作者：郑玉祥 作者单位：大同市第三人民医院，山西 大同 037008
【摘要】 目的：探讨倍频Nd：YAG激光治疗糖尿病性黄斑水肿的临床效果。方法：对218 例(364只眼)分别为局限性黄斑水肿、弥漫性黄斑水肿、囊样黄斑水肿的糖尿病性视网膜病变患者行倍频Nd：YAG激光治疗。对局限性黄斑水肿采用局部光凝，对弥漫性、囊样黄斑水肿采用格栅状光凝。根据不同病变类型选择激光参数，激光后3个月复查视力、荧光血管造影，观察黄斑水肿消退情况。随诊3～39个月。结果：局限性黄斑水肿142只眼，光凝后视力保持不变和提高者139只眼，占97.89％，水肿全部或部分吸收者139只眼，占97.89％；弥漫性黄斑水肿157只眼，光凝后视力保持不变和提高者144只眼，占91.72％，水肿全部或部分吸收者146只眼，占92.99％；囊样黄斑水肿65只眼，光凝后视力保持不变和提高者53只眼，占81.54％，水肿全部或部分吸收者59只眼，占90.77％。结论：根据黄斑水肿类型、视力情况选择激光参数，确保光斑有效，同时治疗糖尿病及其并发症，是激光治疗糖尿病性黄斑水肿的关键。
【关键词】 黄斑水肿 糖尿病性视网膜病变 激光光凝术
Clinical analysis of frequently double Nd：YAG laser for diabetic macular edema
YAN Li，ZHENG Yuxiang，WANG Yanjun，ZHANG Caixia
(The Third People′s Hospital of Datong，Datong 037008，China)
Abstract Objective：To verify the effects of the treatment of frequency double Nd：YAG laser for diabetic macular edema.Methods：A total of 364 eyes in 218 cases of diabetic focal macular edema，diffuse edema and cystoid edema were treated with frequency double Nd：YAG laser photo coagulation.Those with focal macular edema underwent the focal photocoagulaton，and those with diffuse edema and cystoid edema underwent the frid photocoagulation.According to the type of the macular edema，select the proper parameter of laser.The visual acuity examination，fundus fluoresecin angiography were performed in 3 months after the treatment.The changes of macular edema after the treatment were analysed.The followup duration was 3 to 39 months(with an average of 16.3 months).Results：After laser focal photocoagulation in 142 eyes with focal macular edema，visual acuity was improved or maintained in 139 eyes(97.89％).Edema disappeared completely or partially in 139 eyes(97.89％).After laser grid photocoagulation in 157 eyes with diffuse macular edema，visual acuity was improved or maintained in 144 eyes(91.72％).Edema disappeared completely or partially in 146 eyes(92.99％).After laser grid photocoagulation in 65 eyes with cystoid macular edema，visual acuity was improved or maintained in 53 eyes(81.54％).Edema disappeared completely or partially in 59 eyes(90.77％).Conclusion：The key of the treatment of frequency double Nd：YAG laser photocoagulation lies in the insurance of the effective laser macules，treatment of diabetes and its complications，the adaptability of selecting the proper parameter of laser according to the type of the macular edema，and the visual acuity.
Key words：macular edema；diabetic retinopathy；laser coagulation
糖尿病性黄斑水肿(DME)是指黄斑区毛细血管内皮细胞或/和色素上皮细胞屏障功能障碍，导致液体渗漏［1］，它是造成糖尿病患者视力损害的主要原因［2，3］。应用倍频Nd：YAG激光治疗糖尿病性黄斑水肿，疗效较好，报告如下：
1 资料与方法
1.1 一般资料
选择2000年10月—2004年5月就诊的经倍频Nd：YAG激光治疗的糖尿病性黄斑水肿患者218 例，364只眼。其中男78 例128只眼，女140 例236只眼，年龄为30～78 岁。糖尿病病程最短3个月，最长34年，其中1型糖尿病患者8 例，2型210 例。经裂隙灯显微镜、检眼镜和眼底荧光血管造影(FFA)检查确诊为糖尿病性视网膜病变(DR)，并排除影响视力或光凝效果的其他眼科疾病。其中局限性黄斑水肿142只眼，弥漫性黄斑水肿157只眼，黄斑囊样水肿65只眼。
1.2 方法
采用国际标准视力表记录治疗前和末次就诊时的最佳矫正视力，后极镜(Mainster focal/grid retina laser lens)检查判断黄斑区视网膜水肿程度和范围变化，通过眼底荧光血管造影观察治疗前后黄斑区毛细血管渗漏情况。使用德国海德堡共焦激光眼底扫描系统进行荧光血管造影，根据晚期黄斑区荧光素渗漏范围及程度，将黄斑水肿分为局限性、弥漫性和囊样水肿。
参考美国糖尿病视网膜病变早期治疗研究组(ETDRS)对黄斑病变的分型，将黄斑水肿分为以下类型［2］：局限型黄斑水肿型，指黄斑区孤立的斑点状和(或)簇状强荧光或局部渗漏荧光素；弥漫性黄斑水肿型，指黄斑区弥漫性渗漏荧光素，范围达2DD以上；黄斑囊样水肿型，常合并有黄斑弥漫性水肿，造影晚期在黄斑区形成花瓣状和(或)蜂窝状荧光素渗漏。
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