目的：研究全视网膜光凝(panretinal photocoagulation，PRP)联合羟苯磺酸钙治疗对糖尿病视网膜病变(diabetic retinopathy，DR)患者眼底微循环和视网膜神经纤维层(retinal nerve fiber layer，RNFL)厚度的影响。

方法：选取2015-10/2017-10于我院眼科就诊的DR患者166例，按照随机数字表法分为对照组(A组)和研究组(B组)，每组83例。A组患者行PRP术治疗，B组患者在A组的基础上口服羟苯磺酸钙胶囊，观察并对比两组患者临床疗效、PRP术后并发症发生率及治疗前后最佳矫正视力(BCVA)、血液流变学指标\〖红细胞压积(Hct)、血沉(ESR)、红细胞变形指数(DE)、血浆粘度(PV)、红细胞聚集指数(AE)\〗、血流动力学指标\〖中央动脉(CRA)的阻力指数(RI)、舒张末期平均血流速度(EDV)、收缩期峰值平均流速(PSV)\〗和视盘上方、鼻侧、下方、颞侧4个象限及视盘中心平均RNFL厚度情况。

结果：治疗后，两组患者BCVA均较治疗前明显改善，差异均有统计学意义(P<0.05)，B组患者BCVA与A组相比，差异无统计学意义(P>0.05)； B组患者治疗总有效率明显高于A组(P<0.05)； A、B组患者PRP术后并发症发生率、失访率比较，差异均无统计学意义(P>0.05)。与治疗前相比，两组患者治疗后CRA的EDV、PSV值均提高(P<0.05)，RI值下降(P<0.05)，B组患者治疗后CRA的EDV、PSV值均明显高于A组(P<0.05)，RI、Hct、ESR、PV、DE、AE值均明显低于A组(P<0.05)。治疗后，两组患者上方、下方、视盘全周RNFL均值与治疗前相比均变薄(P<0.05)，A组患者上方、下方、鼻侧、视盘全周RNFL均值降低程度均高于B组(P<0.05)。

结论：PRP联合羟苯磺酸钙治疗DR疗效确切、安全性良好，可有效改善眼底微循环，减少PRP对DR患者视力和RNFL的损伤。

METHODS: Totally 166 cases of DR patients in the Department of Ophthalmology of our hospital in October 2015 to October 2017 were selected. According to the random number table method, 166 cases were divided into the control group(Group A)and the study group(Group B), with 83 cases in each group. Group A was treated with PRP, and Group B was given calcium dobesilate on the basis of Group A. Observation and comparison between the two groups on clinical curative effect, postoperative complication rate and the changes of best corrected visual acuity(BCVA), blood rheology index \〖hematocrit(Hct), erythrocyte sedimentation rate(ESR), deformation of erythrocyte(DE), plasma viscosity(PV), aggregation of erythrocyte(AE)\〗 and the changes of hemodynamic indexes \〖resistance index(RI), end diastolic velocity(EDV), peak systole velocity(PSV)of central retinal artery(CRA)\〗 before and after treatment. Besides, the RNFL thickness of the optic disc, the nasal side, the inferior and the superior side, and the average RNFL thickness of the optic disc center were observed and compared.

RESULTS: After treatment, BCVA in both groups decreased significantly compared with that before treatment(P<0.05), and there was no significant change between Group A and B(P>0.05), and the effective rate in Group B was significantly higher than that in Group A(P<0.05). There was no significant difference in the incidence of complications and the rate of loss of visits in the two groups of A and B(P>0.05). Compared with those before treatment, the EDV and PSV values of two groups increased after treatment(P<0.05), and RI value decreased(P<0.05). After treatment, the EDV and PSV values of CRA in Group B were significantly higher than those in Group A(P<0.05), and the values of RI and Hct, ESR, PV, DE and AE were significantly lower than those of Group A(P<0.05). After treatment, the average, inferior and superior RNFL of the two groups were all thinner than those before the treatment(P<0.05). The decrease of average, inferior, superior and nasal RNFL of Group A was more than those in the Group B(P<0.05).

CONCLUSION: Retinal photocoagulation combined with calcium dobesilate in the treatment of DR is effective and safe. It can effectively improve the fundus microcirculation and reduce the damage of PRP to DR patients' visual acuity and retinal nerve fiber layer thickness.