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目的探讨多点扫描矩阵激光对重度非增殖性糖尿病性视网膜病变(nonproliferative diabetic retinopathy,NPDR)的疗效及优势。方法重度NPDR患者40例40只眼,根据光学相干断层扫描(optical coherence tomography,OCT)检查结果分为两大组,分别为重度NPDR伴有临床意义黄斑水肿组(clinical significant macular edema,CSME)(A组)和重度NPDR不伴有黄斑水肿组(non-macular aredema,NE)(B组),每组20只眼。A组内又随机分为2个小组,实验组(A1组)采用多点扫描矩阵激光完成全视网膜光凝,10只眼;对照组(A2组)采用传统单点扫描激光完成全视网膜光凝,10只眼;B组也以同样的方法分为实验组(B1组)和对照组(B2组)。所有患者均于治疗开始前以及治疗结束后1个月、3个月、6个月接受眼压、最佳矫正视力、OCT和微视野仪(microperimetry-1,MP-1)的检查;术后1年时接受眼底荧光素血管造影(fluorescein fundus angiography,FFA)检查。结果 CSME组(A组)中:实验组(A1组)的黄斑厚度、最佳矫正视力、黄斑区光敏度较治疗前无明显变化(P>0.05);对照组(A2组)的黄斑厚度较治疗前明显增加(P<0.05),A2组最佳矫正视力较治疗前明显下降(P<0.05),A2组黄斑区光敏度较治疗前无明显变化(P>0.05)。NE组(B组)中:实验组(B1组)的最佳矫正视力、黄斑厚度和黄斑区光敏度较治疗前均无明显变化(P>0.05);对照组(B2组)的最佳矫正视力、黄斑区光敏度较治疗前均有不同程度的下降(P<0.05),黄斑厚度较治疗前有增加(P<0.05)。术后1年时,所有患眼均未发现视网膜新生血管。结论多点扫描矩阵激光能有效的减轻传统单点扫描激光对黄斑视功能的影响,在远期疗效上具有一致的有效性。
Objective To investigate the efficacy and advantages of multi-spot scanning matrix laser in the treatment of severe nonproliferative diabetic retinopathy (NPDR). Methods 40 patients (40 eyes) with severe NPDR were divided into two groups according to the results of optical coherence tomography (OCT). They were severe NPDR with clinical significant macular edema (CSME) Group A) and severe NPDR were not associated with macular edema (NE) (Group B), 20 eyes each. Group A was divided into two subgroups randomly. The experimental group (group A1) used multi-point scanning matrix laser to complete panretinal photocoagulation (10 eyes). The control group (A2 group) received the traditional single-point scanning laser to complete the whole retinal photocoagulation , 10 eyes. Group B was also divided into experimental group (group B1) and control group (group B2) in the same way. All patients underwent intraocular pressure (IOP), best corrected visual acuity (OCT), and microperimetry-1 (MP-1) at the beginning of treatment and at 1, 3 and 6 months after the end of treatment. At 1 year, fundus fluorescein angiography (FFA) was performed. Results In the CSME group (group A), the macular thickness, the best corrected visual acuity and the macular area photosensitivity in the experimental group (group A1) were not significantly different from those before treatment (group A) (P> 0.05) (P <0.05). The best corrected visual acuity in group A2 was significantly lower than that before treatment (P <0.05). There was no significant change in the macular area of group A2 before treatment (P> 0.05). In the NE group (group B), the best corrected visual acuity, the macular thickness and the macular sensitivity of the experimental group (group B1) had no significant changes compared with those before treatment (group B) (P> 0.05) The visual acuity and the macular area had a decreased degree of photosensitivity (P <0.05), and the macular thickness increased compared with that before treatment (P <0.05). At 1 year after surgery, no retinal neovascularization was found in all affected eyes. Conclusion Multi-point scanning matrix laser can effectively reduce the impact of traditional single-point laser on macular function and has the same efficacy in long-term efficacy.