糖尿病视网膜病变患者广泛视网膜光凝术后黄斑色素光密度的变化

Study on the changes of macular pigment optical density in patients with diabetic retinopathy after panretinal photocoagulation

目的探讨糖尿病视网膜病变(DR)患者行广泛视网膜光凝术(PRP)后黄斑色素光密度(MPOD)的变化。方法纳入我院2018年8月至2020年10月收治的DR患者74例(98眼),所有患者均行PRP治疗,记录PRP的激光斑点总面积、激光能量,分别在术前及术后1周、3个月、6个月检测MPOD值,包括黄斑区平均光密度(DMean)、黄斑区光密度最大值(DMax),同时检测患者的黄斑中心凹视网膜厚度(CRT)、黄斑中心凹下脉络膜厚度(SFCT)。观察患者术后MPOD与患者临床资料及CRT、SFCT的关系。结果DR患者PRP后1周、3个月、6个月黄斑区DMean(0.25±0.08)du、(0.20±0.08)du、(0.19±0.06)du、DMax(0.38±0.06)du、(0.34±0.05)du、(0.33±0.07)du均低于术前DMean(0.30±0.09)du、DMax(0.48±0.07)du,术后1周的CRT、SFCT分别为(266.53±47.51)μm、(361.92±64.28)μm,均高于术前CRT(240.51±43.62)μm、SFCT(326.49±76.43)μm,但术后3个月、6个月的CRT(241.92±45.89)μm、(239.84±48.82)μm、SFCT(328.17±70.56)μm、(325.31±68.72)μm均低于术后1周(均为P<0.05)。年龄≥50岁、术前低密度脂蛋白胆固醇≥4.12 mmol·L-1、PRP激光能量≥283.39 mW患者术后黄斑区DMean、DMax均低于年龄<50岁、术前低密度脂蛋白胆固醇<4.12 mmol·L-1、PRP激光能量<283.39 mW的患者,且术前甘油三酯≥2.17 mmol·L-1患者术后黄斑区DMax(0.33±0.06)du低于术前甘油三酯<2.17 mmol·L-1患者术后DMax(0.38±0.05)du(P<0.05)。患者术后黄斑区DMean、DMax与激光能量均呈负相关(均为P<0.05)。结论DR患者术后的MPOD较术前下降,MPOD变化与PRP术中激光能量密切相关,而术前血脂紊乱、患者年龄可能是混杂因素。

Objective To explore the changes of macular pigment optical density(MPOD)in patients with diabetic retinopathy(DR)after panretinal photocoagulation(PRP).Methods A total of 74 patients(98 eyes)with DR admitted to our hospital from August 2018 to October 2020 were enrolled.All patients were treated with PRP,the total laser spot area and laser energy of PRP were recorded,and MPOD before the operation,1 week,3 months and 6 months after the operation were obtained,including the mean macular optical density(DMean)and the maximum macular optical density(DMax).At the same time,the patients’central retinal thickness(CRT)and subfoveal choroidal thickness(SFCT)were measured.The relationship between MPOD of patients after operation and CRT and SFCT was observed.Results The DMean of the patients at 1 week,3 months,and 6 months after operation are(0.25±0.08)du,(0.20±0.08)du,(0.19±0.06)du,and DMax are(0.38±0.06)du,(0.34±0.05)du,(0.33±0.07)du,all these values are lower than the preoperative DMean of(0.30±0.09)du and DMax of(0.48±0.07)du.The CRT and SFCT results of the patients at 1 week after operation are(266.53±47.51)μm and(361.92±64.28)μm,which are higher than the preoperative(240.51±43.62)μm and(326.49±76.43)μm.The CRT results of the patients at 3 and 6 months after operation are(241.92±45.89)μm and(239.84±48.82)μm,respectively,and the SFCT results are(328.17±70.56)μm and(325.31±68.72)μm,respectively,which are lower than those at 1 week after operation(P<0.05).DMean and DMax values of patients over 50 years old with preoperative LDL≥4.12 mmol·L-1 and laser energy≥283.39 mW are lower than those of patients less than 50 years old with preoperative LDL<4.12 mmol·L-1 and laser energy<283.39 mW.The DMax value of patients with preoperative TG≥2.17 mmol·L-1 is(0.33±0.06)du,which is lower than that of patients with preoperative TG<2.17 mmol·L-1,that is(0.38±0.05)du(P<0.05).The postoperative DMean and DMax of the patients are negatively correlated with laser energy(P<0.05).Conclusion The MPOD value of patients with DR is lower after operation.The change of MPOD value is closely related to the laser energy during PRP.Preoperative dyslipidemia and age may be confounding factors.