糖尿病性黄斑水肿视野缺失的微脉冲激光治疗效果观察

发布时间：2018-01-30 02:39

本文关键词： 糖尿病视网膜病变黄斑水肿视野缺失微脉冲激光　出处：《中国糖尿病杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨糖尿病性黄斑水肿(DME)与视野缺失的相关性并观察微脉冲激光治疗的效果。方法选取糖尿病视网膜病变(DR)患者117例(149眼),根据美国糖尿病视网膜病变早期治疗研究小组(ETDRS)DME诊断标准,分为DME组50例(70眼)和N-DME组67例(79眼)。选取体检健康者40名(80眼)作为正常对照(NC)组。收集各组临床资料和生化指标并进行视野检查。另将DME组分为微脉冲激光亚组和传统激光亚组,各35眼,观察激光治疗后1个月、3个月、6个月、9个月、12个月视野恢复状况。结果 DME组糖尿病病程、FPG、HbA1c及HOMA-IR高于N-DME组(P0.05)。各组可置信因子RF15%,提示检查结果可靠。DME组和N-DME组平均缺陷值(MD指数)[(7.81±0.75)vs(4.32±0.67)vs(1.14±0.22)dB]、视野丢失方差(LV)[(20.17±4.85)vs(15.34±3.19)vs(4.72±1.11)dB]及视野的刺激丢失方差值(sLV)[(10.71±1.37)vs(7.22±1.12)vs(2.35±0.41)dB]水平均高于NC组,且DME组高于N-DME组(P0.01)。自治疗后3个月起,微脉冲激光亚组MD指数、LV、及sLV水平均较治疗前降低,且均低于传统激光亚组(P0.05)。传统激光亚组各时间点MD指数、LV及sLV水平比较,差异均无统计学意义(P0.05)。多元Logistic回归分析发现,糖尿病病程、FPG、HbA_1c及HOMA-IR为DEM的危险因素(P0.01)。结论 DME患者存在严重的视野缺失,微脉冲激光治疗有助于视野恢复,而传统激光治疗对其无明显效果。糖尿病病程及IR程度增加,FPG、HbA1c升高,均增加DME的发生风险。
[Abstract]:Objective to investigate the correlation between diabetic macular edema (DME) and visual field loss and to observe the effect of micropulse laser. Methods 117 patients with diabetic retinopathy (DRR) were selected. According to the early treatment of diabetic retinopathy in the United States the DME diagnostic criteria for ETDRS. DME group (n = 50, n = 70) and N-DME group (n = 67, n = 79). 40 healthy subjects (n = 40, n = 80) were selected as normal control group (n = 80). The clinical data and biochemical indexes of each group were collected and the visual field was examined. The DME group was divided into two groups: micropulse laser subgroup and traditional laser subgroup. 35 eyes of each group were observed to observe the recovery of visual field in 1 month, 3 months, 6 months, 9 months and 12 months after laser treatment. HbA1c and HOMA-IR were higher in N-DME group than in N-DME group (P 0.05). The confidence factor RF15% in each group was higher than that in N-DME group. The results suggest that the average defect value and MD index of DME and N-DME groups are reliable. [VSD 4.32 卤0.67 vs 1.14 卤0.22 dB], visual field loss variance (LVV). [T = 20.17 卤4.85 vs 15.34 卤3.19 vs 4.72 卤1.11dB) and the stimulus loss variance (sLVV) of visual field. [The level of VSD was higher than that of NC group (10.71 卤1.37 vs 7.22 卤1.12 卤2.35 卤0.41 dB). The levels of MD index and sLV in DME group were lower than those in N-DME group 3 months after treatment. All of them were lower than the conventional laser subgroup (P 0.05). The MD index LV and sLV were compared at different time points in the traditional laser subgroup. There was no significant difference between the two groups (P 0.05). Multiple Logistic regression analysis showed that the course of diabetes was significant. HbA_1c and HOMA-IR were the risk factors for DEM. Conclusion there is serious visual field deficit in patients with DME, and micro-pulse laser therapy is helpful to the recovery of visual field. The course of diabetes and the degree of IR were increased and the risk of DME was increased.
【作者单位】：郑州人民医院眼科;郑州大学第一附属医院眼科;
【分类号】：R587.2;R779.63
【正文快照】： 糖尿病视网膜病变(DR)是糖尿病特异性慢性并发症之一,对我国10省的流行病学调查[1]显示,DR的患病率约为31.5%。糖尿病性黄斑水肿(DME)是导致DR患者视力衰退甚至致盲的主要原因之一,可发生于DR之前或DR发展进程中的任何阶段[2]。据报道[3],根据不同病程和糖尿病类型,DME的发病

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