单点与多点扫描模式激光治疗糖尿病视网膜病变疗效比较

目的：:分析比较单点与多点扫描模式全视网膜激光光凝术（PRP）对非增殖性糖尿病视网膜病变（NPDR）患者的疗效及对视网膜结构和功能的影响。方法：:回顾性系列病例研究。选择2019年1月至2020年7月在青岛市市立医院被确诊为重度NPDR后行PRP治疗且随访6个月以上的患者57例（93眼）。其中27例（46眼）行单点扫描...

Comparing the Effect of Single-Point and Multi-Point Scanning Laser Photocoagulation on Patients with Diabetic Retinopathy

Objective: To analyze and compare the effect of single-point and multi-point scanning mode for panretinal photocoagulation (PRP) on retinal structure and function in patients with non-proliferative diabetic retinopathy (NPDR). Methods: In a retrospective case series study, 57 patients (93 eyes) who were clinically diagnosed as severe NPDR and treated with PRP in Qingdao Municipal Hospital from January2019 to July 2020 were analyzed retrospectively. Among them, PRP was performed on 27 patients (46 eyes) in single point scanning mode for 3-4 times as a control group. Thirty patients (47 eyes) underwent 532 nm multi-point scanning mode as an observation group, and PRP was performed twice. The therapeutic efficiency rate was calculated based on best corrected visual acuity. Pain was scored according to the numerical rating scale (NRS) on the day after laser treatment. The laser energy, the number of laser spots and the energy density were compared between the two groups. To observe the therapeutic effects, the mean sensitivity in the 30°-60° visual field, a/b-wave amplitude of F-ERG, and the central macular thickness (CMT) were compared between the two groups at 1 day, 1 month, 3 months, and 6 months after treatment. The non-perfusion area (NPA) was measured at 1 day preoperatively and neovascularization based on fundus fluorescein angiography (FFA) was observed at 6 months after treatment. Data were analyzed by a chi-square test, independent-samples t test and repeated measurements analysis of variance. Results: The effective rates of the control group and the observation group were 80% and 85%. The difference was not statistically significant (χ2 =0.36, P=0.55). The postoperative pain score of the observation group was significantly lower than that of control group (t=6.84, P<0.001). There were significant differences in laser energy and energy density between the two groups (t=0.24, P=0.02; t=12.84, P<0.001), but there was no significant difference in the number of laser spots between the two groups. One month and 3 months after treatment, the mean sensitivity in the 30°-60° visual field, a-wave amplitude of F-ERG and the central macular thickness range of the control group and the observation group were significantly different from parameters 1 day before treatment (P<0.001). The amplitudes of the F-ERG b waves at 1 month, 3 months and 6 months after treatment were significantly lower than those before treatment (P<0.001). There was no significant difference in NPA 1 day preoperatively. FFA at postoperative 6 months showed no neovascularization or obvious non-perfusion areas in either group. Conclusions: There is no difference in retinal structure and function in patients with severe NPDR treated with 532 nm single-point laser and multi-point scanning mode at 6 months postoperatively. However, the multi-point scanning mode can improve the compliance of patients with a shorter treatment time and less pain.