CAJ | 학술논문

目的探討出血偏多的缺血型视网膜静脉阻塞光凝方法及其疗效。方法采用Zeiss Lumenis NOVUS OMNI多波长激光仪，利用红光、大光斑、低能量、长时间对视网膜出血偏多的缺血型分支、半侧或中央静脉阻塞并黄斑水肿患者49人52只眼实施局部或全视网膜光凝。参数：黄斑区：0.1 ～0.3秒，光斑大小50～100 μm，能量100～200 mW,中心凹1000 μm外开始，Ⅰ级光斑反应；其余区域：0.3～0.7 s,200～500μm，150～300 mw,III级光斑轻-中强度反应，如光斑反应不足，则以增长时间为主，增加能量为辅；分2～4次完成，间隔2～3周。观察视网膜出血水肿消退及视力改变等情况，随访3～30个月。结果 (1)18只眼(34.62％)首次光凝2～3周后视网膜出血水肿明显消退，其中9只眼(17.31％)视力提高，8只眼(15.39％)视力不变，1只眼(1.92％)视力下降。激光后3个月FFA证实治疗有效。(2)31只眼(59.62％)首次光凝2～3周后视网膜出血水肿部分消退，全部光凝完成后3月，眼底出血水肿完全消退,FFA证实治疗有效。其中8只眼(15.38％)视力提高；20只眼(38.46％)视力保持不变；3只眼(5.77％)视力下降。(3)3只眼新生血管性青光眼患者，病情部分改善稳定。其余患者随访期内未新发生玻璃体出血及新生血管性青光眼。结论对出血偏多的缺血型视网膜静脉阻塞，可选用红光，使用大光斑、低能量、长时间的光凝方法，获得足够数量和强度的有效光斑，促进视网膜出血水肿吸收，减少病情恶化可能。
목적 탐토출혈편다적결혈형시망막정맥조새광응방법급기료효。방법 채용Zeiss Lumenis NOVUS OMNI다파장격광의，이용홍광、대광반、저능량、장시간대시망막출혈편다적결혈형분지、반측혹중앙정맥조새병황반수종환자49인52지안실시국부혹전시망막광응。삼수：황반구：0.1 ～0.3초，광반대소50～100 μm，능량100～200 mW,중심요1000 μm외개시，Ⅰ급광반반응；기여구역：0.3～0.7 s,200～500μm，150～300 mw,III급광반경-중강도반응，여광반반응불족，칙이증장시간위주，증가능량위보；분2～4차완성，간격2～3주。관찰시망막출혈수종소퇴급시력개변등정황，수방3～30개월。결과 (1)18지안(34.62％)수차광응2～3주후시망막출혈수종명현소퇴，기중9지안(17.31％)시력제고，8지안(15.39％)시력불변，1지안(1.92％)시력하강。격광후3개월FFA증실치료유효。(2)31지안(59.62％)수차광응2～3주후시망막출혈수종부분소퇴，전부광응완성후3월，안저출혈수종완전소퇴,FFA증실치료유효。기중8지안(15.38％)시력제고；20지안(38.46％)시력보지불변；3지안(5.77％)시력하강。(3)3지안신생혈관성청광안환자，병정부분개선은정。기여환자수방기내미신발생파리체출혈급신생혈관성청광안。결론 대출혈편다적결혈형시망막정맥조새，가선용홍광，사용대광반、저능량、장시간적광응방법，획득족구수량화강도적유효광반，촉진시망막출혈수종흡수，감소병정악화가능。
Objective To discuss the laser treatment method to the ischemic retinal vein occlusion (RVO) with more hemorrhage. Methods Fifty-two eyes in 49 cases suffering from ischemic RVO with more hemorrhage were treated with local or panretinal photocoagulation in red light, big spot size, long pulse duration and lower power. Results The hemorrhage and edema in the retina disappeared quickly in the 2-3 weeks after laser in 18 eyes (34.62％) and the visual acuity improved in 9 eyes (17.31％), no changes in 8 eyes (15.38％) and declined in 1 eye (1.92％). In 31 eyes (59.62％), the hemorrhage and edema disappeared partly in the 2-3 weeks after laser and it disappeared completely after 3 months and the visual acuity improved in 8 eyes (15.38％),no change in 20 eyes (38.46％) and declined in 3 eyes (5.77％). FFA verified that most of the nonperfusion areas covered over by photocoagulation and did not enlarged, the neovascular disappeared completely or partly. There were no new bleeding in vitreous and neovascular glaucoma in these patients during the follow up. In the 3 eyes with neovascular glaucoma, the condition had been controlled and stabilized in some extent. Conclusion In the ischemic retinal vein occlusion with more hemorrhage, the laser of red light,big spot size, long pulse duration and lower power can make effective photocoagulation and help the absorb of the hemorrhage and edema in the retina, reduce the incidence of serious complication such as vitreous bleeding and neovascular glaucoma.