行全视网膜光凝时不同象限顺序对治疗效果影响的临床研究  

Influence of different sequence of laser photocoagulation position on curative effect

作　　者：董丽[1] 穆华[1] 冯卓蕾[1] 张晓梅[1] 王彬杰[1] 

机构地区：[1]哈尔滨医科大学附属第一临床医学院眼科,中国黑龙江省哈尔滨市150001

出　　处：《国际眼科杂志》2008年第4期760-762,共3页International Eye Science

基　　金：中国黑龙江省卫生厅科教处基金资助(No.2006-067)~~

摘　　要：目的:利用光学相干断层扫描仪(OCT)视网膜地形图,探讨糖尿病性视网膜病变患者行不同顺序全视网膜光凝术前后对黄斑水肿的影响。方法:随机选择发生糖尿病性视网膜病变Ⅲ和Ⅳ期患者共19例(30眼),按不同象限顺序行全视网膜光凝。分成3组,每组10眼。第1组光凝顺序鼻侧、下方、上方、颞侧象限;第2组下方、鼻侧、上方、颞侧象限;第3组颞侧、下方、鼻侧、上方象限。每周一个象限,共4周完成。分别在术前、术后1,2,3,4,8wk测量视网膜地形图,比较各组间黄斑水肿程度及视力有无差异。结果:第1组和第2组术后8wk视力较术前轻度提高,第3组术后8wk视力较术前轻度下降,差异无统计学意义(P>0.05);第1组和第2组术后4wk黄斑视网膜厚度较术前增加,差异有统计学意义(P<0.05);第3组术后4wk黄斑视网膜厚度较术前增加,差异有统计学意义(P<0.01);术后8wk3组黄斑视网膜厚度均较术前变薄,前两组比第3组减轻幅度大,第1组、第2组在中心环处视网膜水肿减轻同术前比差异有统计学意义(P<0.05),第3组中心环处视网膜厚度同术前相比差异无统计学意义(P>0.05),余各处3组较术前相比差异均无统计学意义(P>0.05)。结论:对于Ⅲ期和Ⅳ期糖尿病性视网膜病变全视网膜光凝时,第2组获得较好视力,引起黄斑水肿较轻;通过OCT检查视网膜地形图是观察糖尿病性视网膜病变激光手术前后黄斑水肿的一种有效、敏感方法。AIM：To evaluate the effects of different sequence of laser photocoagulation position by measuring the macular retinal thickness of patients with diabetic retinopathy and the macular edema condition.METHODS：Nineteen patients（30 eyes）with diabetic retinopathy at stage Ⅲ or Ⅳwere divided into three groups with 10 eyes in each group and treated with panretinal photocoagulation.Group 1 were treated by changing the sequence of panretinal photocoagulation from nasal quadrant to downside quadrant,upside quadrant and then temporal quadrant;Group 2 were treated by changing the sequence of panretinal photocoagulation from downside quadrant to nasal quadrant,upside quadrant and then temporal quadrant;Group 3 were treated by changing the sequence of panretinal photocoagulation from temporal quadrant to downside quadrant,nasal quadrant and then upside quadrant.The laser photocoagulation was performed on one quadrant once a week,and the whole treatment was finished in four weeks.Optical coherent tomography was applied to measure the retinal map and to observe the macular edema at postoperative 1,2,3,4,8 weeks,and the changes of visual acuity（VA）were recorded at the same time.RESULTS：At 8 weeks after operation slight VA improvement was found in groups 1 and 2,while slight VA decrease was found in group 3,but there was no significant difference（P〉0.05）.At 4 weeks after operation significant increase of macular retinal thickness was found in three groups（group 1,P〈0.05;group 2,P〈0.05;group 3,P〈0.01）.The decrease of macular retinal thickness was found in all groups at 8 weeks after operation.The extent of the macular retinal thickness decreasing of the first two groups was greater than the third group,but there was no significant difference（P〉0.05）.Significant decrease of retinal edema was found in groups 1 and 2（P〈0.05）and no significant decrease was found in group 3 at the central ring.No significant changes were found in other areas.CONCLUSION：In patients with diabetic ret

关 键 词：糖尿病性视网膜病变 全视网膜光凝 光学相干断层扫描仪 视网膜地形图 

分 类 号：R779.63[医药卫生—眼科]