577nm阈下微脉冲激光治疗黄斑水肿时光凝斑的影像学观察  

Image observation of laser spots from subthreshold micropulse laser （577nm） photocoagulation for maeular edema

作　　者：侯军军[1] 闫爱珍[1] 袁红[1] 贾亚丁[1] 

机构地区：[1]山西省眼科医院,太原030002

出　　处：《中华眼视光学与视觉科学杂志》2012年第7期414-417,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的用多波长照相技术（F=10）观察577nm阈下微脉冲激光光凝治疗黄斑水肿时光凝斑的形态学改变。方法前瞻性系列病例研究。黄斑水肿患者17例（19眼）纳入研究。所有患者均经眼底荧光索血管造影（FFA）及光学相干断层扫描（OCT）检查确诊，其中，糖尿病黄斑水肿患者8例（10眼），视网膜中央静脉阻塞引起的黄斑水肿患者5例（5眼），视网膜分支静脉阻塞引起的黄斑水肿患者4例（4眼）。首先在传统连续波激光下对患眼进行阌能量P测定，然后在F-10的retromode模式检测下对这19眼进行阈下微脉冲光凝测试及治疗，微脉冲激光所用能量的调整参照阈能量P。留取患眼光凝前后眼底彩照及自发荧光成像，并随访观察术后1个月患眼中心凹厚度（CMT）及最佳矫正视力（BCVA）变化。分别采用配对t检验、配对秩和检验对数据进行分析。结果术后即刻retromode成像中，6眼在122-4％P能量下出现光凝斑；8眼在153．1％P能量下出现光凝斑：5眼在183．7％P能量下出现光凝斑。术后即刻在眼底彩照及自发荧光成像下光凝区未发生改变。术后1个月患眼CMT较术前明显降低，差异有统计学意义（t=4．238，P〈0．01），BCVA与术前相比无明显变化。结论Retromode成像可检测到阈下微脉冲激光光凝产生的不可见光凝斑，在治疗时可用于指导光凝能量大小的选择。Objective To observe the laser spots created by subthreshold micropulse laser （577 nm） photocoagulation for macular edema with a multi-wavelength photographic technique （F-10）. Methods It was a prospective case-series study. Seventeen patients （19 eyes） with macular edema diagnosed by fundus fiuorescein angiography （FFA） and optical coherence tomography （OCT） were included. Eight patients （10 eyes） were diagnosed with diabetic macular edema （DME）, 5 patients （5 eyes） with macular edema attributable to central retinal vein occlusion （CRVO） and 4 patients （4 eyes） with maeular edema attributable to branch retinal vein occlusion （BRVO）. First, the threshold energy （P） was tested by continuous wave laser photocoagulation, then with the detection of the F-10 in retro mode, 19 eyes underwent subthreshold micropulse laser photoeoagulation. The laser energy was based on P. Fundus color images and autofluorescence were obtained before and immediately after subthreshold micropulse laser photocoagulation. Changes in central macular thickness （CMT） and best corrected visual acuity （BCVA） before treatment and 1 month after treatment were compared with a paired t test and signed rank sum test, respectively. Results Immediately after treatment, in retro mode images, laser spots appeared under laser energy of 122.4% P in 6 eyes, 153.1% P in 8 eyes and I83.7% P in 5 eyes. There were no changes in fundus color images or autofluorecenee in any of the eyes. After 1 month of treatment, CMT had significantly decreased compared to that before treatment （t=4.238, P〈0.01）, BCVA showed no significant difference between pre- and post-treatment. Conclusion Retro mode imaging is useful to detect the invisible laser spots created by subthreshold micropulse laser photocoagulation, and can help to select the appropriate laser energy for treatment.

关 键 词：阈下微脉冲激光 黄斑水肿 激光光凝斑 激光能量 RETRO mode 

分 类 号：R779.63[医药卫生—眼科]