. Results As to the group with clinically significant macular edema, no significant change occurred to macular thickness, best corrected visual acuity and maeular sensitivity in the experimental group（ P 〉 0. 05 ）after the therapy, but the macular thickness increased significandy（ P 〈 0. 05 ） and best corrected visual acuity decreased significantly （ P 〈 0. 05 ） in the control group despite of slight change of macular sensitivity （P 〉 0. 05 ）. For the group without macular edema, no significant change occurred to best corrected visual acuity, macular thickness and macular sensitivity in the experimental group （ P 〉 0.05 ） after the therapy, but the best corrected visual acuity and macular sensitivity decreased significantly （ P 〈 0. 05 ） and macular thickness increased significantly （ P 〈 0. 05 ） in the control group. No retinal neovascularization was found in any of these eyes one year after the treatment. Conclusions Compared with single-spot scan laser, multi-spot scan laser effectively prevents the damage of panretinal photocoagulation on macular function. Same efficacy can be found in treating severe nonproliferative diabetic retinopathy with panretinal photocoagulation based on single-spot scan laser and multi-spot scan laser.