不同波长激光治疗重度非增生型糖尿病视网膜病变的疗效观察

Clinical observation of different wavelength laser in the treatment of severe non-proliferative diabetic retinopathy

目的比较577 nm、532 nm激光全视网膜激光光凝(panretinal photocoagulation,PRP)治疗重度非增生型糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)的临床疗效。方法前瞻性临床对照研究。纳入重度NPDR患者42例64眼,随机分为577 nm组和532 nm组,采用单点模式行PRP,术前及术后1 d、1个月、3个月、6个月检查最佳矫正视力(best corrected visual acuity,BCVA)、眼底、光学相干断层扫描(optical coherence tomography,OCT)、全视野闪光视网膜电图(flash electroretinogram,F-ERG),术后3个月、6个月行眼底荧光血管造影(fundus fluorescein angiography,FFA)检查。结果 577 nm组和532nm组光斑点数分别为(1969.25±278.19)点、(2098.16±289.27)点;激光功率分别为(425.23±50.15)m W、(438.15±38.48)m W;能量密度分别为(7.54±1.54)m W·ms-1·μm-2、(7.68±3.01)m W·ms-1·μm-2,平均光斑数(t=2.68)、平均激光功率(t=1.46)、平均能量密度(t=2.15)的组间差异均无统计学意义(均为P>0.05)。两组患者术后1个月、3个月、6个月,组间黄斑中心凹厚度(central macular thickness,CMT)差异均无统计学意义(t=1.98、1.88、1.81,均为P>0.05);两组患者术后1个月、3个月、6个月F-ERG振幅(a波:t=5.94、5.19、6.97;b波:t=5.67、4.56、5.12)组间差异均有统计学意义(均为P<0.05)。术后6个月两组患者治疗有效率分别为87.5%、46.9%,差异有统计学意义(χ2=7.56,P<0.05)。结论 577 nm激光比532nm激光治疗重度NPDR有效率更高,视功能损伤程度更小。

Objective To compare the clinical effects of 577 nm and 532 nm la- ser panretinal photocoagnlation in the treatment of severe non-proliferative diabetic reti- nopathy （NPDR）. Methods A prospective, controlled trial was conducted in 42 pa- tients（64 eyes）with severe NPDR,who were randomly divided into 577 nm group and 532 nm group. All of patients received PRP with the single-point model. Preoperative and postoperative 1 day,1 month,3 and 6 months,the best corrected visual acuity （BC- VA）, fundus, optical coherence tomography （OCT） and full field flash electroretinogram （F-ERG） were examined. After treatment 3 and 6 months, fundus fluorescein angiogra- play （FFA） examination was performed between two groups. Results In 577 nm group and 532 nm group ,the average number of laser spot was （ 1969.25 ± 278.19） and （2098.16 ± 289.27） respectively; average laser power was （425.23 ± 50.15 ） mW and （438.15 ± 38.48）mW respectively;and average energy density was （7.54 ± 1.54） mW· ms^-1 μm^-2 and （7.68±3.01）mW · ms · μm 2. There was no difference in num- ber of laser spot（ t = 2.68 ）, laser power （ t = 1.46） and energy density （ t = 2. 15 ） be- tween the two groups （ all P 〉 0.05 ）, and the differences of macular central thickness after treatment 1 month,3 and 6 months （ t = 1.98,1.88,1.81 respectively） approached no statistical significance between the two groups （ all P 〉 0.05 ）, while F-ERG a, b wave amplitudes after treatment 1 month, 3 and 6 months （ a wave ： t = 5.94,5. 19,6. 97 ; b wave ： t = 5.67,4.56,5. 12 ） had significant differences between groups （ all P 〈 0.05 ）. The effective rate of treating 6 months after operation in the two groups were 87.5% and 46.9% respectively,with significant difference （X^2 = 7.56 ,P 〈 0.05 ）. Conclusion 577 nm laser is more effective and has less damage to visual function than 532 nm laser in the treatment of NPDR.