激光光凝治疗视网膜静脉阻塞的临床研究

发布时间：2019-02-18 21:50

【摘要】： 目的：评价氩激光光凝治疗不同时期视网膜静脉阻塞(retinal vein occlusion, RVO)的临床疗效；探讨氩激光光凝治疗视网膜静脉阻塞的临床时机和光斑设置。 方法：回顾性分析我院自2008年2月-2009年7月应用日本KOWA眼底荧光血管造影(fundus fluorescein angiography,FFA)确诊RVO的患者111例(111眼),其中CRVO患者40例(40眼),HCRVO患者13例(13眼),BRVO患者58例(58眼)。根据FFA的观察,将出现毛细血管无灌注区但尚未有新生血管生成的58眼作为预防性光凝组,将出现新生血管的53眼作为治疗性光凝组。其中预防性光凝组58眼中CRVO者21眼,BRVO者30眼,HCRVO者7眼。治疗性光凝组53眼中CRVO者19眼,BRVO者28眼,HCRVO者6眼；将两组患者行视网膜激光光凝术,术后第1,3,6个月后复查,行视力、最佳矫正视力、裂隙灯、眼底及FFA检查。如果FFA发现新的或光凝不及无灌注区和新生血管未消退则给予补充光凝。两组均以6个月后的复查结果为评价标准。所有患者资料均经SPSS统计软件进行统计学处理。 结果：(1)预防性光凝组58眼光凝后51眼未出现新生血管,占87.9%,7眼出现新生血管,占12.1%,其中一眼出现新生血管性青光眼；治疗性光凝组53眼光凝后末次随访48眼新生血管萎缩,占90.6%；5眼治疗无效,占9.4%,其中一眼出现新生血管性青光眼；两组比较疗效无明显差异。(2)两组CRVO患者光凝治疗前后视力均较差,无明显差别；HCRVO患者视力预后较CRVO稍好；BRVO患者光凝后视力预后较好。患者光凝后视力水平与静脉阻塞的类型密切相关。(3)预防性光凝组Ⅱ级光斑与Ⅲ级光斑治疗无显著性差异；治疗性光凝组中Ⅲ级光斑反应1个光斑直径间隔密度优于Ⅱ级光斑反应1.5光斑直径间隔密度；结论：(1)氩激光光凝在抑制和减少RVO引起的眼内新生血管方面有显著疗效；当新生血管出现时进行光凝治疗是RVO患者激光治疗的较佳时机；预防性光凝可以降低新生血管或者新生血管性青光眼的发生率,但是并不能完全阻止新生血管或者新生血管性青光眼的出现。(2)光凝可不同程度改善视功能,但视力提高程度与视网膜静脉阻塞的类型密切相关。(3)光斑设置：RVO患者出现新生血管之后应给予Ⅲ级光斑；未出现新生血管的RVO患者应给予Ⅱ级光斑。
[Abstract]:Objective: to evaluate the clinical efficacy of argon laser photocoagulation in the treatment of retinal vein occlusion (retinal vein occlusion, RVO) at different stages, and to explore the clinical timing and spot setting of argon laser photocoagulation in the treatment of retinal vein occlusion (RVO). Methods: 111 patients (111 eyes) with KOWA fundus fluorescein angiography (fundus fluorescein angiography,FFA) in our hospital from February 2008 to July 2009 were analyzed retrospectively. Among them, 40 cases (13 eyes) with), HCRVO were diagnosed by CRVO. 58 cases (58 eyes) with BRVO. According to FFA, 58 eyes with no capillary perfusion but no neovascularization were used as prophylactic photocoagulation group and 53 eyes with neovascularization as therapeutic photocoagulation group. In the prophylactic photocoagulation group, 21 eyes were CRVO, 30 eyes were BRVO and 7 eyes were HCRVO. In the therapeutic photocoagulation group, 19 eyes were CRVO, 28 eyes BRVO, and 6 eyes HCRVO. Retinal laser photocoagulation was performed in both groups, and the visual acuity, best corrected visual acuity, slit lamp, fundus and FFA were examined 3 months after operation. If new or photocoagulation is found in FFA without perfusion and neovascularization does not recede, supplemental photocoagulation is given. The two groups were evaluated by the results after 6 months. All patient data were statistically processed by SPSS statistical software. Results: (1) in the prophylactic photocoagulation group, there were no neovascularization in 51 eyes (87.9 eyes), the neovascularization in 7 eyes (12.1%), and neovascular glaucoma appeared in one eye. In the therapeutic photocoagulation group, 48 eyes were followed up for the last time after 53 eyes, accounting for 90.6%, 5 eyes were ineffective and 9.4%, neovascularization glaucoma appeared in one eye. There was no significant difference between the two groups. (2) the visual acuity of the two groups before and after photocoagulation treatment of CRVO patients were poor, there was no significant difference; the visual acuity prognosis of HCRVO patients was slightly better than that of CRVO, and that of BRVO patients after photocoagulation was better. The level of visual acuity after photocoagulation was closely related to the type of vein occlusion. (3) there was no significant difference in the treatment of grade 鈪，

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