白内障术后糖尿病性视网膜病变多波长激光治疗

目的 回顾性分析评价白内障超声乳化人工晶状体植入后糖尿病性视网膜病变的多波长激光治疗时机及疗效.方法 白内障术后糖尿病性视网膜病变患者35例(47只眼),所有病例均在植入人工晶状体术后二周行眼底全视网膜镜检查和FFA、OCT检查,行DR分期,第三周根据病变部位和分期,依次采用氪黄光、氪红光、氪绿光进行局灶光凝,格珊样光凝,全视网膜光凝.结果 光凝后随访3～12个月,视力提高11只眼,占23.40%,视力稳定30只眼占63.83%,视力下降6只眼占12.77%,FFA示黄斑水肿完全消退23只眼占48.94%,部分消退16只眼占34.04%,不变甚至加重8只眼占17.02%,激光治疗前OCT示黄斑部中央凹平均厚度为(390.35±102.53)μm,治疗后1个月平均厚度(287.67±82.81)μm,治疗后3个月平均厚度(208.47±56.72)μm,治疗后6个月平均厚度(168.38±42.56)μm,差异有统计学意义(P＜0.05).FFA示视网膜毛细血管渗漏广泛消退或视网膜新生血管完全萎缩20只眼,无效4眼.结论 糖尿病性白内障摘除人工晶体植入术后早期进行眼底全视网膜镜、FFA、OCT检查,根据病变分期及部位采用多波长激光治疗,能有效控制白内障术后DR的进一步发展,保护视功能.

Multi-wavelength laser treatment after diabetic cataract surgery

Objective To investigate the effect and opportunity of multiwavelength laser Photocoagulation on diabetic retinopathy after cataract extraction combined with intraocular lens implantation. Methods Retrospective analysis. Forty-seven eyes (35cases) with diabetic retinopathy after cataract extraction combined with intraocular lens implantation staged by examination results of retinophotoscopy, FFA and OCT two weeks later. All patients received multiwavelength laser Photocoagulation relied on diseased region and stage in third week, including local Photocoagulation, grid pattern Photocoagulation and panretinal Photocoagulation. Results All patients completed 3-12 months of follow-up. In all eyes, visual acuity improved in 11 eyes, remained stable in 32 eyes, decreased in 6 eyes, accounting for 23.40%, 63.83%, 12.77%, respectively. FFA showed that macular edema subsided completely in 23 eyes, subsided partly 16 eyes, remained stable or even worsen 8 eyes, accounting for 48.94%, 34.04%, 17.02%, respectively. OCT showed the mean forveal thickness were (390.3± 102.5)μ m before Photocoagulation and (287.67± 82.81)μ m, (208.47± 56.72)μ m, (168.38±42.560)μ m after Photocoagulation 1 month, 3 and 6 months, respectively, the difference was significant (P＜0.05). Retinal capillary leakage subsided extensively or neovascular atrophied completely 20 eyes, invalid 4 eyes by FFA. Conclusions To examine patients by retinophotoscopy, FFA and OCT in time after cataract extraction combined with inuaocular lens implantation and then receive multiwavelength laser Photocoagulation rely on diseased region and stage, such can control further development of diabetic retinopathy and conserve vision function effectively.