本文關鍵詞： 糖尿病視網(wǎng)膜病變 激光光凝術 激光參數(shù)　出處：《河南科技大學》2011年碩士論文　論文類型：學位論文

【摘要】：目的觀察由低能量小光斑所產生的II級光斑、高能量大光斑所產生的III級光斑這兩種治療方法下,激光光凝術對各級糖尿病視網(wǎng)膜病變(DR)的近期臨床療效。探討低能量小光斑光凝治療DR是否既能取得很好的療效,又能減輕光凝引起的不良反應。 方法選取我院經(jīng)熒光素眼底血管造影(FFA)確診的DR患者120例228只眼納入研究。其中,中度非增生級(NPDR)60只眼,重度非增生級(NPDR)92只眼,增生級(PDR)76只眼。術前行血壓、空腹血糖、糖化血紅蛋白、血脂等全身檢查和詳細的眼科檢查,包括裸眼視力、驗光、眼壓、眼前節(jié)裂隙燈檢查、視野、視覺誘發(fā)電位(VEP)、視網(wǎng)膜電圖(ERG)、眼底彩照和眼底熒光血管造影(FFA)檢查。然后分為兩組,A組用低能量小光斑進行光凝,B組用高能量大光斑進行光凝。對A、B兩組中的中度NPDR行次全視網(wǎng)膜激光光凝(Sub-PRP),重度NPDR及PDR行全視網(wǎng)膜光凝(PRP)。術后3個月做與術前相同的檢查,將兩組術后治療結果及并發(fā)癥進行比較并進行統(tǒng)計學分析。 結果 1.中度NPDR、重度NPDR光凝后,兩組視力比較無統(tǒng)計學意義(X2=0.373,0.276,P0.05)。PDR光凝后,兩組視力比較有統(tǒng)計學意義(X2=6.373,P0.05)。 2.中度及重度NPDR光凝后,兩組視網(wǎng)膜病變改善情況比較無統(tǒng)計學意義(X2=0.741,0.449,P0.05)。PDR光凝后視網(wǎng)膜病變改善情況兩組比較有統(tǒng)計學意義(X2=10.431,P0.05)。 3.中度NPDR、重度NPDR光凝前后視野比較:術前中心30°與周邊60°兩組間比較,無統(tǒng)計學意義(t中心30°=0.684,t周邊60°=0.692,P0.05),術后中心30°與周邊60°兩組間比較,有統(tǒng)計學意義(t中心30°=2.818,t周邊60°=2.591,P0.05),說明A、B兩組間視野改變有差異。 4.中度NPDR、重度NPDR光凝前后F-ERG比較:術前a波振幅(aA)、b波振幅(bA)、a波潛時(aT)、b波潛時(bT)兩組間比較,無統(tǒng)計學意義(t=0.695,0.824,0.676,0.803,P0.05);術后aA、bA兩組間比較,有統(tǒng)計學意義(t=4.15,4.87,P0.05);術后aT、bT兩組間比較,沒有統(tǒng)計學意義(t=0.738,0.813,P0.05)。說明A、B兩組間aA、bA改變有差異。5.中度NPDR、重度NPDR光凝前后P-VEP比較:術前P波振幅(AP100)、P波潛伏時(LP100)兩組比較,無統(tǒng)計學意義(t=0.771,0.665,P0.05),術后AP100、LP100兩組比較,無統(tǒng)計學意義(t=0.874,1.246,P0.05),說明A、B兩組間VEP改變沒有差異。 結論 1.中度和重度NPDR患者光凝術后,II級光斑與III級光斑在視力和視網(wǎng)膜病變改善上可以取得同樣的效果,對視野、VEP、ERG影響較小,并發(fā)癥少。 2.PDR患者光凝后,III級光斑取得比II級光斑更好的療效。 3.在DR的光凝治療上,應根據(jù)患者的病情輕重程度采用不同的光斑反應級別進行光凝,不能一味的為了避免減少并發(fā)癥而影響治療效果。
[Abstract]:Objective to observe the effects of two kinds of treatment methods: class II light spot produced by low energy small spot and III grade light spot produced by high energy large spot. The short term clinical effect of laser photocoagulation on various levels of diabetic retinopathy (DRR). To explore whether low energy and small spot photocoagulation can not only obtain good effect but also reduce the adverse reaction caused by photocoagulation. Methods A total of 228 eyes of 120 patients with Dr diagnosed by fluorescein fundus angiography (FFAA) were enrolled in the study, including 60 eyes with moderate nonproliferative grade NPDRD, 92 eyes with severe nonproliferative grade NPDRN, 76 eyes with proliferative grade PDR and 76 eyes with proliferative grade PDR. General examination of glycosylated hemoglobin, blood lipids and detailed ophthalmic examination, including naked vision, optometry, intraocular pressure, slit lamp examination, visual field, Visual evoked potential (VEP), electroretinogram (ERG), fundus color and fundus fluorescein angiography (FFAA) were examined. Subtotal retinal laser photocoagulation was performed with subretinal laser photocoagulation (NPDR), severe NPDR and PDR were performed with total retinal photocoagulation, and the same examinations were performed 3 months after operation. The results and complications of the two groups were compared and statistically analyzed. Results. 1. After moderate NPDR, severe NPDR photocoagulation, there was no significant difference in visual acuity between the two groups. After photocoagulation, the visual acuity of the two groups was significantly higher than that of the control group. 2.After moderate and severe NPDR photocoagulation, there was no significant difference in the improvement of retinopathy between the two groups. 3. Comparison of visual field before and after photocoagulation in moderate NPDR and severe NPDR: there was no significant difference between the preoperative center 30 擄and peripheral 60 擄, there was no statistical significance between the two groups. There was no significant difference between the two groups. There was no statistical significance between the two groups. There was no statistical significance between the two groups. There was no statistical significance between the two groups, the postoperative center was 30 擄and the peripheral 60 擄, and there was no significant difference between the two groups. There was significant difference in visual field between group A and group A (30 擄/ 2.818 t, 60 擄/ 2.591), indicating that there was a difference in visual field between the two groups. 4. Comparison of F-ERG before and after photocoagulation of severe NPDR: there was no significant difference between the two groups in the amplitude of a wave before photocoagulation and before photocoagulation. There was no significant difference between the two groups in terms of the amplitude of a wave before and after photocoagulation. There was no statistical significance between the two groups in terms of t 0.695n 0.824 ~ 0.6760.803P 0.055.After operation, there was a significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups. There was no statistical significance between the two groups. There was no significant difference between the two groups. 5. Moderate NPDRs, P-VEP comparison before and after severe NPDR: P wave amplitude before and after photocoagulation: there was no significant difference between the two groups in the amplitude of P wave before and after photocoagulation. There was no significant difference between the two groups, and there was no significant difference between the two groups, and there was no significant difference between the two groups. There was no significant difference in VEP between the two groups. Conclusion. 1. The improvement of visual acuity and retinopathy in moderate and severe NPDR patients was the same as that in III grade. The effect on visual field was less and the complications were less. 2. After photocoagulation, the grade III spot of PDR was better than that of grade II. 3. In the photocoagulation therapy of Dr, different light spot reaction grade should be adopted according to the severity of the patient's condition, and the therapeutic effect should not be affected blindly in order to avoid the complication.
【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R587.2;R774.1

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