全視網膜光凝術對重度NPDR與早期PDR患者視盤周圍視網膜RNFL厚度的影響

華絨利，陳 輝

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·臨床研究·

全視網膜光凝術對重度NPDR與早期PDR患者視盤周圍視網膜RNFL厚度的影響

華絨利，陳 輝

?METHODS: Fifty-six cases were diagnosed as diabetic eye disease in our hospital from Jan.2014 to Dec.2015. According to the actual condition, the patients were divided into early PDR group and severe NPDR group. The two groups were given the whole retinal photocoagulation.

?RESULTS: The upper part of the severe NPDR group was (114.26±18.26)μm, which significantly higher than that of postoperative (105.55±11.73)μm (t=2.085,P=0.042). The lower part was (118.85±20.16)μm, which significantly higher than that of (107.37±16.38)μm (t=2.296,P=0.026). Preoperative nasal side, the temporal side was slightly higher than the postoperative, but the difference was not statistically significant (P>0.05). The average thickness was (90.16±14.81)μm, which significantly lower than that of (99.85±17.28)μm (t=2.212,P=0.031). The upper part of the PDR group was significantly lower than that before operation, and the difference was statistically significant (P<0.01). At the nasal side, the temporal side was slightly lower than the preoperative, the difference between two groups was not statistically significant (P>0.05). The average thickness was (87.58±16.08)μm, which significantly lower than that before operation (97.17±13.46)μm (t=2.463,P=0.017). There was no significant difference in the average thickness of the temporal and the early PDR group (P>0.05) in the upper and lower sides of the severe group NPDR after 6mo. The nasal side of severe NPDR group was (66.29±9.36)μm, which significantly higher than that in early PDR group (59.88±11.71)μm, and the difference was statistically significant (t=2.252,P=0.028).

?CONCLUSION: Laser photocoagulation has a significant influence on the thickness and the average thickness of the upper and lower quadrant of the retina, which leads to the thinning of retinal RNFL, and the clinical attention should be paid to the injury of retinal nerve cells.

目的：研究全視網膜光凝術(PRP)對重度非增生性糖尿病視網膜病變(non-proliferative diabetic retinopathy，NPDR)與早期增生性糖尿病視網膜病變(proliferative diabetic retinopathy，PDR)患者的視盤周圍視網膜神經纖維層(retinal nerve fiber layer，RNFL)厚度影響。

方法：選取我院2014-01/2015-12門診部確診為糖尿病眼病患者56例，根據實際病情分為早期PDR組和重度NPDR組，兩組均給予PRP。

結果：重度NPDR組術前上方為114.26±18.26μm，明顯高于術后的105.55±11.73μm，差異有統計學意義(t=2.085，P=0.042)；術前下方為118.85±20.16μm，明顯高于術后的107.37±16.38μm，差異有統計學意義(t=2.296，P=0.026)；術前鼻側、顳側略高于術后，但差異均無統計學意義(P>0.05)；術后平均厚度為90.16±14.81μm，明顯低于術前(99.85±17.28μm)，差異有統計學意義(t=2.212，P=0.031)；早期PDR組術后上方、下方均明顯低于術前，差異有統計學意義(P<0.01)；術后鼻側、顳側均略低于術前，兩組差異均無統計學意義(P>0.05)；術后平均厚度為87.58±16.08μm，明顯低于術前(97.17±13.46μm)，差異有統計學意義(t=2.463，P=0.017)；重度NPDR組術后6mo的上方、下方、顳側與平均厚度與早期PDR組差異均無統計學意義(P>0.05)；重度NPDR組術后6mo鼻側為66.29±9.36μm，明顯高于早期PDR組(59.88±11.71μm)，差異有統計學意義(t=2.252，P=0.028)。

結論：PRP對視網膜上下象限厚度及平均厚度影響較為顯著，導致視網膜RNFL變薄，臨床應注意PRP對視網膜神經細胞的損傷。

全視網膜激光光凝術；糖尿病視網膜病變；重度非增生性DR；早期增生性DR

引用：華絨利，陳輝.全視網膜光凝術對重度NPDR與早期PDR患者視盤周圍視網膜RNFL厚度的影響.國際眼科雜志2016;16(12):2261-2263

0引言

糖尿病眼病為糖尿病常見并發癥之一，嚴重糖尿病眼病常為視網膜病變，可造成視力衰退甚至失明，糖尿病視網膜病變(diabetic retinopathy，DR)已成為僅次于老年性視網膜變性之后的四大致盲因素之一[1]。目前全視……