阈下微脉冲激光与多点扫描激光治疗糖尿病性黄斑水肿的临床疗效

Clinical Observation on Treatment of Diabetic Macular Edema with Subliminal Micro-pulse Laser and Multi-point Scanning Laser

目的比较阈下微脉冲激光与多点扫描激光治疗糖尿病性黄斑水肿的临床疗效。方法回顾性分析2015年3月至2018年5月,糖尿病视网膜病变增生期Ⅳ期合并黄斑水肿患者50例100只眼的临床资料,分为微脉冲激光组和多点扫描激光组,每组患者25例50只眼。微脉冲激光组,黄斑区采用微脉冲激光治疗;多点扫描激光组,黄斑区采用多点扫描激光治疗。术后随访6个月,比较两组患者治疗前后患眼的最佳矫正视力(Best corrected visual acuity,BCVA)、黄斑中心区视网膜厚度(Central macular thickness,CMT)和视网膜平均光敏感度(Mean sensitivity,MS)。结果治疗后2个月,微脉冲激光组CMT较多点扫描激光组明显降低(P<0.05);治疗后6个月,两组的CMT比较,差异无统计学意义(P>0.05)。治疗后2个月,两组BCVA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BCVA显著优于多点扫描激光组(P<0.05)。治疗后2和6个月,微脉冲激光组MS均优于多点扫描激光组(P<0.05)。两组不良反应发生率分别为2%和4%,差异无统计学意义(P>0.05)。结论两种激光手术方法均可减轻糖尿病性黄斑水肿,降低黄斑中心区视网膜厚度,但相较而言,微脉冲激光疗法BCVA和MS改变更明显,术后视功能恢复效果更佳。

Objective To compare the clinical efficacy of subthreshold micro-pulse laser and multi-point scanning laser in the treatment ofdiabetic macular edema.Methods Fifty patients(100 eyes)of Stage IV diabetic retinopathy complicated with macular edema were selected and divided intotwo groups with random number table:the micro-pulse laser group and multi-point scanning laser group.The patients in the formerwere treated with micro-pulse laser,and those in the latter with multi-point scanning laser.The best corrected visual acuity,centralretinal thickness and average retinal light sensitivity were compared between the two groups before and after the treatment respectively.Results Two months after the treatment,the CMT in the micro-pulse laser group was significantly lower than that in the multi-pointscanning laser group(P<0.05),but the difference was not significant 6 months after the treatment(P>0.05).There was nosignificant difference in BCVA between the two groups(P>0.05)2 months after the treatment,but the BCVA of the micro-pulse lasergroup was significantly better than that of the multi-point scanning laser group(P<0.05)6 months after the treatment.The MS of themicro-pulse laser group was better than that of the multi-point scanning laser group 2 and 6 months after the treatment(P<0.05).Theincidence of adverse reactions in the two groups was 2%and 4%respectively,and the difference was not significant(X2=0.344,P=0.558).Conclusions Both micro-pulse laser and multi-point scanning laser will reduce the diabetic macular edema and retinal thickness inthe central macular area and improve the best corrected visual acuity,but only micro-pulse laser treatment may improve the averagelight sensitivity and visual functions of the retina.