【摘要】 目的观察577 nm微脉冲激光(MPL)治疗不同类型糖尿病黄斑水肿(DME)的疗效。方法回顾性分析2017年9月至2019年10月,经MPL治疗的DME患者37例48只眼。所有患者治疗前后均行眼光学相干断层扫描(OCT)检查,DME按照OCT图像分为两类:弥漫性视网膜增厚型糖尿病黄斑水肿(DRT-DME),黄斑囊样水肿型糖尿病黄斑水肿(CME-DME)。分别比较治疗前后黄斑中心凹直径6 mm视网膜容积(6mmRV)与黄斑中心凹视网膜厚度(CRT)的变化。通过t检验对两组年龄、治疗前6mmRV、CRT、随访时间比较。χ~2检验判断不同类型DME对于MPL治疗是否存在疗效上的差异。结果总计纳入48眼,DRT-DME共27眼,CME-DME共21眼。以6mmRV变化作为判定标准:48眼中治疗有效的共18眼,总体有效率为37.50%。DRT-DME有效14眼,有效率为51.85%。CME-DME判定为有效的4眼,有效率为19.05%。两类DME有效率差异有统计学意义(χ~2=5.424,P=0.02)。以CRT变化作为判定标准:判定为有效的共6眼,总体有效率为12.50%。其中DRT-DME判定为有效的4眼,有效率为14.81%。CME-DME判定为有效的2眼,有效率为9.52%。两类DME有效率差异无统计学意义(χ~2=0.302,P=0.58)。结论 MPL治疗可以减轻DME;MPL治疗DRT-DME、CME-DME对前者视网膜容积的改善更为明显,两者CRT的改善程度无明显差异。更多还原

【Abstract】 Objective To observe the efficacy of 577 nm micropulse laser(MPL) in treating different types of diabetic macular edema(DME). Methods In a retrospective analysis, 37 patients(48 eyes), from September 2017 to October 2019, with DME treated by MPL were examined by SD-OCT before and after treatment. According to OCT images, DME cases were divided into two types: diffused retinal thickening diabetic macular edema(DRT-DME), cystoid macular edema diabetic macular edema(CME-DME). Retinal volume(RV) changes of 6 mm macular fovea and Central Retinal thickness(CRT) before and after treatment were compared. The effective rate of MPL on different types of DME was analyzed, and the difference in the therapeutic effect of MPL on different types of DME was judged. T test was used to compare the age, 6 mm RV, CRT, and follow-up time before treatment between the two groups. χ~2 test to determine whether there is a difference in efficacy between different DME types for MPL treatment. Results Among the 48 eyes, there were 27 eyes of DRT-DME and 21 eyes of CME-DME. Taking the change of 6 mmRV as the criterion: 18 eyes were effective among 48 eyes, the overall effective rate was 37.50%. 14 eyes of DRT-DME were effective after treatment, and the effective rate was 51.85%. 4 eyes of CME-DME were effective after treatment, and the effective rate was 19.05%. There was a statistically significant difference in the effective rate between the two groups after MPL treatment(χ~2=5.424, P=0.02). Taking the change of CRT as the criterion 6 eyes were effective among 48 eyes, and the overall effective rate was 12.50%. 4 eyes of DRT-DME were effective after treatment, and the effective rate was 14.81%. 2 eyes of CME-DME were effective after treatment with an effective rate of 9.52%. There was no significant difference in efficiency between the two groups(χ~2=0.302, P=0.58). Conclusion MPL therapy can alleviate DME. Compared with CRT, 6 mmRV is a more comprehensive evaluation index of efficacy. MPL is more effective in treating DRT-DME than CME-DME; MPL treatment for DRT-DME and CME-DME showed no significant difference in CRT improvement.更多还原