激光光凝治疗缺血型视网膜静脉阻塞的疗效分析

目的 观察氩激光光凝对缺血型视网膜静脉阻塞（ischemic retinal vein occlusion，IRVO)性新生血管的预防和治疗效果。 方法 本院眼底病组门诊及住院的IRVO缺血型患者244例268只眼经日产Topcon50VT相机荧光素眼底血管造影（fundus fluorescein angiography, FFA）确诊。以新生血管的有无分为预防组和治疗组。2组患者均以下述相同的条件进行治疗：用美国产hgm型氩离子激光器、绿兰混合光，光斑200~500 μm，时间0.1~0.5 s,功率0.3~1.0 w，III级轻、中度反应，激光光凝覆盖全部无灌注区，分别在激光光凝术后3、24周行FFA复查，如有新的或光凝不全的无灌注区则进行补充光凝，2组患者均以光凝后半年行检眼镜及FFA观察的结果为准。 结果 预防性激光光凝组160只眼，激光中光凝后仅17只眼产生了新生血管，占10.6%；143 只眼未发生新生血管，占89.4%。治疗性激光光凝组行激光光凝治疗的108只眼中，激光光凝后69只眼新生血管萎缩，占63.9%；39只眼激光光凝无效，占36.1%。III级反应一个光斑直径间隔的密度疗效优于II~III级反应1.5个光斑直径间隔和II级或低于II级反应2个光斑直径间隔的密度 ，相比差异有显著性的意义（P＜0.01）。 结论 氩激光对IRVO新生血管的预防性激光光凝和治疗性激光光凝均有明显的效果，预防性激光光凝更有意义；III级反应的激光光凝能量和一个光斑的间隔密度是治疗IRVO性新生血管的较佳参数。 （中华眼底病杂志，2003，19：201-268）

The photocoagulated effect on ischemic retinal vein occlusion by argon laser

Objective To observe the preventive and therapeutic effect of different times, spot reactions and spot density of argon laser photocoagulation on retinal neovas cularization of ischemic retinal vein occlusion (IRVO).Meth9al of 244 patients (268 eyes) with IRVO diagnosed by fundus fluorescein angiography (FFA) were treated by HGM argon laser photocoagulator with green-blue light with 200~500 μm lightspot, 0.1~0.5 s, 0.3~1.0 w, and II~III class spot reaction . All capillary nonperfusion areas (CNA) were photocoagulated, and so were the retinal neovascularization in some patients. The follow up periods were from 6 to 60 months. After 3 and 24 weeks after photocoagulation FFA was performed again. Photocoagulation was performed supplementarilly for the new CNA or incompletely photocoagulated areas. Ophthalmoscopic examination and FFA were performed in all the patients after half a year.Results Only 17 eyes (10.6%) with neovascularization were found after preventive photocoagulation in 160 eyes in non-neovacularization group. Sixty-nine eyes(63.9%) with neovascular atrophy and 39 eyes (36 .1%) with unsuccessful photocoagulation were found after therapeutic photocoagulation in 108 eyes in neovascularization group. There was statistical significance between the two groups (P＜0.01). Photocoagulation energy with reaction of III class and density of 1 lightspot diameter was more effective than which with reaction of II~III class and density of 1.5 lightspot diameter or reaction of ≤II class and density of 2 lightspot diameter (P＜0.01). Conclusion Efficacy of preventive photocoagulation is better than which of therapeutic photocoagulation. Photocoagulation energy with reaction of III class and density of 1 lightspot diameter is an effective method for IRVO.(Chin J Ocul Fundus Dis，2003，19：201-268)