全视网膜光凝治疗不同阶段缺血型视网膜中央静脉阻塞的疗效分析

Efficiency of panretinal photocoagulation in treatment of ischemic central retinal vein occlusion at different stages

摘要:

目的 评价全视网膜光凝（PRP）治疗对不同阶段缺血型视网膜中央静脉阻塞（CRVO）的疗效。方法 2011年6月至2014年4月来上海交通大学医学院附属仁济医院眼科门诊通过视功能、裂隙灯、扩瞳眼底及眼底荧光血管造影（FFA）检查诊断为缺血型CRVO的患者，根据激光治疗时是否存在虹膜新生血管（INV）将患者分为无INV的A组（34眼）和已出现INV的B组（7眼）。所有患者均接受PRP治疗，并根据病情变化和FFA的结果在随访中予补充光凝。随访6个月～3年，平均（19.3±8.5）个月，观察PRP在减少和预防缺血型CRVO严重并发症及光凝等方面的差异。结果 A、B两组患者在发病年龄上差异无统计学意义（P＞0.05）。经PRP治疗后，B组患者最终的激光次数和总光凝点数均显著多于A组（P＜0.05）；B组患者新生血管性青光眼（NVG）的发生率较高（P＜0.05），但两组间的玻璃体出血（VH）的发生率差异无统计学意义（P＞0.05）；两组患者在治疗前后的视力差异无统计学意义（P＞0.05）。结论 本研究提示缺血型CRVO患者在没有出现INV之前进行PRP，最终严重并发症的发生率相对较低，所需光凝次数和点数均较少。

Abstract:

Objective To evaluate the therapeutic effect of panretinal photocoagulation (PRP) in the treatment of ischemic central retinal vein occlusion (CRVO) at different stages. Methods From June 2011 to April 2014, all the patients with ischemic CRVO diagnosed in our department by visual function, slit-lamp biomicroscopy, funduscopy under dilated pupil and fluorescein angiography were recruited in this study. Before PRP, the cohort was divided into 2 groups according to the existence of iris neovascularization (INV), that is, group A (34 eyes without INV) and group B (7 eyes with INV). All patients received standard PRP treatment in a period of 2 to 3 weeks, and the additional laser treatments were given during the follow-up period based on the results of fundus fluorescein angiography (FFA) or clinical manifestations. They were followed up for 6 months to 3 years [(19.3±8.5) months]. The incidence of severe complications and the times of laser treatment were observed and compared between the 2 groups. Results There was no statistical difference in the term of age of onset between the 2 groups (P＞0.05). When PRP finished, the times of laser treatment and the total number of laser spots needed were significantly greater in group B than those in group A (P＜0.05). The incidence of neovascular glaucoma (NVG) was obviously higher in group B (P＜0.05), but there was no statistical difference in vitreous hemorrhage (VH) between the 2 groups (P＞0.05). No significant difference was found in the visual acuity before and after treatment in both groups (P＞0.05). Conclusion For ischemic CRVO, the incidence of severe complications is relatively low, and the times of laser treatment and the total number of laser spots are also less when PRP is performed before the occurrence of INV.