目的：分析增生型糖尿病视网膜病变(PDR)患者全视网膜激光光凝(PRP)治疗前后视网膜结构和功能的变化。

方法：前瞻性研究。纳入2022-01/2023-05在温州医科大学附属眼视光医院行PRP治疗的PDR患者98例98眼。在治疗前，完成PRP治疗后1 wk，1、3 mo行光学相干断层扫描血管成像(OCTA)检查中心视网膜厚度(CRT)、黄斑中心厚度(CMT)、黄斑中心凹脉络膜厚度(SFCT)、黄斑中心凹无血管区面积(FAZ)、深层血管丛(DVC)血流密度、浅层血管丛(SVC)血流密度。随访过程中1眼行玻璃体切割，2眼不明原因失访，最终95眼完成1 a随访，失访率3%。根据治疗后1 a时视力预后情况分为两组：预后良好组73眼和预后不良组22眼(包括视力残疾9眼和视力回退13眼)，比较两组患者PRP治疗前后视网膜结构和功能变化，采用受试者工作特征(ROC)曲线和决策曲线，分析视网膜结构和功能对PDR患者PRP治疗的预测价值。

结果：两组患者治疗前PDR 分期、CRT、CMT、SFCT、DVC血流密度、SVC血流密度比较均有差异(均P<0.05)。两组患者治疗后1 wk，1、3 mo FAZ均较治疗前降低，DVC、SVC血流密度较治疗前均升高(均P<0.05)，但两组间治疗后1 wk，1、3 mo FAZ、DVC、SVC血流密度比较均无差异(均P>0.05)； 两组治疗后1 wk CRT、CMT、SFCT较治疗前升高(均P<0.05)，但组间比较均无差异(均P>0.05)； 两组治疗后1、3 mo CRT、CMT、SFCT较治疗后1 wk和治疗前均降低，预后不良组治疗后3 mo CRT、CMT、SFCT均较治疗后1 mo升高，且均高于预后良好组(均P<0.05)。ROC曲线分析，PDR患者治疗后3 mo时CRT、CMT、SFCT单独及联合预测PRP治疗后1 a治疗情况的曲线下面积分别为0.788、0.781、0.783、0.902，联合预测价值更高(P<0.05)。决策曲线显示PDR患者PRP治疗后3 mo CRT、CMT、SFCT联合检测能提高预测价值。

结论：PDR患者行PRP治疗后1 wk-1 mo期间是视网膜结构和功能恢复的最佳时刻，治疗后3 mo时采用OCTA测量CRT、CMT、SFCT能预测治疗1 a期间视力预后情况。

METHODS: Prospective study. Totally 98 cases(98 eyes)of PDR patients who underwent PRP in Eye Hospital of Wenzhou Medical University from January 2022 to May 2023 were included. Optical coherence tomography angiography(OCTA)was used to detect central retinal thickness(CRT), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), foveal avascular zone(FAZ), deep vascular complex(DVC)blood flow density, superficial vascular complex(SVC)blood flow density before and at 1 wk, 1 and 3 mo after PRP. During the follow-up, 1 eye underwent vitrectomy, 2 eyes were lost to follow-up, and finally 95 eyes completed 1 a follow-up, with a loss rate of 3%. According to the visual prognosis at 1 a after treatment, the patients were divided into two groups: 73 eyes in good prognosis group and 22 eyes in poor prognosis group(including 9 eyes of visual disability and 13 eyes of visual regression). The changes in retinal structure and function before and after PRP treatment were compared between the two groups of patients, and the receiver operating characteristic(ROC)curve and decision curve were used to analyze the predictive value of retinal structure and function for PDR treatment.

RESULTS: There were statistical significant differences in PDR staging, CRT, CMT, SFCT, DVC blood flow density, and SVC blood flow density between the two groups of patients before treatment(all P<0.05). At 1 wk, 1 and 3 mo after treatment, the FAZ area of both groups decreased compared to before treatment, while the blood flow density of DVC and SVC increased compared to before treatment(both P<0.05). However, there was no significant difference in the blood flow density of FAZ, DVC, and SVC between the two groups at 1 wk, 1 and 3 mo after treatment(all P>0.05). The CRT, CMT and SFCT of the two groups at 1 wk after treatment were higher than those before treatment(all P<0.05), but there were no significant differences between the two groups(all P>0.05). The CRT, CMT and SFCT at 1 and 3 mo after treatment were lower than those at 1 wk after treatment and before treatment in both groups. The CRT, CMT and SFCT in the poor prognosis group at 3 mo after treatment were higher than those at 1 mo after treatment, and were higher than those in the good prognosis group(all P<0.05). ROC analysis showed that, at 3 mo after laser treatment in PDR patients, the area under the curve of the CRT, CMT, and SFCT alone or in combination after treatment for 1 a was 0.788, 0.781, 0.783, and 0.902, respectively, and the combined prediction value was better(P<0.05). Decision curve analysis showed that the combined detection of CRT, CMT, and SFCT in PDR patients at 3 mo after treatment can improve the predictive value of visual prognosis.

CONCLUSION: The optimal time for retinal structure and function recovery in PDR patients after PRP treatment is between 1 wk and 1 mo. OCTA measurement of CRT, CMT, and SFCT at 3 mo after treatment can predict the visual prognosis during the 1 a treatment period.