改良超全视网膜光凝术治疗高危增殖性糖尿病视网膜病变

目的：观察应用改良的超全视网膜光凝术(extra panretinal photocoagulation,E-PRP)治疗高危增殖性糖尿病视网膜病变(high risk proliferative diabetic retinopathy,hsPDR)的疗效及安全性。
　　方法：将我院2011-02/2014-12通过荧光素眼底血管造影(fundus fluorescein angiography,FFA)确定为高危 PDR患者88例102眼纳入研究。采用倍频532激光对其中52眼行改良的 E-PRP 治疗,50眼行标准全视网膜光凝术(panretinal photocoagulation, PRP)治疗。激光治疗后每3mo 行 FFA 及彩色眼底照像,对新生血管未消退、大片无灌注区未消失的患者追加光凝,随访6~36mo。
　　结果：高危 PDR 经改良的 E-PRP 和 PRP 治疗后,两组患者视力比较差异无统计学意义( P>0.05)。经改良的E-PRP 治疗后视网膜无灌注区消失、新生血管消退35眼(67%),有效率88%；有6眼因严重玻璃体积血、纤维增殖及牵拉性视网膜脱离需行玻璃体切除手术治疗,占12%。经 PRP 治疗后视网膜无灌注区消失、新生血管消退23眼(46%),有效率66%。有17眼出现视网膜前出血或玻璃体积血,需行玻璃体切除手术治疗,占34%。两组比较,新生血管消退率及有效率差异有统计学意义(P<0.05)。
　　结论：改良的 E-PRP 是治疗高危 PDR 的安全、有效手段,其疗效优于传统 PRP。

Observation of improved extra panretinal photocoagulation for high risk proliferative diabetic retinopathy

AIM: To observe the therapeutic effect and safety of improved extra panretinal photocoagulation(E-PRP)in the treatment of high risk proliferative diabetic retinopathy(hsPDR).

METHODS: A total of 88 consecutive cases(102 eyes)with hsPDR were diagnosed by fundus fluorescein angiography(FFA)from February 2011 to December 2014 in our hospital. Fifty two eyes had been treated by improved E-PRP with 532nm frequency-doubled laser. Fifty eyes had been treated by standard PRP. All cases were checked by FFA and fundus photocoagulation every 3mo. Patients with persisting neovascularization or non perfusion area were treated with laser again. All cases were followed up 6-36mo.

RESULTS: The postoperative visual acuity had no statistical difference between two groups(P>0.05). In improved E-PRP group, retinal non perfusion area and neovascularization disappeared in 35 eyes(67%). Effective rate was 88%. Six eyes(12%)underwent pars plana vitrectomy because of vitreous hemorrhage, fiberosis and stretched retinal detachment. In standard PRP group, retinal nonperfusion area and neovascularization disappeared in 23 eyes(46%). Effective rate was 66%. Seventeen eyes(34%)underwent pars plana vitrectomy because of anterior retina bleeding or vitreous hemorrhage.The rate of neovascularization disappeared and effective rate had statistical difference between two groups(P<0.05).

CONCLUSION: It is a safe and effective methods to treat hsPDR by improved E-PRP and it was more effective than traditional PRP.