剔络化瘀法联合激光治疗缺血型视网膜分支静脉阻塞黄斑水肿的临床研究

摘要

目的 探讨剔络化瘀法联合激光治疗缺血型视网膜分支静脉阻塞(BRVO)黄斑水肿的疗效.方法 回顾性临床研究.缺血型BRVO继发黄斑水肿患者30例(30只眼),予荧光素眼底血管造影(FFA)指导下的视网膜光凝治疗,并口服归元剔络化瘀方至少6个月(2个疗程).治疗前及中药治疗后3个月、6个月进行最佳矫正视力(BCVA)及光学相干断层扫描(OCT)检查,比较治疗前后BCVA、视网膜中心凹容积、视网膜中心凹厚度的变化,评价疗效.结果 1.视力疗效:治疗后6个月时,30只眼中痊愈4只眼(13.3％),显效5只眼(16.7％),有效14只眼(46.7％),无效7只眼(23.3％),总有效率76.7％.初诊、治疗后3个月、6个月时的患眼视力(logMar视力)分别为0.74±0.23,0.44±0.14,0.30±0.06,相邻时间点差异均有统计学意义(P＜0.05).2.黄斑水肿疗效:治疗后6个月时,30只眼中痊愈4只眼(13.3％),显效8只眼(26.7％),有效14只眼(46.7％),无效4只眼(13.3％),总有效率为86,7％.初诊、治疗后3个月、6个月时的患眼视网膜中心凹厚度分别为(624.34±155.2) μm,(465.6±183.7) μm,(385.2± 144.8)μm;视网膜中心凹容积分别为(12.4±1.1)mm3,(11.9±1.2) mm3,(11.1±1.1) mm3.两项指标相邻时间点差异均有统计学意义(P＜0.05).结论 剔络化瘀法联合激光疗法对缺血型BRVO黄斑水肿有一定疗效,可以减轻黄斑水肿程度并提高患眼视力.%OBJECTIVE To observe the effect of Tiluo Huayu method combined with laser treatment on ischemic branch retinal vein occlusion with macular edema.METHODS It was a retrospective study involved 30 eyes of 30 patients suffered from ischemic branch retinal vein occlusion with secondary macular edema managed by Tiluo Huayu method combined with laser photocoagulation.All patient underwent macular laser grid photocoagulation on non-perfusion area and new vessels under FFA.In addition,they took Guiyuan Tiluo Huayu decoction for more than 6 months which consisted of 2 courses.The best corrected visual?acuity (BCVA)and optical coherence tomography (OCT) were measured before treatment,3 month,6 month after it for comparison of BCVA,volume of fovea centralis and retinal concave thickness.RESULTS 1.Vision:After 2 courses,4 in 30 eyes were cured (13.3％),5 eyes were markedly effective(16.7％),14 eyes were effective(46.7％),7 eyes were inefficiency(23.3％),the total effective rate was 76.7％.The average logMAR visual acuity of 30 eyes at the first consult,after the first and the second courses were 0.74±0.23,0.44±0.14,0.30±0.06 respectively.The differences between each adjacent time point was statistically significant (P＜0.05).2.Macular edema:After 2 courses,4 in 30 eyes were cured (13.3％),8 eyes were markedly?effective (26.7％),14 eyes were effective (46.7％),4 eyes were inefficiency (13.3％),the total effective rate was 86.7％.The average central macular thickness of 30 eyes at the first consult,after the first and the second courses were 624.34±155.2nm,465.6±183.7um,385.2±144.8um respectively;the average volume of fovea centralis of 30 eyes at the first consult,after the first and the second courses were 12.4±1.1mm3,11.9±1.2mm3,11.1± 1.1mm3.The differences of two indexes between each two adjacent time points was statistically significant (P＜0.05).CONCLUSIONS The method of Tiluo Huayu method combined laser photocoagulation yielded certain effects on ischemic branch retinal vein occlusion with macular edema,it improved vision and macular edema to some extent.