摘要目的 观察视网膜激光光凝治疗对糖尿病视网膜病变(DR)黄斑区功能和形态变化的影响.方法 30例重度非增生型DR患者40只眼,在视网膜激光光凝治疗前及治疗后2、7、14 d,分别进行多焦视网膜电图(mfERG)及光相干断层扫描(OCT)检查,采用方差分析及t检验对其检查结果进行统计学分析,对比观察激光光凝治疗前后患者黄斑功能及黄斑中心凹厚度的变化情况.结果 激光光凝治疗后2 d,mfERG P1波反应密度在1、3、5环分别为(131.79±50.92)、(37.50±17.27)、(24.07±11.49),与手术前(212.96±53.75)、(46.70±15.89)、(30.91±10.78)比较,差异有统计学意义(t=7.910,2.174,2.205;P＜0.05);NI波反应密度在1环为(60.39±20.69),与治疗前(107.11±44.63)相比,差异有统计学意义(t=5.375,P＜0.01);P1波潜伏期在4环为(41.83±3.41),与治疗前(39.52±2.64)比较,差异有统计学意义(t=-2.770,P＜0.05).治疗后7 d,黄斑中央5°区域P1波、N1波的反应密度有所同升,至治疗后14 d分别上升至(179.70±47.10)、(81.11±34.18),但仍较治疗前(212.96±53107.11±44.63)有显著降低(t=3.840,2.746;P＜0.05);4环的P1波潜伏期在治疗后7 d时为(41.78±3.57),与治疗前(39.52±2.64)相比,仍有显著延迟(t=-3.144,P＜0.01);至治疗后14 d,与治疗前相比差异无统计学意义(t=-1.809,P＞0.05);1环的N1波潜伏期在治疗后7 d时为(20.67±3.85),与治疗前(18.78±3.29)相比,差异无统计学意义(t=-1.171,P＞0.05).激光光凝治疗前,黄斑中心凹厚度为(224.42±122.88),激光光凝后2 d黄斑中心凹厚度与治疗前相比差异有统计学意义(t=-2.420,P＜0.05),治疗后14 d时黄斑中心凹厚度与治疗前相比差异无统计学意义(t=-0.578,P＞0.05).黄斑中央5°区域P1波反应密度与黄斑中心凹厚度在激光光凝前和激光光凝后7 d呈显著负相关(r=-0.755,-0.594;P＜0.05).结论 DR视网膜激光光凝后,黄斑功能出现一定程度的降低,黄斑区视网膜功能与黄斑区组织形态的改变关系密切;mfERG和OCT联合应用可更加全面地对黄斑功能及黄斑断面的组织形态结构进行客观的评价.

abstractsObjective To investigate the influence of photocoagulation on macular function and morphous in patients with diabetic retinopathy (DR).Methods Forty eyes of thirty patients with severe non-proliferative diabetic retinopathy (NPDR) were examined by multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) before and 2,7,and 14 days after photocoagulation.The results were statistically analyzed by using analysis of variance and t test;the changes of macular function and macular fovea thickness were detected and observed.Results P1 response densities of ring 1,3,and 5 were 131.79±50.92,37.50±17.27,24.07±11.49,respectively,2 days after photocoagulation;and were 212.96±53.75,46.70±15.89,and 30.91±10.78,respectively,before photocoagulation.The densities before and after photocoagulation differed much(t=7.910,2.174,2.205;P＜0.05).N1 response density of ring 4 was(60.39±20.69) and the pre-photocoagulation corresponding response density was ( 107.11±44.63);the difference was significant(t=5.375,P＜0.01).The latency of P1 of ring 4 was(41.83±3.41),which had significant statistically difference (t=-2.770,P＜0.05 ) with that before photocoagulation ( 39.52±2.64);there was no significant changes in the latency of N1 (P＞0.05).The most significant changes of P1 and N1 response densities occurred in the central macular 5° area.Seven days after photocoagulation,the response density of P1 and N1 in the central macular 5° area seemed to be recoverd to some extend and increased to (179.70±47.10)and (81.11±34.18) respectively until 14 days after photocoagulation,which was still much lower than that before the photocoagulation (t=3.840,2.746;P＜0.05) ;the response densities of other areas had no significant differences (P＞0.05).Seven days after photocoagulation,the latency of P1 in ring 4 was delayed to(41.78±3.57),which had significant difference(t =-3.144,P＜0.01)with that before the photocoagulation(39.52±2.64);but there was no significant difference between 14 days after photocoagulation and pre-photocoagulation (t=-1.809,P＞0.05).The latency of N1 in ring 1 was(20.67±3.85) at seven days after photocoagulation,It had no significant difference (t=-1.171,P＞0.05) with that before the phtocoaguation( 18.78±3.29).Before and 2 days after photocoagulation,the macular fovea thickness were(224.42±122.88)and(274.85±108.20)respectively,and the difference was statistically significant (t=-2.120,P＜0.05 ).Forteen days after photocoagulation,the macular fovea thickness was(236.29±70.45),It had no significant difference with that before the photocoagulation(t=-0.578,P＞0.05).Before and seven days after photocoagulation,P1 response density had obvious negative correlation with corresponding macular fovea thickness ( r=-0.755,P＜0.01;r =-0.594,P＜0.05 ).Conclusions After photocoagulation in patients with DR,the macular function decreased in a certain degree,and the relationship of macular retinal function and macular morphology changes was close;combination of mfERG and OCT can evaluate macular function and macular morphology structure comprehensively and objectively.