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目的:观察577-nm多点激光用于新近诊断的增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)行全视网膜光凝(panretinal photocoagulation,PRP)的疗效。方法:该前瞻性对照研究共纳入32例40眼PDR患者,随机分为2组,每组16例患者(20眼)。第1组采用多点激光(pattern scan laser,PSL)行PRP治疗,第2组采用单点激光(single spot laser,SSL)治疗。所有患者在PRP治疗前与最后一次PRP治疗后3mo均行荧光素眼底血管造影检查(fundus fluorescein angiography,FFA),以判断是否存在无灌注区。激光点数、完成PRP的治疗次数、治疗时长以及患者在治疗时的疼痛程度均作为判断指标。结果:PSL组患者需3次治疗以完成PRP,而SSL组需4次完成。第1组每次治疗时间为7.3±2.3min,较第2组的时间(13.2±4.1min)明显缩短(t38=5.596,P<0.01)。第1组的治疗疼痛指数较第2组明显降低(P<0.01)。最后一次PRP治疗3mo后复查FFA,第1组有5眼(25%)出现无灌注区,而第2组有8眼(40%)出现无灌注区,需要进一步治疗。结论:多点激光用于PDR行PRP治疗较单点激光有着明显的优势。它具有效率高,治疗疼痛轻,疗效好的特点。
Objective: To observe the curative effect of 577-nm multipoint laser on newly diagnosed proliferative diabetic retinopathy (PDR) under panretinal photocoagulation (PRP). Methods: This prospective, controlled study enrolled 32 patients with 40 eyes of PDR and was randomly divided into two groups of 16 patients (20 eyes). Group 1 received PRP with pattern scan laser (PSL) and group 2 received single spot laser (SSL). All patients received fundus fluorescein angiography (FFA) 3 months before PRP treatment and 3 months after the last PRP treatment to determine whether there was no perfusion area. The number of laser points, the number of PRP treatments completed, the duration of treatment, and the degree of pain of the patient during treatment were all used as judgment indicators. RESULTS: Patients in the PSL group required 3 treatments to complete the PRP, whereas the SSL group required 4 to complete. The first treatment time was 7.3 ± 2.3min, which was significantly shorter than that of the second group (13.2 ± 4.1min) (t38 = 5.596, P <0.01). The pain index of the first group was significantly lower than that of the second group (P <0.01). FFA was reexamined 3 months after the last PRP treatment, with no perfusion area in 5 eyes (25%) in group 1 and no perfusion area in 8 eyes (40%) in group 2 requiring further treatment. Conclusion: Multi-point laser is more effective than single-point laser for PRP in PDR. It has the characteristics of high efficiency, light treatment and good curative effect.