不同波长阈下微脉冲激光在糖尿病视网膜病变治疗中的应用比较

Comparison of Subthreshold Micropulse Laser of Different Wavelength in Treatment of Diabetic Retinopathy

目的比较不同波长阈下微脉冲激光在糖尿病视网膜病变(diabetic retinopathy,DR)治疗中的疗效。方法选择2019年10月至2022年10月,DR患者100例,按照随机数字表法随机分为A组与B组,每组患者各50例。A组行波长577 nm阈下微脉冲激光治疗,B组行波长532 nm阈下微脉冲激光治疗,每次治疗间隔1周,分3~4次完成。记录术中两组激光治疗光参数。治疗前和治疗后3个月,检测两组患者视力以判定疗效。治疗前、治疗后1个月、3个月,采用光学相干断层扫描技术(optical coherence tomography,OCT)仪检测黄斑中心凹厚度,采用自动视野仪检测视野阈值敏感度,采用罗兰电生理仪检测全视野闪光视网膜电图(flash electroretinogram,F-ERG)中F-ERGa波振幅、F-ERGb波振幅。同时,比较两组血清中血管内皮生长因子(vascular endothelial growth factor,VEGF)、白细胞介素-6(Interleukin-6,IL-6)水平改变及不良反应发生情况。结果A组临床治疗总有效率(86.0%)高于B组(66.0)%(P<0.05);两组激光光斑数、治疗功率及能量密度比较,差异无统计学意义(P>0.05);治疗1个月、3个月A组视野阈值敏感度高于B组(P<0.05);治疗1个月、3个月,两组黄斑中心凹厚度组间比较,差异均无统计学意义(P>0.05);治疗后1个月、3个月A组F-ERGa波振幅、F-ERGb波振幅高于B组(P<0.05);治疗1后个月、3个月A组血清中VEGF、IL-6水平低于B组(P<0.05);治疗期间两组均未出现不良反应。结论DR患者行阈下微脉冲激光治疗,波长577 nm治疗比波长532 nm治疗疗效显著,对视功能损害小。

Objective To compare the efficacy of subthreshold micropulse laser of different wavelengths in treating diabetic retinopathy(DR).Methods Totally 100 DR patients admitted between Oct.2019 and Oct.2022 were randomly divided into Group A and Group B,50 patients in each group.The patients in Group A were given 577 nm subthreshold micropulse laser therapy,and those in Group B 532nm subthreshold micropulse laser therapy.Altogether 3-4 sessions of the treatment were given to each patient at an interval of 1 week.The optical parameters of the two sets of laser treatments during surgery were recorded.The visual acuity of the patients in each group was tested respectively before and 3 months after the treatment to determine the therapeutic effect.The thickness of macular fovea was measured with optical coherence tomography(OCT),the sensitivity of visual field threshold with automatic perimetry,and the amplitude of F-ERGa wave and F-ERGb wave in full field flash electroretinogram(F-ERG)with Roland electrophysiological instrument before and 1 month after the treatment respectively.At the same time,the levels of vascular endothelial growth factor(VEGF),interleukin 6(IL-6)and adverse reactions in serum were compared.Results The total clinically effective rate in Group A was 86.00%,which was higher than 66.00%in Group B(P<0.05).There was no significant difference in number of laser spots,treatment power and energy density between the two groups(P>0.05).One month and 3 months after the treatment,the sensitivity of visual field threshold was higher in Group A than in Group B(P<0.05),and the difference between the two groups in macular fovea thickness was not remarkable(P>0.05).The amplitude of F-ERGa wave and F-ERGb wave in Group A were higher than those in group B(P<0.05).In addition,the levels of VEGF and IL-6 in serum were lower in Group A than in Group B(P<0.05).During the treatment,no adverse reaction occurred in either group.Conclusions The therapy with 577 nm subliminal micropulse laser is more effective than that with 532 nm subliminal micropulse laser while bringing in less damage to visual functions.