高压氧结合激光光凝治疗糖尿病性黄斑水肿  

Treatment of diabetic macular edema by combination of hyperbaric oxygen with focal or grid photocoagulation

作　　者：黄杜茹[1] 黄中宁[2] 尹东明[2] 

机构地区：[1]中山大学附属第一医院东山院区眼科,510080 [2]广东省人民医院眼科,510080

出　　处：《广州医药》2008年第2期12-15,共4页Guangzhou Medical Journal

基　　金：广州市越秀区科技计划资助项目(2006-WS-003)

摘　　要：目的了解高压氧对糖尿病性黄斑水肿的疗效。方法糖尿病性黄斑水肿病人34例61眼,病例随机等分为高压氧加光凝组和光凝组。两组黄斑水肿程度基本齐同。光凝组在黄斑区行局灶或格栅样激光光凝,高压氧加光凝组在光凝基础上加高压氧(0.22 MPa)治疗,每日60分钟,疗程12天。结果治疗前对数视力:高压氧加光凝组为(4.3±0.5),光凝组为(4.1±0.7);治疗3个月后视力提高:高压氧加光凝组15眼(15/31)多于光凝组9眼(9/30)。高压氧加光凝组对数视力(4.5±0.5)较治疗前提高(t=3.042,P=0.005);光凝组(4.1±0.7)与治疗前比较,差异无统计学意义(t=1.394,P=0.174)。眼底血管荧光造影或光学相干断层扫描显示,高压氧加光凝组黄斑水肿消退有效率较光凝组高(77.4%比46.7%,2χ=6.139,P=0.013)。治疗后黄斑水肿消退分级与治疗视力改善、高压氧治疗、黄斑水肿程度、空腹血糖、总胆固醇、舒张压、糖化血红蛋白及糖尿病病情相关,而与糖尿病视网膜病变分期和病程、治疗前视力、是否用胰岛素、收缩压、甘油三酯、血尿素氮和血肌酐无关。结论高压氧联合黄斑区格栅样激光光凝有助于糖尿病性黄斑水肿吸收及部分病人视力改善。Objective To study the efficacy of hyperbaric oxygen therapy on diabetic macular edema. Methods Thlrty-four patients （61 eyes） with diabetic macular edema were divided randomly into hyperbaric oxygen-added photocoagulation group and photoeoagulation group, with comparability in statistics. All patients in both groups were treated with focal or grid photocoagulation, hyperbaric oxygenation therapy 60 rain a day for 12 days was performed in hyperbaric oxygen-added photoeoag- ulation group. Results Log scale of visual acuities were （4.3±0.5） in hyperbaric oxygen-added photoeoagulation group and （4.1±0.7） in photocoagulation group before treatment. After treatment for three months, the significant improvement of visual acuities was found in 15 eyes of patients treated with hyperbaric oxygen, but 9 eyes of patients given only photocoagulation treat-ment. Log scale of visual acuities increased to （4.5±0.5） in the former （ t = 3.042, P =0.005 ） , but changed insignificantly in the later （t= 1.394, P=0.174） . Fundus fluoreseein angiography and optical coherence tomography showed that the effective rate of combined hyperbaric oxygen therapy on diabetic macular edema was higher than that only photoeoagulation treatment （77.4% vs 46.7% , X^2=6.139, P =0.013） . The associated factors with regression of maeular edema included improvement of visual acuity after treatment, whether hyperbaric oxygen therapy or not, degree of macular edema, fasting blood glucose, to- tal cholesterol, diastolic blood pressure, glycosylated hemoglobin and history of diabetes, but classification and history of diabetic retinopathy, visual acuity before treatment, whether insulin or not , systolic blood pressure, triglyeeride and urea nitrogen are not. Conclusion Hyperbaric oxygen therapy helps to regression of macular edema and improves visual acuity in some patients with diabetic maeular edema.

关 键 词：视网膜病变 糖尿病性 黄斑水肿 糖尿病性 高压氧 格栅样光凝 

分 类 号：R774.5[医药卫生—眼科] R587.2[医药卫生—临床医学]