不同激光参数治疗糖尿病视网膜病变的疗效分析

发布时间：2018-02-15 13:46

本文关键词： 糖尿病视网膜病变激光光凝术激光参数　出处：《河南科技大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的观察由低能量小光斑所产生的II级光斑、高能量大光斑所产生的III级光斑这两种治疗方法下,激光光凝术对各级糖尿病视网膜病变(DR)的近期临床疗效。探讨低能量小光斑光凝治疗DR是否既能取得很好的疗效,又能减轻光凝引起的不良反应。方法选取我院经荧光素眼底血管造影(FFA)确诊的DR患者120例228只眼纳入研究。其中,中度非增生级(NPDR)60只眼,重度非增生级(NPDR)92只眼,增生级(PDR)76只眼。术前行血压、空腹血糖、糖化血红蛋白、血脂等全身检查和详细的眼科检查,包括裸眼视力、验光、眼压、眼前节裂隙灯检查、视野、视觉诱发电位(VEP)、视网膜电图(ERG)、眼底彩照和眼底荧光血管造影(FFA)检查。然后分为两组,A组用低能量小光斑进行光凝,B组用高能量大光斑进行光凝。对A、B两组中的中度NPDR行次全视网膜激光光凝(Sub-PRP),重度NPDR及PDR行全视网膜光凝(PRP)。术后3个月做与术前相同的检查,将两组术后治疗结果及并发症进行比较并进行统计学分析。结果 1.中度NPDR、重度NPDR光凝后,两组视力比较无统计学意义(X2=0.373,0.276,P0.05)。PDR光凝后,两组视力比较有统计学意义(X2=6.373,P0.05)。 2.中度及重度NPDR光凝后,两组视网膜病变改善情况比较无统计学意义(X2=0.741,0.449,P0.05)。PDR光凝后视网膜病变改善情况两组比较有统计学意义(X2=10.431,P0.05)。 3.中度NPDR、重度NPDR光凝前后视野比较:术前中心30°与周边60°两组间比较,无统计学意义(t中心30°=0.684,t周边60°=0.692,P0.05),术后中心30°与周边60°两组间比较,有统计学意义(t中心30°=2.818,t周边60°=2.591,P0.05),说明A、B两组间视野改变有差异。 4.中度NPDR、重度NPDR光凝前后F-ERG比较:术前a波振幅(aA)、b波振幅(bA)、a波潜时(aT)、b波潜时(bT)两组间比较,无统计学意义(t=0.695,0.824,0.676,0.803,P0.05);术后aA、bA两组间比较,有统计学意义(t=4.15,4.87,P0.05);术后aT、bT两组间比较,没有统计学意义(t=0.738,0.813,P0.05)。说明A、B两组间aA、bA改变有差异。5.中度NPDR、重度NPDR光凝前后P-VEP比较:术前P波振幅(AP100)、P波潜伏时(LP100)两组比较,无统计学意义(t=0.771,0.665,P0.05),术后AP100、LP100两组比较,无统计学意义(t=0.874,1.246,P0.05),说明A、B两组间VEP改变没有差异。结论 1.中度和重度NPDR患者光凝术后,II级光斑与III级光斑在视力和视网膜病变改善上可以取得同样的效果,对视野、VEP、ERG影响较小,并发症少。 2.PDR患者光凝后,III级光斑取得比II级光斑更好的疗效。 3.在DR的光凝治疗上,应根据患者的病情轻重程度采用不同的光斑反应级别进行光凝,不能一味的为了避免减少并发症而影响治疗效果。
[Abstract]:Objective to observe the effects of two kinds of treatment methods: class II light spot produced by low energy small spot and III grade light spot produced by high energy large spot. The short term clinical effect of laser photocoagulation on various levels of diabetic retinopathy (DRR). To explore whether low energy and small spot photocoagulation can not only obtain good effect but also reduce the adverse reaction caused by photocoagulation. Methods A total of 228 eyes of 120 patients with Dr diagnosed by fluorescein fundus angiography (FFAA) were enrolled in the study, including 60 eyes with moderate nonproliferative grade NPDRD, 92 eyes with severe nonproliferative grade NPDRN, 76 eyes with proliferative grade PDR and 76 eyes with proliferative grade PDR. General examination of glycosylated hemoglobin, blood lipids and detailed ophthalmic examination, including naked vision, optometry, intraocular pressure, slit lamp examination, visual field, Visual evoked potential (VEP), electroretinogram (ERG), fundus color and fundus fluorescein angiography (FFAA) were examined. Subtotal retinal laser photocoagulation was performed with subretinal laser photocoagulation (NPDR), severe NPDR and PDR were performed with total retinal photocoagulation, and the same examinations were performed 3 months after operation. The results and complications of the two groups were compared and statistically analyzed. Results. 1. After moderate NPDR, severe NPDR photocoagulation, there was no significant difference in visual acuity between the two groups. After photocoagulation, the visual acuity of the two groups was significantly higher than that of the control group. 2.After moderate and severe NPDR photocoagulation, there was no significant difference in the improvement of retinopathy between the two groups. 3. Comparison of visual field before and after photocoagulation in moderate NPDR and severe NPDR: there was no significant difference between the preoperative center 30 掳and peripheral 60 掳, there was no statistical significance between the two groups. There was no significant difference between the two groups. There was no statistical significance between the two groups. There was no statistical significance between the two groups. There was no statistical significance between the two groups, the postoperative center was 30 掳and the peripheral 60 掳, and there was no significant difference between the two groups. There was significant difference in visual field between group A and group A (30 掳/ 2.818 t, 60 掳/ 2.591), indicating that there was a difference in visual field between the two groups. 4. Comparison of F-ERG before and after photocoagulation of severe NPDR: there was no significant difference between the two groups in the amplitude of a wave before photocoagulation and before photocoagulation. There was no significant difference between the two groups in terms of the amplitude of a wave before and after photocoagulation. There was no statistical significance between the two groups in terms of t 0.695n 0.824 ~ 0.6760.803P 0.055.After operation, there was a significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups. There was no statistical significance between the two groups. There was no significant difference between the two groups. 5. Moderate NPDRs, P-VEP comparison before and after severe NPDR: P wave amplitude before and after photocoagulation: there was no significant difference between the two groups in the amplitude of P wave before and after photocoagulation. There was no significant difference between the two groups, and there was no significant difference between the two groups, and there was no significant difference between the two groups. There was no significant difference in VEP between the two groups. Conclusion. 1. The improvement of visual acuity and retinopathy in moderate and severe NPDR patients was the same as that in III grade. The effect on visual field was less and the complications were less. 2. After photocoagulation, the grade III spot of PDR was better than that of grade II. 3. In the photocoagulation therapy of Dr, different light spot reaction grade should be adopted according to the severity of the patient's condition, and the therapeutic effect should not be affected blindly in order to avoid the complication.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R587.2;R774.1

【参考文献】