黄色微脉冲激光与传统格栅样激光光凝治疗糖尿病黄斑水肿疗效比较

目的 比较黄色微脉冲激光与传统格栅样激光光凝（MLG）治疗糖尿病黄斑水肿（DME）的临床疗效。方法 经荧光素眼底血管造影（FFA）及光相干断层扫描（OCT）检查确诊的弥漫性DME患者78例106只眼纳入研究。采用随机数字表法将患者分为微脉冲组和MLG组，分别为39例51只眼、39例55只眼。微脉冲组患者行577 nm黄色微脉冲激光治疗，MLG组行561 nm黄绿光连续波长激光光凝治疗。治疗前后所有患者均行眼底、矫正视力、OCT及微视野检查，检测其矫正视力、黄斑中心视网膜厚度（CMT）及黄斑10°范围内视网膜平均光敏感度（MS）。以治疗后6个月为疗效判定时间点，观察患者治疗前后平均矫正视力、平均CMT及平均MS的变化，对比分析治疗前后两组患者平均矫正视力、平均CMT及平均MS差值之间的差异。结果 治疗后6个月，微脉冲组、MLG组平均矫正视力分别为0.45±0.20、0.42±0.20，均较治疗前提高，差异有统计学意义（t=3.404、2.316，P＜0.05）。微脉冲组、MLG组组内治疗前后平均矫正视力的差值分别为0.08±0.02、0.06±0.03，两组差值比较，差异无统计学意义（t=0.532，P＞0.05）。治疗后6个月，微脉冲组、MLG组平均CMT分别为（323.94±68.30）、（355.85±115.88） μm，均较治疗前降低，差异有统计学意义（t=4.028、2.039，P＜0.05）。微脉冲组、MLG组组内治疗前后平均CMT的差值分别为（55.12±13.68）、（22.25±10.92） μm，两组差值比较，差异无统计学意义（t=1.891， P＞0.05）。治疗后6个月，微脉冲组、MLG组平均MS分别为（6.63±2.65）、（4.53±1.81） dB；微脉冲组平均MS较治疗前提高，差异有统计学意义（tt=3.335，P＜0.05）；MLG组平均MS较治疗前降低，差异也有统计学意义（t=3.589，P＜0.05）。微脉冲组、MLG组组内治疗前后平均MS的差值分别为（1.10±0.33）、（-0.91±0.25） dB，两组差值比较，差异有统计学意义（t=4.872，P＜0.05）。结论 黄色微脉冲激光和MLG治疗DME均能提高患者视力，降低CMT；但黄色微脉冲激光可提高患者MS，而MLG降低了患者MS。

Comparison of yellow micro pulse photocoagulation and traditional laser grid photocoagulation for diabetic macular edema

Objective To compare the clinical results of yellow micro-pulse laser and traditional laser grid (MLG) photocoagulation for diabetic macular edema (DME). Methods Seventy-eight patients (106 eyes) with DME diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in this study. The patients were divided into micro-pulse group (39 patients, 51 eyes) and MLG group (39 patients, 55 eyes). The patients of micro pulse group underwent 577 nm yellow micro-pulse laser therapy, while the patients of MLG group underwent continuous wavelength laser photocoagulation with a 561 nm yellow green laser. All the patients were examined documenting corrected visual acuity, macular retinal thickness (CMT) and mean sensitivity within macular 10 ° examination before and after treatment. Six months after treatment was considered as the judgment time for the therapeutic effects. The mean corrected visual acuity, CMT and MS were comparatively analyzed. Results Six months after treatment, the mean corrected visual acuity of micro pulse group and MLG group were 0.45±0.20 and 0.42±0.20, which increased significantly compared to those before treatment (t=3.404,2.316; P＜0.05). The difference of mean corrected visual acuity between before and after treatment of micro-pulse group and MLG group were 0.08±0.02 and 0.06±0.03, the difference was statistically significant between two groups (t=0.532, P＞0.05). The mean CMT of micro pulse group and MLG group were (323.94±68.30) and (355.85±115.88) μm, which decreased significantly compared to those before treatment (t=4.028, 2.039; P＜0.05). The difference of mean CMT between before and after treatment of micro-pulse group and MLG group were (55.12±13.68) and (22.25±10.92) μm. The difference was not statistically significant between two groups (t=1.891, P＞0.05). The mean MS of micro-pulse group and MLG group were (6.63±2.65) and (4.53±1.81) dB. The mean MS of micro-pulse group increased significantly compared to that before treatment(t=3.335, P＜0.05). The mean MS of MLG group decreased significantly compared to that before treatment (t=3.589, P＜0.05). The difference of mean MS between before and after treatment of micro-pulse group and MLG group were (1.10±0.33) and (-0.91±0.25) dB.The difference was statistically significant between groups (t=4.872，P＜0.05). Conclusions In the treatment of DME, yellow micro-pulse laser therapy and MLG can improve visual acuity, and reduce CMT. In addition, yellow micro-pulse laser therapy can improve the MS, but MLG reduces MS.