激光光凝治疗进展期先天性视网膜劈裂症的疗效观察

目的 观察激光光凝治疗进展期先天性视网膜劈裂症（XLRS）的临床效果。方法 临床确诊为XLRS的27例患儿36只眼纳入研究。所有患儿均随访1年以上，其劈裂有缓慢发展但在随访期间未发生相关并发症。患儿均为男性。年龄3～12岁，平均年龄6.47岁。单眼18例，双眼9例。将患眼随机分为治疗组和对照组，每组18只眼。采用多波长激光机的氪黄激光对治疗组患眼劈裂周围行堤坝式激光光凝，避开黄斑与视盘周围1个视盘直径范围的区域。对照组患儿每隔半年门诊随访观察。两组患儿均随访3年，以末次随访为疗效判定时间点，观察患儿的最佳矫正视力（BCVA）及玻璃体积血、视网膜脱离等严重并发症的发生情况。BCVA检查结果换算为最小分辨角对数（logMAR）视力记录。结果 末次随访时，治疗组患眼平均logMAR BCVA为0.73±0.41，较治疗前无明显变化，差异无统计学意义（t=1.187，P=0.201）。对照组患眼平均logMAR BCVA为0.88±0.60，较治疗前也无明显变化，差异无统计学意义（t=1.895，P=0.098）。治疗组与对照组治疗前后患眼平均logMAR BCVA提高值比较，差异有统计学意义（t=-2.093，P=0.033）。治疗组18只眼中，视力提高4只眼，占22.2%；视力稳定10只眼，占55.6%；视力下降4只眼，占22.2%。对照组18只眼中，视力提高3只眼，占16.7%；视力稳定4只眼，占22.2%；视力下降11只眼，占61.1%。治疗组视力下降率较对照组明显降低，差异有统计学意义（χ²=5.600，P＜0.01）。治疗组18只眼中，出现严重并发症2只眼，占11.1%。对照组18只眼中，出现严重并发症7只眼，占38.9%。治疗组严重并发症发生率较对照组明显降低，差异有统计学意义（χ²=3.710，P＜0.05）。结论 激光光凝治疗进展期XLRS可稳定或提高患儿视力，防止严重并发症的发生。

Photocoagulation of X-linked congenital retinoschisis in progress stage

Objective To evaluate the outcomes of laser photocoagulation of congenital X-linked retinoschisis (XLRS) at progressive stage. Methods Twenty-seven cases (36 eyes) of XLRS sick kids were enrolled in this study. All patients were followed up for more than 1 year, retinoschisis has developed slowly but complications occurred during the follow-up. They are all boys from 3 to 12 years old; the average age was 6.47 years old. There were 18 unilateral cases, 9 bilateral cases. The affected eyes were randomly divided into treatment group and control group (n=18 eyes). The treatment group eyes received multi wavelength krypton yellow laser photocoagulation around the retinoschisis, but no laser spots were laid in a optic disk area surrounding the macular and optic disc. Children in the control group were followed up every six months without treatment. Both groups of children were followed up for 3 years. The best corrected visual acuity (BCVA, logMAR), complications (vitreous hemorrhage, retinal detachment) were measured at the last follow up. Results At the last follow-up, the treatment group mean logMAR BCVA was 0.73±0.41, which is the same as pre treatment BCVA (t=1.187, P=0.201). The control group mean logMAR BCVA 0.88 ± 0.60, which is the same as pre treatment BCVA (t=-2.093, P=0.033). The changes of the BCVA in these two groups was statistically different (t=-2.093, P=0.033). For the treated 18 eyes, visual acuity improved in four eyes (22.2%); not changed in 10 eyes (55.6%) and decreased in four eyes (22.2%). For the 18 eyes in the control group, visual acuity improved in three eyes (16.7%); not changed in four eyes (22.2%) and decreased in 11 eyes (61.1%). The vision reduction rate in treatment group was statistically less than the control group (χ²=5.600,P＜0.01). There were 2 eyes (11.1%) and 7 eyes (38.9%) with serious complications in the treated and control eyes respectively. The complication rate treatment group was statistically less than the control group (χ²=3.710，P＜0.05). Conclusion Laser photocoagulation can stabilize or improve vision of advanced XLRS patients, and prevent the occurrence of serious complications.