目的：探讨利用577nm阈值下微脉冲激光治疗糖尿病性黄斑水肿(DME)的临床效果。

方法：回顾性分析48例64眼DME患者临床资料，行577nm阈值下微脉冲激光术者26例35眼，行传统格栅样激光术者22例29眼。比较术前及术后1、3、6mo时BCVA(LogMAR)、黄斑中心凹视网膜厚度(CFT)、平均光敏感度(MS)及平均视野缺损(MD)变化，分析两组患者眼底硬性渗出持续时间及并发症。

结果：术后1、3、6mo时，两组视力(0.30±0.09 vs 0.35±0.10、0.19±0.07 vs 0.26±0.09、0.13±0.04 vs 0.18±0.05)及CFT(349.26±21.80μm vs 364.37±23.91μm、314.46±20.49μm vs 335.07±22.68μm、328.35±21.74μm vs 352.43±23.60μm)均较术前下降，且观察组明显低于同一时间对照组(均P<0.05)； 观察组MS、MD水平均较术前提升，且明显高于同一时间对照组5.83±1.16dB vs 4.22±1.04dB、6.38±1.29dB vs 4.49±1.17dB、6.75±1.22dB vs 4.68±1.20dB，-5.53±1.41dB vs -7.66±1.52dB、-5.09±1.30dB vs -7.26±1.39dB、-4.68±1.14dB vs-7.05±1.26dB)(均P<0.05)。观察组眼底硬性渗出持续时间明显少于对照组(3.39±0.80mo vs 4.25±1.14mo)(P<0.05)。术后6mo内，观察组眼球疼痛发生率明显低于对照组[3%(1/35)vs 24%(7/29)](P<0.05)，而前房炎性反应、视野缺损、高眼压及角膜水肿发生率比较均无差异(P>0.05)。

结论：577nm阈值下微脉冲激光术治疗DME安全有效。

METHODS: The clinical data of 48 patients with DME(64 eyes)were retrospectively analyzed. The patients with micro-pulse laser at 577nm threshold were included in observation group(26 cases, 35 eyes), and the patients who underwent conventional grid-like laser were included in control group(22 cases, 29 eyes). The best corrected visual acuity(BCVA)(LogMAR visual acuity chart), central macular foveal thickness(CFT), mean tetinal sensitive(MS)and mean visual deviation(MD)were compared before surgery and at 1, 3 and 6mo after surgery. And duration of fundus hard exudate and the occurrence of complications after surgery were analyzed in the two groups.

RESULTS: At 1, 3 and 6mo after surgery, the LogMAR visual acuity test results and CFT levels in the two groups were significantly decreased compared with those before surgery, and the indexes in observation group were significantly lower than those in control group at the same time(0.30±0.09 vs 0.35±0.10, 0.19±0.07 vs 0.26±0.09, 0.13±0.04 vs 0.18±0.05; 349.26±21.80 μm vs 364.37±23.91μm, 314.46±20.49μm vs 335.07±22.68μm, 328.35±21.74μm vs 352.43±23.60μm)(all P<0.05). Compared with preoperative, the MS and MD levels in observation group were significantly increased, and significantly higher than that in control group at the same time(5.83±1.16dB vs 4.22±1.04dB, 6.38±1.29dB vs 4.49±1.17dB, 6.75±1.22dB vs 4.68±1.20dB, -5.53±1.41dB vs -7.66±1.52dB, -5.09±1.30dB vs -7.26±1.39dB, -4.68±1.14dB vs -7.05±1.26dB)(all P<0.05). The duration of fundus hard exudate in observation group was significantly lower than that in control group(3.39±0.80mo vs 4.25±1.14mo)(P<0.05). Within 6mo after surgery, the incidence rate of eyeball pain in observation group was significantly lower than that in control group \〖3%(1/35)vs 24%(7/29)\〗(P<0.05), but there were no statistically significant differences in the incidence rates of anterior chamber inflammatory response, visual field defect, intraocular hypertension and corneal edema.

CONCLUSION: Micro-pulse laser at 577nm threshold is safe and effective for DME.