山东大学耳鼻喉眼学报 ›› 2024, Vol. 38 ›› Issue (2): 18-25.doi: 10.6040/j.issn.1673-3770.0.2023.313
周静琳,李金香,曾琦
ZHOU Jinglin, LI Jinxiang, ZENG Qi
摘要: 目的 探讨577 nm阈值下微脉冲激光(subthrehold micropulse laser photocoagulation, SMLP)联合玻璃体腔注射康柏西普(intravitreal conbercept, IVC)与单纯IVC治疗难治性糖尿病性黄斑水肿(diabetic macular edema, DME)的临床疗效。 方法 本研究为非随机对照研究。选取2022年1月至2022年12月在湖南省人民医院眼科就诊的难治性DME患者,将入选病例分为实验组(共10例,16眼)和对照组(共12例,17眼)。实验组采用577 nm SMLP联合IVC治疗,对照组采用单纯IVC治疗。收集两组治疗基线及随访6个月每月的最佳矫正视力(best corrected visual acuity, BCVA)、黄斑中心视网膜厚度(central macular thickness, CMT)、硬性渗出面积(hard exudates, HE)及微血管瘤数量(microangioma, MA)的变化情况以及玻璃体腔注药次数,观察两组患者治疗后并发症的发生情况。 结果 治疗6个月后,实验组、对照组LogMAR BCVA分别为0.300(0.100,0.400)、0.400(0.300,0.600),两者差异具有统计学意义(t=-2.575,P=0.015);CMT分别为237.00(230.75,254.75)μm、263.00(237.00,341.50)μm,两者差异具有统计学意义(t=-2.252,P=0.035);HE[411.50(72.25, 8 757.50)pixels2] vs. [3 000.00(10.00,6 604.00)pixels2 ]和MA[1.00(0.00,7.25)个]vs.[2.00(1.00,8.00)个]差异均无统计学意义(t=0.766, P=0.452; t=-0.861, P=0.400)。实验组、对照组的注药次数分别为(4.6±0.2)次、(5.3±0.2)次,差异具有统计学意义(t=-2.182,P=0.039)。实验组577 nm SMLP治疗6个月后患眼眼底检查无明显色素沉积和激光瘢痕。实验组与对照组在治疗6个月后均未见明显并发症发生。 结论 577 nm SMLP具有较好的安全性。577 nm SMLP联合IVC与单纯IVC治疗对比,在针对难治性DME患者的HE面积和出血点、MA的数量改善方面具有同等的效果,但联合治疗能在短期内更好地减轻部分患者的黄斑水肿,提升BCVA,并且延长玻璃体腔注药间隔时间,减少玻璃体腔注药频次,具有一定的临床应用前景。
中图分类号:
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