激光光凝治疗缺血型视网膜静脉阻塞的疗效分析  

The photocoagulated effect on ischemic retinal vein occlusion by argon laser

作　　者：王润生[1] 杜善双[1] 程娟[1] 王建洲[1] 吕沛霖[1] 

机构地区：[1]西安市第四医院暨西安市眼底病研究所,710004

出　　处：《中华眼底病杂志》2003年第4期201-204,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的　观察氩激光光凝对缺血型视网膜静脉阻塞 (ischemic retinal vein occlusion,IRVO)性新生血管的预防和治疗效果。　方法　本院眼底病组门诊及住院的 IRVO缺血型患者 2 4 4例 2 6 8只眼经日产 Topcon5 0 VT相机荧光素眼底血管造影 (fundus fluorescein angiography,FFA)确诊。以新生血管的有无分为预防组和治疗组。 2组患者均以下述相同的条件进行治疗 :用美国产 hgm型氩离子激光器、绿兰混合光 ,光斑 2 0 0～ 5 0 0μm,时间 0 .1～ 0 .5 s,功率 0 .3～ 1.0 w, 级轻、中度反应 ,激光光凝覆盖全部无灌注区 ,分别在激光光凝术后 3、2 4周行 FFA复查 ,如有新的或光凝不全的无灌注区则进行补充光凝 ,2组患者均以光凝后半年行检眼镜及 FFA观察的结果为准。　结果　预防性激光光凝组 16 0只眼 ,激光中光凝后仅 17只眼产生了新生血管 ,占 10 .6 % ;14 3只眼未发生新生血管 ,占 89.4 %。治疗性激光光凝组行激光光凝治疗的 10 8只眼中 ,激光光凝后 6 9只眼新生血管萎缩 ,占 6 3.9% ;39只眼激光光凝无效 ,占 36 .1%。 级反应一个光斑直径间隔的密度疗效优于 ～ 级反应 1.5个光斑直径间隔和 级或低于 级反应 2个光斑直径间隔的密度 ,相比差异有显著性的意义 (P<0 .0 1)。　结论　氩激光对Objective To observe the preventive and therapeutic effect of different times, spot reactions and spot density of argon laser photocoagulation on retinal neovascularization of ischemic retinal vein occlusion (IRVO). Methods A total of 244 patients (268 eyes) with IRVO diagnosed by fundus fluorescein angiography (FFA ) were treated by HGM argon laser photocoagulator with green-blue light with 200~500 μm lightspot, 0.1~0.5 s, 0.3~1.0 w, and Ⅱ~Ⅲ class spot reaction . All capillary nonperfusion areas (CNA) were photocoagulated, and so were the retinal neovascularization in some patients. The follow up periods were from 6 to 60 months. After 3 and 24 weeks after photocoagulation FFA was performed again. Photocoagulation was performed supplementarilly for the new CNA or incompletely photocoagulated areas. Ophthalmoscopic examination and FFA were performed in all the patients after half a year. Results Only 17 eyes (10.6%) with neovascularization were found after preventive photocoagulation in 160 eyes in non-neovacularization group. Sixty-nine eyes (63.9%) with neovascular atrophy and 39 eyes (36.1%) with unsuccessful photocoagulation were found after therapeutic photocoagulation in 108 eyes in neovascularization group. There was statistical significance between the two groups (P<0.01). Photocoagulation energy with reaction reaction of III class and density of 1 lightspot diameter was more effective than which with reaction of Ⅱ~Ⅲ class and density of 1.5 lightspot diameter or reaction of ≤Ⅱ class and density of 2 lightspot diameter (P<0.01). Conclusion Efficacy of preventive photocoagulation is better than which of therapeutic photocoagulation. Photocoagulation energy with reaction of III class and density of 1 lightspot diameter is an effective method for IRVO.

关 键 词：治疗 缺血型视网膜静脉阻塞 IRVO 氩激光光凝 激光凝固术 治疗 

分 类 号：R774.1[医药卫生—眼科] R454.2[医药卫生—临床医学]