577nm阈下微脉冲激光治疗干性年龄相关性黄斑变性的疗效观察  

Efficacy of 577nm Subthreshold Micropulse Laser on Age-Related Dry Macular Degeneration

作　　者：李红 宋艳萍 闫明[2] 黄晓莉[2] 叶娅[2] 丁琴[2] 

机构地区：[1]南方医科大学武汉临床医学院,广州市510515 [2]广州军区武汉总医院眼科

出　　处：《中国激光医学杂志》2017年第6期293-297,346,共6页Chinese Journal of Laser Medicine & Surgery

基　　金：国家自然科学基金资助(61378084)

摘　　要：目的观察577 nm阈下微脉冲激光治疗干性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效。方法回顾性分析2016年4~8月,临床确诊为干性AMD患者12例12只眼的临床资料,所有患眼病变区均行全黄斑577 nm阈下微脉冲激光光凝治疗,光斑直径200μm,激光光凝时间0.1 s+间歇时间1.9 s。光凝后随访12个月,对比治疗前与治疗后1、3、6、9和12个月的最佳矫正视力(best corrected visual acuity,BCVA),将BCVA检测结果转换为最小分边角对数(logMAR)视力记录,同时记录黄斑部患眼(pigment epithelium detachment,PED)高度的改变。并观察眼底玻璃膜疣变化。结果治疗前平均logMAR BCVA为0.30±0.09,PED高度为(336.3±86.6)μm;治疗后1、3、6、9和12个月平均logMAR BCVA分别为0.29±0.1、0.29±0.1、0.30±0.1,0.31±0.1、0.32±0.1;平均PED高度分别为(322.0±83.2)μm、(249.8±56.9)μm、(205.9±69.1)μm、(160.3±103.8)μm、(137.6±132.7)μm。治疗前与治疗后1、3、6、9和12个月的logMAR BCVA比较,差异无统计学意义(P>0.05),视力均无明显提高;PED高度比较,差异有统计学意义(P<0.05),PED高度明显降低。开始治疗后12个月,治疗眼玻璃膜疣数目明显较治疗前减少,未发现新的玻璃膜疣产生。12例12只眼中,视力下降2例,视力无明显改变10例;PED高度改变不明显2例,PED高度升高1例,PED高度明显下降9例。12只眼均重复微脉冲激光治疗。重复治疗2、3、4次的例数分别为2只眼、8只眼、2只眼。结论 577 nm阈下微脉冲激光能有效治疗干性AMD,使患者视力维持在较好水平,消退玻璃膜疣,并降低PED高度,可重复治疗,是安全有效的。Objective To investigate the efficacy of 577 nm subthreshold micropulse laser on age-related dry macular degeneration.Methods A retrospective case study was conducted on twelve patients（12 eyes） of dry AMD who had been given the treatment of 577 nm subthreshold micropulse laser. The best corrected visual acuity（BCVA） and PED height were compared and analyzed before and after the treatment during the 12-month follow-up.Results The preoperative mean of the logMAR BCVA were（0.30 ± 0. 1） and PED Height（336. 3 士 86. 6） μm,while the average logMAR BCVA were（0.29 ±0. 1）,（0. 29 ±0. 1）,（0. 30 ±0. 1）,（0. 31 ±0. 1） and（0. 32 ±0. 1）,1,3,6,9,12 months after the treatment and the average height of PED（322.0±83.2） μm,（249.8 ±56.9） μm,（205.9 ±69.1）μm,（160.3±103.8）μm and（137. 6 ± 132. 7）μm. The differences of the logMAR BCVA and visual acuity were not remarkable（P〈0. 05 before and the after the treatment, but the differences of the PED height were statistically significant（P〈0. 05）, which was represented by an obvious drop of the PED height. After 1 year of treatment, the number of ocular drusen reduced significantly, and no new drusen appeared for all these patients. As to the 12 eyes of these patients, the visual acuity decreased in 2 cases and changed insignificantly in 10 cases,and the PED height had an unapparent change in 2 cases, a obrious increase in 1 case and a significant decrease in 9 cases. All these12 eyes were given repeated micropulse laser treatment. The numbers of the repetitions were 2, 3 and 4 times for 2, 8, and 2 eyes respectively.Conclusions The treatment of 577 nm subthreshold micropulse laser is rather efficacious for dry AMD and may keep the vision of patients at a good level as well as reduce PED height. It is repeatabled, which is safe and effective and without side effect.

关 键 词：微脉冲激光 干性 年龄相关性黄斑变性 

分 类 号：R774.5[医药卫生—眼科]