目的：观察经全视网膜激光光凝(PRP)治疗的重度非增生型糖尿病视网膜病变(NPDR)患者视网膜神经纤维层(RNFL)厚度变化和视野缺失情况及相关性。

方法：前瞻性临床研究。选取2017-01/2018-03经我院眼科确诊的重度NPDR患者35例52眼(光凝组，常规药物治疗的同时行PRP治疗)，另选取同期入院、年龄和性别等相匹配的重度NPDR患者35例52眼作为对照组(常规药物治疗)。随访1a，分析比较两组患者最佳矫正视力(BCVA)、RNFL厚度和视野变化情况。

结果：治疗后1a，光凝组患者BCVA无明显改善(P>0.05)，而对照组BCVA明显降低(P<0.05)； 光凝组患者颞侧RNFL厚度无明显变化(74.5±13.7μm vs 70.8±11.3μm，P>0.05)，其余象限RNFL和平均RNFL厚度均较治疗前变薄(均P<0.05)，且颞侧神经纤维对应视野MS值无明显变化(22.5±8.7dB vs 20.8±7.2dB，P>0.05)，其余象限和平均MS值均较治疗前降低(均P<0.05)。光凝组患者治疗前后鼻侧、鼻上方、颞上方、颞侧、颞下方、鼻下方及平均RNFL厚度变化值与神经纤维所对应视野MS变化值呈正相关或无相关性。

结论：PRP能有效控制重度NPDR进一步发展，维持患者视力，但PRP对RNFL和视野的损伤作用不容忽视。

METHODS: This was a prospective clinical study. From January 2017 to March 2018, 35 patients(52 eyes)with severe NPDR diagnosed in our hospital were selected as photocoagulation group(conventional therapy combined with PRP)and 35 patients(52 eyes)with severe NPDR matched with age and gender in the same period were selected as the control group(conventional therapy, use difrarel, ginkgo leaves tablets, mecobalamin and other drugs to protect blood vessels, improve microcirculation and nourish nerves). The best corrected visual acuity(BCVA), RNFL thickness and visual field of the two groups were compared after 1a after treatment.

RESULTS: There was no significant difference in BCVA before and after treatment in the photocoagulation group(P>0.05), but the BCVA of the control group decreased(P<0.05). There was no significant difference in temporal RNFL thickness(74.5±13.7μm vs 70.8±11.3μm, P>0.05)in the photocoagulation group, and the thickness of RNFL in the other quadrants and the mean RNFL were thinner than those before treatment(P<0.05); there was no significant change in the MS of the corresponding field of vision of the temporal nerve fiber(22.5±8.7dB vs 20.8±7.2dB, P>0.05), the other quadrants and the mean MS were lower than those before treatment(P<0.05). Before and after treatment, the change of RNFL thickness of the patients in the photocoagulation group showed weak positive correlation or no correlation with the change of visual field MS corresponding to the RNFL at nasal, nasal superior, temporal superior, temporal, temporal superior, temporal inferior and average RNFL.

CONCLUSION: PRP can effectively control the further development of severe NPDR and maintain the visual acuity of patients, but the damage of PRP to RNFL and visual field cannot be ignored.