【摘要】 目的:探讨倍频532nm激光治疗视网膜血管性疾病所致黄斑水肿的临床效果。方法:对89例112眼视网膜血管性疾病所致黄斑水肿患者(糖尿病性视网膜病变53例75眼,视网膜静脉阻塞34例35眼, Coats病1例1眼,旁中心凹视网膜毛细血管扩张症1例1眼),采用倍频532nm激光行黄斑区局部或格栅样光凝治疗黄斑部的局部或弥漫性水肿。术后随访1a观察患者黄斑水肿消退情况和视力变化。结果:光凝治疗后视力提高者21眼(18.7%),不变者84眼(75.0%),下降者7眼(6.3%)。光凝后黄斑水肿完全吸收40眼(35.7%),部分吸收60眼(53.6%),无吸收12眼(10.7%)。且局限性黄斑水肿的治疗效果优于弥漫水肿及囊样水肿(P<0.01)。结论:倍频532nm激光光凝术是治疗视网膜血管性疾病所致黄斑水肿的有效、安全方法。
【关键词】 视网膜血管病;黄斑水肿;激光光凝术
532nm frequencydoubled laser photocoagulation for macular edema caused by retinal angiopathy
XueMei Feng, ShaoYang Shi, Fang Zhao
Department of Ophthalmology, Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Abstract AIM:To investigate the effect of 532nm frequencydoubled laser photocoagulation treatment for macular edema caused by retinal angiopathy. METHODS:Eighhtynine patients (112 eyes) with macular edema caused by retinal angiopathy were enrolled in this study. The topical or grid photocoagulation of macula was performed with 532nm frequencydoubled laser photocoagulation. Of them, localized edema was treated with direct photocoagulation and diffuse edema was treated with grid photocoagulation. The subsidence of the macular edema and the changes of their vision after the treatment were examined during twelve months' followup. RESULTS:After the treatment with photocoagulation , visual acuity of 21 eyes(18.7 %) had been improved , 84 eyes ( 75.0 %) remained the same , and vision of 7 eyes ( 6.3 %) decreased . Macular edema was completely absorbed in 40 eyes (35.7 %) , partly in 60 eyes (53. 6 %) , and was not absorbed at all in 12 eyes ( 10.7%). 532nm frequencydoubled laser photocoagulation was more effective for localized edema than for diffuse edema (P<0.01). CONCLUSION:The method of 532nm frequencydoubled laser photocoagulation has been proved to be safe and effective in treating macular edema caused by retinal angiopathy. KEYWORDS:retinal angiopathy; macular edema; laser photocoagulation
0引言 黄斑水肿是多种眼病的并发症,也是造成视力障碍的重要原因。临床上以视网膜血管性疾病所致黄斑水肿最为多见,如糖尿病性视网膜病变、视网膜静脉阻塞等。如何对视网膜血管性疾病所致黄斑水肿进行良好有效的治疗,一直是国内外眼科医师不断探索和研究的重要课题。我们采用激光光凝治疗黄斑部水肿取得较好效果,现报告如下。
1对象和方法
1.1对象 选择200601/200712在我院就诊、随访资料完整的视网膜血管病所致黄斑水肿患者89例112眼,其中男37例48眼,女52例64眼,年龄16~ 78(平均55.2)岁。其中糖尿病性视网膜病变53例75眼,视网膜中央静脉阻塞12例12眼,视网膜分支静脉阻塞22例23眼,Coats病1例1眼,旁中心凹视网膜毛细血管扩张症1例1眼。病例排除伴有青光眼、视神经萎缩、明显屈光间质混浊等影响治疗及疗效观察者,黄斑区明显牵拉增生膜形成者也除外。根据黄斑水肿的范围将其分为局部水肿、弥漫水肿(视网膜增厚≥2.00PD)和囊样水肿。
1.2方法
1.2.1检查方法 所有病例光凝及随访期间均作最佳矫正视力、眼压、裂隙灯显微镜、间接眼底镜、眼底彩色照片及眼底荧光血管造影(FFA)等检查。部分患者行OCT检查。黄斑水肿诊断依据Ocular全视网膜镜或+90.00D间接眼底镜进行检查,并辅以FFA分型和确定光凝部位。
1.2.2光凝方法 采用Alcon公司OPHTHALS 532倍频激光机。对局限性渗漏点(包括FFA中充盈和渗漏的单个或成簇的毛细血管瘤及渗漏的毛细血管)所致的局部水肿,治疗时采用渗漏点的直接光凝即局部光凝。光斑直径50~100μm,曝光时间0.1~0.15s,功率100~200mW,以光凝后微血管瘤变白或变暗为宜,有些血管瘤1~2个光凝点不足以使其变色,要在同一点做3~4个连续光凝方能达到目的。对成群的微血管瘤采用100~200μm的光斑直径,持续时间可增至0.2s。对弥漫性荧光素渗漏的黄斑水肿(视网膜增厚区域≥2.00PD,并累及中心凹无血管区)参照FFA结果,光凝治疗时可先在中心凹毛细血管区外作马蹄形光凝或格栅样光凝。采用100μm光斑直径,光凝3~5排,间隔1~2个光斑距离,曝光时间0.1~0.15s,功率100~200mW,治疗时随时调整功率,以光斑反应Ⅰ~Ⅱ级为宜。在弥漫性水肿区域内,在格栅光凝基础上,对单个渗漏明显的微血管瘤采用直接光凝。乳头黄斑束部位根据病变程度保留15°~30°范围不光凝区,若此区渗漏明显仍给予光凝,能量不宜过大,Ⅰ~Ⅱ级光斑反应即可。对于视网膜分支静脉阻塞引起的黄斑水肿则在黄斑区作象限光凝。光凝时避开视网膜大血管及出血区,光凝范围根据FFA结果所定,然后分次完成全视网膜光凝或其余视网膜病灶区的光凝。光凝后1,3mo随访1次,以后每3~4mo复查1次。检查项目同前,记录治疗前后的视力和黄斑水肿的变化情况。如光凝3~4mo后视力不提高,FFA仍显示渗漏明显,残留的视网膜增厚或渗漏区延及中心凹无血管区者,则需补充光凝,直至裂隙灯生物显微镜和/或FFA检查证明视网膜水肿已消退时,才无需补充治疗。以治疗后12mo的最佳矫正视力和黄斑水肿情况作为观察指标。 统计学分析:采用SPSS软件(15.0版)对全部数据进行处理,应用等级资料的秩和检验KruskalWallis Test进行比较,以P<0.05作为差异有统计学意义。
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