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目的探讨糖尿病性黄斑水肿(DME)与视野缺失的相关性并观察微脉冲激光治疗的效果。方法选取糖尿病视网膜病变(DR)患者117例(149眼),根据美国糖尿病视网膜病变早期治疗研究小组(ETDRS)DME诊断标准,分为DME组50例(70眼)和N-DME组67例(79眼)。选取体检健康者40名(80眼)作为正常对照(NC)组。收集各组临床资料和生化指标并进行视野检查。另将DME组分为微脉冲激光亚组和传统激光亚组,各35眼,观察激光治疗后1个月、3个月、6个月、9个月、12个月视野恢复状况。结果 DME组糖尿病病程、FPG、HbA1c及HOMA-IR高于N-DME组(P<0.05)。各组可置信因子RF<15%,提示检查结果可靠。DME组和N-DME组平均缺陷值(MD指数)[(7.81±0.75)vs(4.32±0.67)vs(1.14±0.22)dB]、视野丢失方差(LV)[(20.17±4.85)vs(15.34±3.19)vs(4.72±1.11)dB]及视野的刺激丢失方差值(sLV)[(10.71±1.37)vs(7.22±1.12)vs(2.35±0.41)dB]水平均高于NC组,且DME组高于N-DME组(P<0.01)。自治疗后3个月起,微脉冲激光亚组MD指数、LV、及sLV水平均较治疗前降低,且均低于传统激光亚组(P<0.05)。传统激光亚组各时间点MD指数、LV及sLV水平比较,差异均无统计学意义(P>0.05)。多元Logistic回归分析发现,糖尿病病程、FPG、HbA_1c及HOMA-IR为DEM的危险因素(P<0.01)。结论 DME患者存在严重的视野缺失,微脉冲激光治疗有助于视野恢复,而传统激光治疗对其无明显效果。糖尿病病程及IR程度增加,FPG、HbA1c升高,均增加DME的发生风险。
Objective To investigate the correlation between diabetic macular edema (DME) and visual field loss and to observe the effect of micropulse laser treatment. Methods A total of 117 patients (149 eyes) with diabetic retinopathy (DR) were enrolled in this study. According to the DME diagnostic criteria of the American Diabetic Retinopathy Early Treatment Study Group (ETDRS), 50 patients (70 eyes) and 67 N-DME 79 eyes). Forty healthy subjects (80 eyes) were selected as normal control (NC) group. The clinical data and biochemical indexes of each group were collected and examined by field of vision. Another DME group was divided into micro-pulsed laser subgroup and conventional laser subgroup, each 35 eyes. The recovery of visual field at 1 month, 3 months, 6 months, 9 months and 12 months after laser treatment was observed. Results The duration of diabetes, FPG, HbA1c and HOMA-IR in DME group were higher than those in N-DME group (P <0.05). Confidence in each group factor RF <15%, suggesting that the test results are reliable. The average defect value (MD index) [(7.81 ± 0.75) vs (4.32 ± 0.67) vs (1.14 ± 0.22) dB] in the DME group and the N-DME group were lower than those in the DM group [(20.17 ± 4.85) vs (15.34 ± 3.19 vs 4.72 ± 1.11 dB and sLV [(10.71 ± 1.37) vs (7.22 ± 1.12) vs (2.35 ± 0.41) dB] were higher than those in NC group DME group was higher than N-DME group (P <0.01). From 3 months after treatment, the MD index, LV, and sLV levels in the micropulse laser subgroup were lower than those before treatment, and both were lower than those in the conventional laser subgroup (P <0.05). There was no significant difference in MD index, LV and sLV between the traditional laser subgroup at each time point (P> 0.05). Multivariate logistic regression analysis found that diabetes duration, FPG, HbA_1c and HOMA-IR were risk factors for DEM (P <0.01). Conclusion There is a serious field of vision loss in patients with DME. Micropulse laser treatment can help to restore visual field, while traditional laser treatment has no obvious effect on it. Diabetes and IR increased the degree of course, FPG, HbA1c increased, all increased the risk of DME.