中华眼底病杂志

中华眼底病杂志

577 nm氪激光全视网膜激光光凝治疗糖尿病视网膜病变后视野缺失的定量分析

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目的 观察577 nm氪激光全视网膜激光光凝(PRP)治疗糖尿病视网膜病变(DR)后视野缺失情况。 方法 前瞻性临床研究。2014年1月至2015年12月在解放军306医院眼科检查确诊的增生型DR(PDR)和严重非增生型DR(NPDR)患者26例41只眼纳入研究。其中,NPDR 21只眼,PDR 20只眼;合并糖尿病黄斑水肿(DME)13只眼(DME组),无DME28只眼(无DME组)。所有患眼均行BCVA、眼底彩色照相、FFA、OCT检查;采用Humphrey-7401全自动视野计行中心30°视野检查,记录视野指数(VFI)和视野平均缺损(MD)值。DR患眼BCVA为0.81±0.28;VFI、MD值分别为(89.8±8.4)%和(−7.5±3.85)dB。无DME组与DME组患眼BCVA分别为0.92±0.20、0.57±0.27;VFI分别为(90.86±7.86)%、(87.46±9.41)%;MD值分别为(−6.86±3.43)、(−8.87±4,48)dB。采用577 nm氪激光对患眼进行PRP治疗。观察治疗后1、3、6个月患眼VFI、MD值和BCVA的变化。 结果 与治疗前比较,治疗后1、3、6个月DR患眼VFI分别下降了12.0%、12.3%、14.8%,差异有统计学意义(t=7.423、4.549、4.79,P<0.001);MD值分别增加了−4.55、−4.75、−6.07 dB,差异有统计学意义(t=−8.221、−5.313、−5.783,P <0.001)。治疗后1、3、6个月不同时间点DR患眼间VFI(t=1.090、−0.486、P>0.05)、MD值比较(t=−0.560、−0.337,P>0.05),差异均无统计学意义。与治疗前BCVA比较,治疗后1个月,DR患眼BCVA明显下降,差异有统计学意(t=2.871,P<0.05)。治疗前与治疗后1、3、6个月DME组患眼BCVA均低于无DME组,差异有统计学意义(t=4.560、2.848、3.608、5.694,P<0.001); 两组患眼间VFI(t=1.209、0.449、0.922、0.271,P>0.05)和MD值比较(t=1.582、0.776、0.927、1.098,P>0.05),差异均无统计学意义。 结论 577 nm氪激光PRP治疗DR后,30°视野缺失范围约12.0%~14.8%;VFI和MD能定量分析PRP治疗后的视野缺失程度和范围。

Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR). Methods A prospective clinical studies. Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No. 306 Hospital of PLA during January 2014 and December 2015 were included in this study. Among them, 21 eyes of NPDR and 20 eyes of PDR; 13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group). All eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations. The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field). The BCVA of DR eyes was 0.81±0.28; the VFI and MD values were (89.8±8.4)% and −7.5±3.85 dB, respectively. The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27, the VFI were (90.86±7.86)% and (87.46±9.41)%, the MD values were −6.86±3.43 and 8.87±4.48 dB. PRP was performed on eyes using 577 nm krypton laser. The changes of VFI, MD and BCVA were observed at 1, 3, and 6 months after treatment. Results Compared with before treatment, the VFI of DR eyes decreased by 12.0%, 12.3% and 14.8% (t=7.423, 4.549, 4.79; P<0.001); the MD values were increased by −4.55, −4.75, 6.07 dB (t=−8.221, −5.313, −5.383; P<0.001) at 1, 3 and 6 months after treatment, the differences were statistically significant. There was no difference on VFI (t=1.090, −0.486; P>0.05) and MD value (t=−0.560, −0.337; P>0.05) at different time points after treatment. Compared with before treatment, the BCVA was significantly decreased in DR eyes at 1 month after treatment, the difference was statistically significant (t=2.871, P<0.05). Before and after treatment, the BCVA of the DME group was lower than that of the non-DME group, the difference were statistically significant (t=4.560, 2.848, 3.608, 5.694; P<0.001); but there was no differences on the VFI (t=1.209, 0.449, 0.922, 0.271; P>0.05) and MD values (t=1.582, 0.776, 0.927, 1.098; P>0.05) between the two groups. Conclusion The range of 30° visual field loss is about 12%-14.8% after 577 nm krypton laser PRP for DR. VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.

关键词: 糖尿病视网膜病变/治疗; 激光凝固术/副作用; 视野

Key words: Diabetic retinopathy/therapy; Laser coagulation/adverse effects; Visual fields

引用本文: 伍春荣, 闫洪欣, 郭惠玲, 夏丽萍, 刘靓, 曲丽燕. 577 nm氪激光全视网膜激光光凝治疗糖尿病视网膜病变后视野缺失的定量分析. 中华眼底病杂志, 2019, 35(1): 65-69. doi: 10.3760/cma.j.issn.1005-1015.2019.01.014 复制

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