摘要目的:观察全黄斑覆盖微脉冲激光治疗继发于Irvine-Gass综合征的难治性黄斑水肿的临床疗效和安全性。方法:回顾性病例研究。2018年4月至2019年11月于北京医院眼科检查确诊的Irvine-Gass综合征患者21例24只眼纳入研究。其中，女性11例12只眼，男性10例12只眼；平均年龄（54.5±10.1）岁。患眼均行最佳矫正视力（BCVA）、光相干断层扫描（OCT）检查。BCVA采用标准对数视力表进行，记录时将结果转换为最小分辨角对数（logMAR）视力。采用频域OCT仪测量患眼中心凹视网膜厚度（CMT）和直径1、6 mm黄斑区视网膜容积（MRV）。患眼均行577 nm阈值下微脉冲激光治疗，光斑直径200 μm，曝光时间200 ms，功率400 mW，负载系数5%。治疗范围为黄斑上下血管弓内，覆盖全黄斑（包括黄斑中心凹）。治疗后1、3个月，对仍存在黄斑水肿的患眼行2次微脉冲激光治疗，方法同前。治疗后1、3、6个月采用与治疗前相同的设备和方法行相关检查。观察患眼BCVA、CMT、MRV变化以及并发症发生情况。结果:治疗前及治疗后1、3、6个月患眼平均logMAR BCVA分别为0.440±0.320、0.333±0.286、0.250±0.245、0.166±0.184，平均CMT分别为（395.88±79.21 ）、（349.17±78.07）、（317.67±53.72）、（285.29±37.03）μm；直径1、6 mm平均MRV分别为（0.310±0.063）、（0.275±0.060）、（0.245±0.035）、（0.221±0.219 ）mm 3和（9.866±0.846）、（9.494±1.002）、（9.005±0.885）、（8.190±0.850）mm 3。与治疗前比较，治疗后1、3、6个月患眼BCVA明显提高（ t=5.060、5.564、6.466），CMT明显下降（ t=4.854、5.777、7.349 ），差异均有统计学意义（ P<0.01）；直径1、6 mm平均MRV均明显下降，差异有统计学意义（直径1 mm： t=4.527、5.394、7.380， P<0.01；直径6 mm： t=4.577、7.980、11.209， P<0.01 ）。患眼平均微脉冲激光治疗次数1.25次。 结论:全黄斑覆盖微脉冲激光可以安全有效治疗继发于Irvine-Gass综合征的难治性黄斑水肿。

abstractsObjective:To observe the clinical efficacy and safety of full macular coverage micropulse laser in the treatment of refractory macular edema secondary to Irvine-Gass syndrome.Methods:A retrospective case study. From April 2018 to November 2019, 21 cases of Irvine-Gass syndrome patients with 24 eyes were included in the study. Among them, there were 11 females with 12 eyes and 10 males with 12 eyes; the average age was 54.5±10.1 years. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA was performed using a standard logarithmic visual acuity chart, and the results were converted into the logarithmic minimum angle of resolution (logMAR) visual acuity when recording. The frequency domain OCT instrument was used to measure the foveal retinal thickness (CMT) and the retinal volume (MRV) of the macular area with a diameter of 1, 6 mm. All the affected eyes were treated with a micropulse laser under the threshold of 577 nm, with a spot diameter of 200 μm, an exposure time of 200 ms, a power of 400 mW, and a 5% duty cycle. The treatment scope was in the upper and lower vascular arches of the macula, covering the entire macula (including the fovea). One or 3 months after treatment, the eyes with macular edema were treated twice with micropulse laser, the method was the same as before. 1, 3, and 6 months after the treatment, the same equipment and methods as before the treatment were used for related inspections. The changes of BCVA, CMT, MRV and the occurrence of complications in the affected eye were observed.Results:The average logMAR BCVA of the eyes before treatment and 1, 3, and 6 months after treatment were 0.440±0.320, 0.333±0.286, 0.250±0.245, 0.166±0.184, and the average CMT were 395.88±79.21, 349.17±78.07, 317.67±53.72, 285.29±37.03 μm, respectively; the average MRV of diameter 1, 6 mm were 0.310±0.063, 0.275±0.060, 0.245±0.035, 0.221±0.219 mm 3 and 9.866±0.846, 9.494±1.002, 9.005±0.885, 8.190±0.850 mm 3. Compared with before treatment, the BCVA of the eyes at 1, 3, and 6 months after treatment was significantly increased ( t=5.060, 5.564, 6.466), and CMT was significantly decreased ( t=4.854, 5.777, 7.349), and the differences were statistically significant ( P<0.01); the average MRV of diameters 1, 6 mm decreased significantly, and the difference was statistically significant (1 mm diameter: t=4.527, 5.394, 7.380; P<0.01; diameter 6 mm: t=4.577, 7.980, 11.209; P<0.01). The average number of micropulse laser treatments for the affected eye was 1.25 times. Conclusion:Full macular coverage micropulse laser can safely and effectively treat refractory macular edema secondary to Irvine-Gass syndrome and can be used as an alternative treatment.