【摘要】 目的：通过分析142例多波长激光治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)的效果，讨论多波长激光在治疗BRVO中的重要意义。方法：通过对142例142眼BRVO患者应用美国科医人公司生产的多波长氪激光仪进行光凝治疗，在3mo后进行视力、眼压、裂隙灯、眼底镜及FFA检查，总结分析视力变化、视网膜出血吸收情况、黄斑水肿吸收情况。结果：经激光光凝治疗后3mo，出血吸收原面积的1/2以上者51眼(35.9%)，吸收1/2～3/4者62眼(43.7%)，吸收3/4至完全吸收者29眼(20.4%)，同时，黄斑水肿完全吸收33眼(23.2%)，黄斑水肿明显吸收96眼(67.6%)，黄斑水肿轻度吸收或无变化13眼(9.2%)。治疗3mo后复查FFA，发现新生血管完全消退占有新生血管患者的71.2%，部分消退者占28.6%，无变化或加重仅占0.2%。结论：不失时机的应用多波长氪激光光凝治疗BRVO能明显提高视力，促进视网膜出血和黄斑水肿的吸收，同时可预防严重并发症的产生。
【关键词】 视网膜光凝;视网膜分支静脉阻塞;多波长激光
Therapeutic efficacy of polywavelength krypton lasers in branch retinal vein occlusion
XueLong Teng,YaNa Wang,RuiXia Sun
Department of Ophthalmology，Xinji Fuming Eye Hospital，Xinji 052360，Hebei Province,China
Correspondence to: XueLong Teng. Department of Ophthalmology, Xinji Fuming Eye Hospital，Xinji 052360，Hebei Province,China. [email protected]
Received:20100623 Accepted:20100719
Abstract
AIM: To observe the therapeutic effect of polywavelength krypton lasers on the branch retinal vein occlusion (BRVO)，and discuss its therapeutic significance for treatment of BRVO.
METHODS: One hundred and fortytwo patients 142 eyes with BRVO were treated with polywavelength krypton lasers. The changes in visual acuity, IOP were observed, and slitlamp, ophthalmoscope, FFA were applied after 3 months. The changes in visual acuity, absorption of retinal hemorrhage, macular edema were analyzed.
RESULTS: Retinal hemorrhage was absorbed more than 1/2 in 51 eyes(35.9%), between 1/2 to 3/4 in 62 eyes (43.7%), and completely absorbed or more than 3/4 in 29 eyes(20.4%). Macular edema disappeared completely in 33 eyes(23.2%), reduced partially in 96 eyes (67.6%) and absorbed lightly or unchanged in 13 eyes(9.2%) after photocoagulation. Retinal neovascularization disappeared completely accounting for 71.2%， disappeared partially accounting for 28.6%，only 0.2% cases were increased or unchanged in FFA after 3 months.
CONCLUSION: Retinal photocoagulation with polywavelength krypton lasers on BRVO promptly can improve visual acuity，promote absorption of retinal hemorrhage or macular edema，and avoid serious complications .
KEYWORDS: retinal photocoagulation; branch retinal vein occlusion;polywavelength lasers
Teng XL, Wang YN, Sun RX. Therapeutic efficacy of polywavelength krypton lasers in branch retinal vein occlusion. Int J
Ophthalmol(Guoji Yanke Zazhi) 2010;10(9):18071808
视网膜分支静脉阻塞(branch retinal vein occlusion, BRVO)是常见的视网膜血管性疾病，其影响视力的主要原因是黄斑水肿、反复的玻璃体积血。因其病程冗长，并发症多，治疗棘手，到目前为止尚无有效的药物治疗，因而激光光凝治疗不失为一种较为理想的方法。我们总结分析了我科室经多波长氪激光治疗的142例BRVO病例，均取得了不错的治疗效果，现报告如下。
1对象和方法
1.1对象
选择我科200606/200806 BRVO患者142例142眼，其中男83例83眼，女59例59眼;年龄24～72(平均54.5)岁。颞上分支阻塞94眼，颞下分支阻塞31眼，黄斑分支阻塞11眼，鼻侧分支阻塞6眼。所有病例术前均测视力、眼压、裂隙灯检查、眼底检查及眼底血管荧光造影(FFA)检查。经FFA检查，筛选出黄斑部有荧光渗漏且视力≤0.5或有广泛无灌注区和(或)新生血管的患者作为治疗观察对象。
1.2方法
采用美国科医人公司LUMENES NOVUS OMNI多波长氪激光治疗仪，复方托吡卡胺充分散瞳后置全视网膜镜。对黄斑以外的水肿及阻塞区进行播散性光凝，将光凝斑均匀的分布于病变区视网膜上，每个光凝斑之间间隔一个光斑直径，对视网膜上扁平的新生血管可用融合的光凝斑将其覆盖，对黄斑区水肿进行格栅状光凝。根据不同情况选择氪黄或氪绿光治疗，黄斑拱环周围光斑大小为50～100μm，后极部为100～200μm，周边为300～500μm，时间0.05～0.2s，输出功率为75～300mW，光斑反应I～III级。所有病例均于光凝治疗后3mo进行视力、眼压、裂隙灯、眼底镜及FFA检查，了解治疗后视网膜出血、水肿及视力变化，个别患者复查FFA，必要时补充光凝。
2结果
2.1视网膜出血吸收情况
经激光光凝治疗后3mo，出血吸收原面积的1/2以上者为51眼(35.9%);吸收1/2～3/4者62眼(43.7%);吸收3/4至完全吸收者为29眼(20.4%)。所有病例均未见新鲜出血。
2.2黄斑水肿吸收情况
经激光光凝治疗后3mo，黄斑水肿完全吸收33眼(23.2%);黄斑水肿明显吸收96眼(67.6%);黄斑水肿轻度吸收或无变化13眼(9.2%)。
2.3视网膜新生血管消退情况
经激光光凝治疗后3mo，复查FFA，发现新生血管完全消退占有新生血管患者的71.2%，部分消退者占28.6%，无变化或加重仅占0.2%。
2.4视力改变
经激光光凝治疗后3mo，视力增进2行以上者72眼(50.7%)，增进1行者38眼(26.8%)，无变化21眼(14.8%)，下降11眼(7.7%)。
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