眼科 ›› 2021, Vol. 30 ›› Issue (1): 1-4.doi: 10.13281/j.cnki.issn.1004-4469.2021.01.001

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正确认识微脉冲激光治疗糖尿病性黄斑水肿的价值

李毅斌   

  1. 首都医科大学附属北京同仁医院 北京同仁眼科中心 北京市眼科研究所 眼科学与视觉科学北京市重点实验室100005
  • 收稿日期:2020-10-20 出版日期:2021-01-22 发布日期:2021-01-21
  • 通讯作者: 李毅斌, Email:yibinlee@yahoo.com

To comprehend the role of micropulse laser in diabetic macular edema treatment

Li Yibin   

  1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology & Visual Science, Beijing 100005, China. 
  • Received:2020-10-20 Online:2021-01-22 Published:2021-01-21
  • Contact: Li Yibin, Email: yibinlee@yahoo.com

摘要: 微脉冲激光光凝是通过重复的阈值下极短脉冲光凝来降低组织损伤或实现选择性组织损伤的激光光凝方法。阈值下微脉冲激光与传统激光治疗糖尿病性黄斑水肿(diabetic macular edema,DME)具有相同的维持视力的作用,高密度/低强度微脉冲激光光凝可产生有效治疗效果的同时不对视网膜产生任何可检出的激光损害。微脉冲激光治疗DME的作用机制可能是激光对神经视网膜光诱导效应,使其发生一系列细胞因子和分子表达的改变,进而实现微脉冲激光对DME的治疗作用。微脉冲激光治疗前有必要进行激光能量滴定。由于治疗过程中能量滴定不准确或能量转换失误可能,不应过分强调对黄斑中心凹的覆盖。(眼科,2021, 30: 1-4)

关键词: 糖尿病黄斑水肿, 微脉冲激光, 视网膜光凝

Abstract: Micropulse laser photocoagulation is a laser photocoagulation paradigm which can minimize retinal laser injury so as to selectively treat certain retinal layers by delivering the laser energy with a train of repetitive extremely short pulses within an emission instead of one conventional continuous longer pulse. Studies have shown that micropulse laser photocoagulation has the same effect on maintaining visual acuity as conventional laser photocoagulation in the treatment of diabetic macular edema (DME). High density / low intensity micropulse laser photocoagulation can be effective for the DME treatment without any detectable laser damage to the neuroretina. The rationale of micropulse laser photocoagulation for DME treatment may be some specific light-induced effects of the laser on the neuroretina, resulting in series changes of the bioactive factors expression. There are disagreements in clinical application of micropulse laser photocoagulation: whether the power needs to be titrated and whether the fovea can be covered during the treatment. It should be suggested to titrate the laser power in order to achieve idea treatment, and it should not be overemphasized to cover the fovea during treatment in order to avoid disastrous consequences resulted by incorrect power titration. (Ophthalmol CHN, 2021, 30: 1-4)

Key words: diabetic macular edema, micropulselaser, photocoagulation