多点扫描激光与单点激光治疗糖尿病视网膜病变的对比研究

Comparison of the efficacy of multi-point and single-point laser in the treatment of diabetic retinopathy

目的对比观察多点扫描激光及传统的单点氪激光治疗糖尿病视网膜病变(DR)的效果,评估两种治疗方法的安全性。设计病例对照研究。研究对象 2013年1月至2015年6月就诊的117例(220眼)DR患者。方法将入组的DR患者随机分为两组。实验组行多点扫描激光,共58例(112眼);对照组行传统单点多波长氪激光,共59例(108眼)。所有患者光凝前均进行最佳矫正视力(BCVA)、裂隙灯生物显微镜、眼底照相、荧光素眼底血管造影(FFA)、黄斑区OCT及视野检查,术后3个月复查FFA。激光治疗后当天根据数字分级法(NRS)进行疼痛评分,记录激光治疗的能量指标,计算能量密度。术后1、3、6个月分别测量患者的BCVA,OCT检查测量平均黄斑中心凹厚度(CMT),视野检查测量平均视敏度。主要指标激光术后疼痛评分,激光能量和能量密度,术后1、3、6个月患者BCVA、平均CMT及平均视敏度。结果实验组激光时间(39.07±5.10 min)少于对照组(52.36±7.47 min)(t=5.63,P=0.00),能量密度实验组(68.23±12.16 mw*ms/μm^2)也低于对照组(157.64±31.63 mw*ms/μm^2)(t=7.75,P=0.00)。激光术后疼痛评分实验组(1.46±0.633分)显著低于对照组(2.43± 0.95分)(t=6.61, P=0.00)。实验组有30眼(26.78%)视力提高,对照组有32眼(29.62%)视力提高(χ^2=1.85,P=0.39)。术后6个月BCVA提高字符数实验组(2.43± 0.95字符)与对照组(2.70±2.62字符)无显著差异(t=0.27,P=0.82),黄斑中心凹厚度下降幅度对照组(34.47±51.77 μm)高于实验组(27.66±46.87 μm)(t=-1.02,P=0.03),平均视敏度下降幅度实验组(1.22±0.50 dB)小于对照组(2.32±1.10dB)(t=9.55,P=0.00)。随访期间,实验组有3眼(2.67%)出现玻璃体积血,对照组有2眼(1.85%)(χ^2=0.17,P=0.68)。实验组有28眼(25%)再次行激光治疗,对照组有20眼(18.51%)(χ^2=1.35,P=0.24)。结论多点扫描激光与单点激光在治疗DR上疗效相同,并对视网膜功能损伤较小。

Objective To compare the effects of multi-point scanning laser and traditional single-point krypton laser in the treatment of diabetic retinopathy (DR). Design Case-control study. Participants A total of 117patients (220 eyes) with clinically diagnosed DR from January 2013 to June 2015. Methods Patients were randomly divided into two groups including the experimental group (58patients, 112 eyes) and the control group (59 patients,108 eyes).The experimental group received pan-retinal photocoagulation (PRP) with multi-point scanning laser, and the control group received PRP with single-point krypton laser. Fundus fluorescein angiography (FFA) was performed 3 months after laser therapy. On the day after laser treatment, we scored the pain according to the Numerical Rating Scale (NRS), recorded the energy index of laser therapy, and calculated the energy density. Best-corrected visual acuity (BCVA), central macular thickness (CMT), mean deviation of perimetry were measured at 1, 3 and 6 months after laser therapy. Main Outcome Measures BCVA, CMT and mean deviation of perimetry before and after treatment, the pain score on the day of laser therapy, the laser energy and laser energy density. Results The laser time in the experimental group (39.07±5.10 min) was shorter than that in the control group (52.36±7.47 min)(t=5.63, P<0.01). The laser energy density of the experimental group (68.23±12.16 mw*ms/μm^2) were lower than those of the control group (157.64±31.63 mw*ms/μm^2)(t=7.75,P<0.01). The pain score after laser treatment in the experimental group (1.46±0.633) was significantly lower than that in the control group (2.43± 0.95)(t=6.61, P<0.01). There were 30 eyes (26.78%) with improved visual acuity in the experimental group, compared to 32 eyes (29.62%) in the control group (χ^2=1.85, P=0.39). Compare to the pre-treatment measurement, the average BCVA were both improved in the two groups (2.43± 0.95 vs. 2.70±2.62)(t=0.27, P=0.82), but the reduction of MCT was significantly (t=-1.02, P=0.03) smaller in experimental group (27.66±46.87 μm) than in the control group (34.47±51.77 μm). The reduction of average threshold sensitivity was significantly smaller (t=9.55, P<0.01) in experimental group (1.22±0.50 dB) than in control group (2.32±1.10 dB). The vitreous hemorrhage rate of experimental group 2.67%(3/112) was similar to that of control group (1.85%(2/118),χ^2=0.17, P=0.68). There were 28 eyes (25%) in the experimental group received supplemental laser therapy compared to 20 eyes (18.51%) in the control group(χ^2=1.35, P=0.24). Conclusions Multi-point scanning laser achieves the same therapeutic outcomes as the single-point mode with relatively minor functional damage.