糖化血红蛋白对577 nm阈下微脉冲激光治疗糖尿病黄斑水肿的影响

Effect of Glycosylated Hemoglobin on 577 nm Subthreshold Micro Pulse Laser in Treatment of Diabetic Macular Edema

摘要: 目的：探讨糖化血红蛋白对577 nm阈下微脉冲激光治疗糖尿病黄斑水肿的影响。方法：选择2013年5月~2017年9月在石河子大学医学院一附院眼科经散瞳眼底检查、眼底荧光素血管造影(Fluorescein Fundus Angiography, FFA)及光学相干断层扫描(Optical Coherence Tomography, OCT)检查确诊的DME患者62例(68眼)作为研究对象，激光术前三天糖化血红蛋白(HbA1c)的检测，根据HbA1c水平将糖尿病黄斑水肿分为低HbA1c组(HbA1c ≤ 7.0%) 32例(35眼)和高HbA1c组(HbA1c > 7.0%) 30例(33眼)，两组患者黄斑区均进行577 nm阈下微脉冲激光治疗两次，激光治疗前及治疗后1周，1月，2月，3月，自身对比及组间对比分析两组患者治疗前后最佳矫正视力(Best Corrected Visual Acuity, BCVA)、黄斑中心厚度(Central Macular Thickness, CMT)、黄斑总容积、黄斑10˚范围内视网膜光敏感度的变化。结果：低HbA1c组及高HbA1c组DME经577 nm阈下微脉冲激光治疗一月后黄斑容积，黄斑中心厚度降低，黄斑中心视网膜光敏感度，最佳矫正视力提高，较术前均有显著差异(P < 0.05)。术后两月，三月两组CMT、黄斑总容积部分增加，高HbA1c组增加更明显，较低HbA1c组有统计学意义。术后三月组间比较BCVA、黄斑中心视敏感度均有统计学意义(P < 0.05)。结论：微脉冲激光治疗糖尿病DME疗效肯定，糖化血红蛋白的良好控制有利于577 nm阈下微脉冲激光治疗效果的巩固。

Abstract: Objective: To explore the clinical value of glycosylated hemoglobin after 577 nm yellow micropulse laser in Diabetic Macular Edema. Methods: For examination of fundus, fluorescence fundus angiography and optical coherence tomography (OCT) examination of 62 patients (68 eyes) with DME were enrolled in this study from May 2013 to Sep 2017 in ophthalmology department of our hospital. All patients were divided into high HbA1c group (HbA1c > 7.0%) (30 patients with 33 eyes) and low HbA1c group (HbA1c ≤ 7.0%) (32patients with 35eyes) by detection of HbA1c values three days before the twice laser therapy. The total macular volume, central retinal thickness, best corrected visual acuity and central 10˚ visual acuity of the macula were observed before and 1 week, 1 mon, 2 mon, and 3 mon after 577 nm yellow micropulse laser therapy in two groups. Result: The total volume of macular retinal and the central retinal thickness of macular area in two groups (low HbA1c group and high HbA1c group) with DME decreased significantly after a month by 577 nm yellow micro pulse laser treatment. The macular central retinal photosensitivity and the best corrected visual acuity in two groups improved significantly after a month by laser treatment. These were significantly different from those before laser treatment (P < 0.05). In two and three months, the total volume of macular retinal and the central retinal thickness of macular area in two groups increased again partially and the increase was more obvious in the high HbA1c group and statistically significant with the low HbA1c group. The best corrected visual acuity and central visual acuity of macula were statistically significant between the two groups at 3 months after laser treatment (P < 0.05). Conclusion: The effect of 577 nm yellow micro pulse laser for DME is positive, and the good control of glycosylated hemoglobin is conducive to the continuation of the therapeutic effect of micro-pulse laser.