[1]高鸽,薛晓辉,孙娜,等.短脉冲激光术和传统激光术后视网膜结构的变化[J].眼科新进展,2018,38(4):368-372.[doi:10.13389/j.cnki.rao.2018.0086]
　GAO Ge,XUE Xiao-Hui,SUN Na,et al.Changes in retinal structure after short-pulse laser treatment[J].Recent Advances in Ophthalmology,2018,38(4):368-372.[doi:10.13389/j.cnki.rao.2018.0086]
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短脉冲激光术和传统激光术后视网膜结构的变化/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
38卷
期数:
2018年4期
页码:
368-372
栏目:
应用研究
出版日期:
2018-04-05

文章信息/Info

Title:
Changes in retinal structure after short-pulse laser treatment
作者:
高鸽; 薛晓辉; 孙娜; 李佩君; 崔阳阳; 郑波
710004　陕西省西安市，西安市第四医院眼科
Author(s):
GAO Ge; XUE Xiao-Hui; SUN Na; LI Pei-Jun; CUI Yang-Yang; ZHENG Bo
Department of Ophthalmology，the Fourth Hospital of Xi ’an，Xi ’an 710004，Shaanxi Province，China
关键词:
谱域OCT; 眼底自发荧光; 激光光斑; 短脉冲激光; 传统激光
Keywords:
spectrum domain OCT; fundus autofluorescence; laser spot; short-pulse laser; conventional laser
分类号:
R774.1
DOI:
10.13389/j.cnki.rao.2018.0086
文献标志码:
A
摘要:
目的　观察短脉冲激光术及传统激光术后视网膜结构的变化。方法　对短脉冲视网膜激光术后16例（22眼）、传统激光术后19例（25眼）行欧堡眼底照相、谱域光学相干断层扫描（spectral domain optical coherence tomography，SD-OCT）、眼底自发荧光（fundus autofluorescence，FAF）检查，观察光斑情况，观察时间为术后1 h、1～2周、1～3个月、>3～6个月、>6～12个月。结果　短脉冲激光术后1 h，光斑为中央灰白色环绕灰晕的Ⅱ级光斑；光斑处椭圆体区形成环形脱离带，内层视网膜及视网膜色素上皮 （retinal pigment epithelium，RPE）变化不显著；FAF显示多个FAF信号降低的圆形区域。短脉冲术后1~2周，光斑中心为灰白色，环绕灰晕扩大，光斑中心FAF信号增强；外层神经上皮层向光凝斑中心牵拉；1~3个月时光斑处部分神经上皮层恢复正常；>3~6个月时，神经上皮层基本恢复正常；>6~12个月时，神经上皮层恢复正常。传统激光术后1 h，眼底照相与FAF表现与短脉冲激光组类似，SD-OCT提示光斑处视网膜全层水肿；1~2周时，光斑中心为灰白色，环绕灰晕扩大，光斑中心FAF信号增强，神经上皮层全层向光斑中心牵拉粘连；1~3个月时，眼底照相与FAF表现与短脉冲激光组类似，SD-OCT提示光斑处RPE细胞增生，周围环形萎缩；>3~6个月时，光斑周围RPE萎缩逐渐扩大，神经上皮层全层粘连；>6~12个月时，RPE层萎缩，神经上皮层全层粘连。所有随访组自发荧光结果 与OCT结果具有一致性。结论　通过SD-OCT和FAF观察激光术后视网膜结构变化，客观证实了短脉冲激光损伤小于传统激光，为优化激光参数提供新的思路。
Abstract:
Objective　To observe the changes in retinal structure after short-pulse laser technique and conventional laser surgery.Methods　Oburg fundus photography，spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) examination were performed in 16 patients (22 eyes) receiving short-pulse laser surgery,following 19 patients (25 eyes) undergoing conventional laser surgery to observe the spot situation with the time for postoperative 1 h，1-2 weeks，1-3 months，>3-6 months，> 6-12 months.Results　After 1 h of short-pulse laser，fundus color displayed light spot of the center was white and gray，which surrounded by gray dizzy；SD-OCT images showed spot ellipsoid area formed a ring out of band，but the inner retina and retinal pigment epithelium (RPE) had no significant change.FAF showed multiple spontaneous fluorescence signals to reduce the circular area；at 1- 2 weeks after laser surgery，fundus photography showed spot center for white and gray，and the surrounded gray dizzy became larger，and FAF spontaneous fluorescence signal in light spot center was enhanced，while SD-OCT showed that the outer nerve sensory layer was pulled to the photocoagulation spot center.From 1 month to 3 months，some of the epithelial layers of the nerves were restored to normal，and >3-6 months，the epithelial layer of the nerve was basically restored to normal；and > 6-12 months，the nerve epithelium was back to normal.As for conventional laser surgery，1 h later，fundus photography and FAF performance were similar to the short-pulse laser，and the SD-OCT showed that the whole retinal layer had dropsy in the spot place；after 1-2 weeks，the spot center was gray and white，and the surrounded gray halo turned enlargement，and FAF spontaneous fluorescence signal in light spot center was enhanced，while SD-OCT showed that the outer nerve sensory layer was pulled to the spot center with adhesion；after 1-3 months，fundus photography and FAF performance were similar to those of short-pulse laser，while SD-OCT presented the RPE cells hyperplasia and ring atrophy around the spot，and the RPE atrophy around the spot was gradually enlarged，plus the whole layer of the nerve epithelium was adhesion >3-6 months after surgery.>6-12 months later，the results showed the RPE layer atrophy and nerve epithelium layer adhesion.The results of FAF in all follow-up groups were consistent with that of OCT results.Conclusion　OCT and FAF are the important methods to observe the postoperative retinal laser structure changes，which can provideObjective basis for the confirmation that short-pulse laser has less damage than the conventional laser treatment，and this provides a new research idea to optimize the laser parameters.

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更新日期/Last Update: 2018-04-02