Hudson C, Flanagan J G, Turner G S, Chen H C, Young L B, McLeod D
University Department of Ophthalmology, Manchester Royal Eye Hospital, UK.
Diabetologia. 1998 Nov;41(11):1283-92. doi: 10.1007/s001250051066.
The aim of the study was to determine the effect of laser photocoagulation for clinically significant diabetic macular oedema (DMO) on macular visual function as assessed by conventional and short-wavelength automated static threshold perimetry. The sample comprised 24 patients who required laser photocoagulation for clinically significant DMO (mean age 59.75 years, range 45-75 years). One eye of each patient was selected for the study. Patients underwent conventional and short-wavelength perimetry using programme 10-2 of the Humphrey Field Analyser on two separate occasions prior to treatment and subsequently within 1 week of, and at 1, 2, 4 and 12 weeks after, treatment. The pointwise pattern deviation plot was analysed for conventional perimetry and a pointwise horizontal and vertical hemifield asymmetry analysis was derived for short-wavelength perimetry (thereby negating the influence of pre-receptoral absorption). The extent of sensitivity loss was determined by counting the number of stimulus locations with statistical probability levels of p less than 0.05. Group mean log minimum angle of resolution (logMAR) visual acuity was largely unchanged over the course of the study. Conventional perimetry showed an increase in the group mean number of abnormal contiguous stimulus locations from 2.4 (SD 4.3, range 0-14) immediately prior to treatment, to 12.4 (SD 7.8, range 0-30) within 1 week of treatment; at 3 months post-treatment, the group mean number of abnormal contiguous stimulus locations was 8.1 (SD 6.5, range 0-20). A similar but less pronounced change was found for short-wavelength perimetry. The spatial position of the post-treatment localised sensitivity loss corresponded with the area of retinal photocoagulation. Despite proven benefit in the stabilisation of visual acuity, laser photocoagulation for clinically significant DMO invariably results in a localised loss of perimetric sensitivity within 10 degrees eccentricity of the fovea. Evidence for the value of laser therapy for clinically significant DMO must be re-examined.
本研究的目的是通过传统和短波长自动静态阈值视野检查法，确定激光光凝术治疗临床显著性糖尿病性黄斑水肿（DMO）对黄斑视觉功能的影响。样本包括24例因临床显著性DMO需要进行激光光凝术的患者（平均年龄59.75岁，范围45 - 75岁）。为每位患者的一只眼睛进行研究。患者在治疗前分两次使用Humphrey视野分析仪的10 - 2程序进行传统和短波长视野检查，随后在治疗后1周内以及治疗后1、2、4和12周进行检查。对传统视野检查的逐点模式偏差图进行分析，对短波长视野检查得出逐点水平和垂直半视野不对称分析（从而消除感受器前吸收的影响）。通过计算统计概率水平p小于0.05的刺激位置数量来确定敏感度损失的程度。在研究过程中，组平均对数最小分辨角（logMAR）视力基本保持不变。传统视野检查显示，治疗前紧邻的异常刺激位置的组平均数为2.4（标准差4.3，范围0 - 14），治疗后1周内增至12.4（标准差7.8，范围0 - 30）；治疗后3个月，紧邻的异常刺激位置的组平均数为8.1（标准差6.5，范围0 - 20）。短波长视野检查发现了类似但不太明显的变化。治疗后局部敏感度损失的空间位置与视网膜光凝区域相对应。尽管激光光凝术在稳定视力方面已被证明有益，但治疗临床显著性DMO时，在黄斑中心凹10度偏心范围内总会导致局部视野敏感度损失。必须重新审视激光治疗临床显著性DMO的价值证据。
