摘要
目的:分析比较单点与多点扫描模式全视网膜激光光凝术(PRP)对非增殖性糖尿病视网膜病变(NPDR)患者的疗效及对视网膜结构和功能的影响。方法:回顾性系列病例研究。选择2019年1月至2020年7月在青岛市市立医院被确诊为重度NPDR后行PRP治疗且随访6个月以上的患者57例(93眼)。其中27例(46眼)行单点扫描模式激光治疗,分3~4次完成PRP,作为对照组;30例(47眼)行532 nm多点扫描模式激光治疗,分2次完成PRP,作为观察组。根据治疗前后最佳矫正视力计算治疗有效率。激光治疗后当天根据数字分级法进行疼痛评分。比较2组患者激光能量、光斑数量、能量密度,并测量2组治疗前1 d和治疗后1、3、6个月的30°~60°环形范围内视野平均阈值敏感度(MS)、闪光视网膜电流图(F-ERG)a、b波振幅以及黄斑中心凹厚度(CMT)。比较2组术前1 d荧光素眼底血管造影(FFA)无灌注区面积及术后6个月新生血管以及无灌注区情况。数据分析采用χ^(2)检验、独立样本t检验和双因素重复测量方差分析。结果:对照组和观察组治疗有效率分别为80%和85%,差异无统计学意义(χ^(2)=0.36,P=0.55)。观察组术后疼痛评分明显低于对照组(t=6.84,P<0.001)。2组激光能量和能量密度比较差异有统计学意义(t=0.24,P=0.02;t=12.84,P<0.001),光斑数量差异无统计学意义。治疗后1、3个月,对照组和观察组30°~60°环形范围内MS、F-ERG a波振幅及CMT与治疗前1 d比较差异均有统计学意义(均P<0.001)。2组患者治疗后1、3、6个月F-ERG b波振幅较治疗前均明显下降(均P<0.001)。术前1 d 2组患者FFA无灌注区面积差异比较无统计学意义,术后6个月FFA示2组均未出现新生血管及明显无灌注区病例。结论:532 nm激光单点与多点扫描模式治疗重度NPDR患者术后6个月视网膜结构和功能变化无差异,但多点扫描模式治疗耗时更短,疼痛感更轻,可提高患者依从性。
Objective:To analyze and compare the effect of single-point and multi-point scanning mode for panretinal photocoagulation(PRP)on retinal structure and function in patients with non-proliferative diabetic retinopathy(NPDR).Methods:In a retrospective case series study,57 patients(93 eyes)who were clinically diagnosed as severe NPDR and treated with PRP in Qingdao Municipal Hospital from January 2019 to July 2020 were analyzed retrospectively.Among them,PRP was performed on 27 patients(46 eyes)in single point scanning mode for 3-4 times as a control group.Thirty patients(47 eyes)underwent 532 nm multi-point scanning mode as an observation group,and PRP was performed twice.The therapeutic efficiency rate was calculated based on best corrected visual acuity.Pain was scored according to the numerical rating scale(NRS)on the day after laser treatment.The laser energy,the number of laser spots and the energy density were compared between the two groups.To observe the therapeutic effects,the mean sensitivity in the 30°-60°visual field,a/b-wave amplitude of F-ERG,and the central macular thickness(CMT)were compared between the two groups at 1 day,1 month,3 months,and 6 months after treatment.The non-perfusion area(NPA)was measured at 1 day preoperatively and neovascularization based on fundus fluorescein angiography(FFA)was observed at 6 months after treatment.Data were analyzed by a chi-square test,independent-samples t test and repeated measurements analysis of variance.Results:The effective rates of the control group and the observation group were 80%and 85%.The difference was not statistically significant(χ^(2)=0.36,P=0.55).The postoperative pain score of the observation group was significantly lower than that of control group(t=6.84,P<0.001).There were significant differences in laser energy and energy density between the two groups(t=0.24,P=0.02;t=12.84,P<0.001),but there was no significant difference in the number of laser spots between the two groups.One month and 3 months after treatment,the mean sensitivity in the 30°-60°visual field,a-wave amplitude of F-ERG and the central macular thickness range of the control group and the observation group were significantly different from parameters 1 day before treatment(P<0.001).The amplitudes of the F-ERG b waves at 1 month,3 months and 6 months after treatment were significantly lower than those before treatment(P<0.001).There was no significant difference in NPA 1 day preoperatively.FFA at postoperative 6 months showed no neovascularization or obvious non-perfusion areas in either group.Conclusions:There is no difference in retinal structure and function in patients with severe NPDR treated with 532 nm single-point laser and multi-point scanning mode at 6 months postoperatively.However,the multi-point scanning mode can improve the compliance of patients with a shorter treatment time and less pain.
作者
崔梦琪
袁斌
张婷
童念庭
公慧敏
张昱
Mengqi Cui;Bin Yuan;Ting Zhang;Nianting Tong;Huimin Gong;Yu Zhang(Department of Ophthalmology,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao 266000,China)
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2021年第5期356-361,共6页
Chinese Journal Of Optometry Ophthalmology And Visual Science
