预防性激光治疗年龄相关性黄斑变性的疗效和随访观察  

Prophylactic laser treatment to macular soft drusen in age-related maculopathy of updated results

作　　者：黄映湘[1] 向里南[1] 王艳玲[1] 高立新[1] 胡詠霞[1] 

机构地区：[1]首都医科大学附属北京友谊医院眼科,100050

出　　处：《中华眼科杂志》2008年第11期1002-1006,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨年龄相关性黄斑变性（AMD）经预防性激光治疗的效果。方法系列病例研究。选择双眼黄斑部均有软性玻璃膜疣（均〉10个）的患者10例（10只眼），对玻璃膜疣数量多者行氩激光C型光凝治疗，对侧眼（10只眼）作为自身对照。检查患者治疗前后矫正视力和Amsler表视力。患者随诊时间均超过8年，平均98．5个月。激光治疗后8年，复查荧光素眼底血管造影（FFA）情况；激光治疗后2年，检查视网膜对比敏感度；激光治疗后3年，6例行多焦视网膜电图（mERG）检查。应用SPSS10．0统计学软件，对6例（6只眼）患者入选时和复查时治疗眼与对照眼mERG检查结果进行比较，采用配对t检验，以P〈0．05作为差异有统计学意义。结果激光治疗后8年随访，治疗眼黄斑部玻璃膜疣数目明显少于对照眼，但有新的玻璃膜疣出现，眼底后极部可见轻度色素脱失，无明显色素增生。患者最佳矫正视力仍保持治疗前水平，激光治疗眼和对照眼均未发现脉络膜新生血管。激光治疗后2年，检查视网膜敏感度，双眼对照分析未见明显不同。双眼治疗前后mERG检测结果比较，显示黄斑区中心1环N1波和P1波的振幅和潜伏期与对照眼差异均无统计学意义（治疗前t=-0．779，0．722，-0．491，0．286；治疗后t=1．342，0．043，0．937，0．350；均P〉0．05）。结论预防性激光治疗AMD对黄斑功能无明显损伤，可促进玻璃膜疣消退，长期随访无脉络膜新生血管出现，可作为预防性治疗AMD的有效方法之一。Objective To investigate the follow-up results of the prophylactic laser treatment to macular soft drusen in age-related macular degeneration. Methods Prospective, 10 persons with bilateral soft drusen and with good visual acutity were observed for 8 years. 10 eyes were treated. The fellow eyes were as control group. Fluorescein angiography and Amsler test were studied after 8 years. Scanning laser ophthalmoscope was performed after 2 years. Some of them were performed multifocal ERG to test the macular function after 3 years. Results There is no choroidal neovascularization in both the laser group and the control group. There is no differences in the best corrected visual acuity after 8 years. All eyes had good fovea fixation. Light sensitivity of both eyes had no significant difference to be found by scanning laser ophthalmoscope. The latencies and amplitude densities of the N1 and P1 waves in the cental first ring remained unchanged at 3 years post-treatment （ before treatment t = -0. 779,0. 722, -0. 491,0. 286 ;after treatment t = 1. 342,0. 043,0. 937,0. 350 ; P 〉 0. 05 ） compared with the fellow eyes. Conclusions There is no impairment to be found in the macula after preventive laser treatment. The treatment did not demonstrate a clinically significant benefit for choroidal neovascularization in eyes of people with bilateral large drusen.

关 键 词：黄斑变性 视网膜小疣 凝光凝固术 随访研究 

分 类 号：R686[医药卫生—骨科学]