摘要　目的　观察中药和黄斑区网格样光凝术对视网膜分支静脉阻塞后黄斑区水肿的治疗效果。方法　将患者随机分为观察组(21例,23只眼)和对照组(20例,22只眼)，分别采用中药加黄斑区网格样光凝术和单纯黄斑区网格样光凝术进行治疗，并从视力、黄斑区水肿及黄斑区水肿消退的时间观察疗效。结果　观察组的总有效率明显高于对照组，眼底黄斑区水肿的吸收好于对照组；达到最好疗效的时间也比对照组短。结论　对视网膜分支静脉阻塞黄斑水肿用中药加黄斑区网格样光凝术明显优于单纯黄斑区网格样光凝术的疗效。

　　A clinical observation of Laser combined with traditional Chinese medicine on the treatment of macular edema with branch retinal vein occlusion

　　Wei Chun hui　Wei Wei

　　Department of Ophthalmology,Affiliated Hospital of Nanjing Railway Medical College,Jiangsu 210009,China

　　Abstract OBJECTIVE　To observe the efficacy of grid pattern photocoagulation combined with traditional Chinese medicine on macular edema with branch retinal vein occlusion.METHODS　All patients were divided into observed group (21cases,23eyes) treated with grid pattern photocoagulation combined with traditional Chinese medicine,the contralled group (20cases,22eyes) treated with grid pattern photocoagulation only;The results were observed according to vision improving, subsiding of macular edema and the time of subsiding of macular edema.RESULTS　The total efficacious rate in observed group is higher than the contralled group,and in controlled group the absorbing of macular edema is better and the time is shorter.CONCLUSION　Effect of grid pattern photocoagulation combined with traditional Chinese medicine is better than that of grid pattern photocoagulation only in the treatment of macular edema with branch retinal vein occulation.

　　To observe the efficacy of grid pattern photocoagulation combined with traditional Chinese medicine on macular edema with branch retinal vein occlusion.METHODS　All patients were divided into observed group (21cases,23eyes) treated with grid pattern photocoagulation combined with traditional Chinese medicine,the contralled group (20cases,22eyes) treated with grid pattern photocoagulation only;The results were observed according to vision improving, subsiding of macular edema and the time of subsiding of macular edema.RESULTS　The total efficacious rate in observed group is higher than the contralled group,and in controlled group the absorbing of macular edema is better and the time is shorter.CONCLUSION　Effect of grid pattern photocoagulation combined with traditional Chinese medicine is better than that of grid pattern photocoagulation only in the treatment of macular edema with branch retinal vein occulation.

　　Key words　laser traditional Chinese medicine retina vein occlusion macular

　　视网膜分支静脉阻塞是中老年人常见的、一种严重危害视力的眼底疾病，黄斑区水肿的发生是其影响视力的主要原因之一〔1〕，黄斑区激光光凝是目前较为有效的治疗方法〔2〕，我们在此基础上结合中药治疗取得了更好的治疗效果，总结如下。

　　1　资料和方法

　　1.1　临床资料

　　所有病例均为两家医院1996年至1999年6月所收治，共41例45只眼，其中男22例24只眼；女19例21只眼。发病年龄40～65岁，发病时间均在2～3个月。

　　1.2　病例选择

　　在门诊选择病史为2～3个月；眼底检查有黄斑区水肿并经荧光素眼底血管造影(FFA)确认存在黄斑区荧光渗漏或荧光潴留；视力低于0.5；无影响视力的其它疾病的患者随机分为观察组和对照组。两组在病变情况、发病年龄等方面相比差异无显著性，见表1～表3。

　　表1　两组患者年龄分布

　　表2　两组患者治疗前视力分布

　　表3　两组伴有黄斑区囊样改变比较

　　1.3　分组及治疗方法

　　对照组：采用黄斑区网格样光凝术。用氪黄或氩绿激光，光斑100μm，曝光时间0.1秒，功率以产生轻度灰白色光凝斑为度，光凝斑之间间隔1个光斑直径，范围从中心凹外2PD至中心凹外1/3PD(500μm)，保留黄斑乳头束。一般光凝1次，特殊情况间隔1～2周后再进行1次。

　　观察组：同样采用黄斑区网格样光凝术，同时口服中药，主要药物有太子参、茯苓、猪苓、赤小豆、泽泻、红花等，服药时间2～6周。

　　2　结果

　　2.1　疗效标准

　　显效：视力提高3行以上或达到0.8，或/和黄斑区水肿完全消退；有效：视力提高2～3行，或/和黄斑区水肿明显消退；无效：视力无明显提高，黄斑区水肿未见消退，甚至出现囊样改变及板层裂孔。

　　2.2　临床疗效

　　两组总有效率比较见表4，两组达到最好疗效的时间比较见表5，两组黄斑区水肿消退情况比较见表6。观察组在各方面均优于对照组，差异有显著性。

　　表4　两组疗效比较

　　表5　两组达到最好疗效的时间比较

　　表6　两组黄斑区水肿消退眼数比较

　　3　讨论

　　视网膜分支静脉阻塞之后发生的黄斑区水肿，以及其后导致的黄斑区囊样变性、板层裂孔等一系列病变，是其影响视力的主要原因，由于黄斑区网格样光凝能够促进神经上皮下液体的吸收，减少新的毛细血管渗漏，是现在普遍采用的治疗方法〔2〕。我们在临床上发现中药对于黄斑区水肿也有一定的治疗效果，因此将两者结合进行治疗，并与单纯激光治疗进行了对比，结果激光结合中药明显优于传统的治疗方法。

　　观察组总有效率明显高于单纯激光治疗对照组，尤其是显效者明显增加；黄斑区水肿吸收情况明显好于对照组；进一步产生黄斑区囊样变性、板层裂孔等并发症的可能性显著减少；达到最好疗效时间也比对照组短。

　　中药与激光治疗之所以取得这样的效果，主要是因为在网格状光凝之后，以健脾利水为主的中药，改善了视网膜缺氧状态，减轻了整个视网膜水肿，促进了视网膜下积液的吸收。所以说中药是从整体上改善了视网膜所处的环境，因而总体上取得更好的治疗效果。

　　参考文献

　　1.李凤鸣，主编.眼科全书.北京：人民卫生出版社，1996.2232

　　2.李绍珍，主编.眼科手术学.北京：人民卫生出版社，1997.955