全视网膜激光光凝治疗高危增生型糖尿病视网膜病变的效果分析

目的　分析全视网膜激光光凝术（ｐａｎｒｅｔｉｎａｌｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ，ＰＲＰ）治疗高危增生型糖尿病视网膜病变（ｈｉｇｈ-ｒｉｓｋｐｒｏ-ｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＨＲ-ＰＤＲ）临床效果、预后及影响因素。方法　回顾性分析２００８年７月至２０１５年７月西安交通大学第二附属医院眼科ＰＲＰ治疗的糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＤＲ）患者８５例（１５０眼）的临床资料，依据我国糖尿病视网膜病变临床诊疗指南，根据眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）检查结果分为两组:严重ＤＲ组包括重度非增生型ＤＲ（重度ＮＰＤＲ）和增生早期ＤＲ（早期ＰＤＲ）组，共９０眼，ＨＲ-ＰＤＲ组包括ＨＲ-ＰＤＲ６０眼。观察两组患者ＰＲＰ治疗的效果、术后３个月的视力，分析ＨＲ-ＰＤＲ的危险因素。结果　严重ＤＲ组ＰＲＰ术后１３．３％（１２／９０）需要补充激光，１６．６％（１５／９０）患眼黄斑水肿加重，２眼发生玻璃出血，１眼发生新生血管性青光眼。ＨＲ-ＰＤＲ组ＰＲＰ术后５５．０％（３３／６０）需要补充激光，３０．０％（１８／６０）患眼黄斑水肿加重，５眼发生玻璃体出血，３眼发生新生血管性青光眼。ＰＲＰ术后３个月，严重ＤＲ组４０．０％（３６／９０）视力下降，而ＨＲ-ＰＤＲ组６５．０％（３９／６０）视力下降。ＨＲ-ＰＤＲ患者主要的危险因素包括:年龄小于５０岁、糖尿病病程长、高糖化血红蛋白、高血脂及颈动脉Ｂ超异常。结论　ＨＲ-ＰＤＲ的概念临床意义重大，其病变进展迅速，ＰＲＰ效果不佳，需要密切随访，及时追加激光或者联合其他治疗方案。

Panretinal photocoagulation for high-risk proliferative diabetic retinopathy

Objective To analyze the clinical effects ,prognosis and effective factors of panretinal photocoagulation ( PRP) for high-risk proliferative diabetic retinopathy ( HR-PDR) . Methods Eighty-five DR patients ( 150 eyes) underwent PRP from July 2008 to July 2015 in the Second Affiliated Hospital of Xi’ an Jiaotong University were retrospectively analyzed. According to the clinical diagnosis and treatment of diabetic retinopathy Guide ( 2014 edition) , the eyes were divided into two groups according to FFA : Severe DR group included severe non-proliferative DR and early PDR patients,a total of 90 eyes; HR-PDR group included 60 eyes with HR-PDR. PRP treatment effects and postoperative complications were observed in two group, the visual acuity of 3 months after operation was recorded.and the risk factors for HR-PDR were analyzed. Results After PRP,13. 3% (12/90) of eyes in the severe DR group required supplemental PRP laser , worse macular edema were observed in 16. 6% ( 15/90) eyes , the vitreous hemorrhage occurred in 2 eyes , and the neovascular glaucoma happened in I eye. After PRP.55. 0% ( 33/60) of eyes in the HR-PDR group needed to add laser , there were 30% ( 18/60) of eyes with worse macular edema,5 eyes of vitreous hemorrhage , and 3 eyes of neovascular glaucoma. At 3 months after PRP . the visual acuity in 40% ( 36/90) eyes of severe DR group decreased. and 65% ( 39/60) eyes of HR-PDR group decreased. The main risk factors for HR-PDR included the age younger than 50 years old, longer duration of diabetes , high glycated hemoglobin , high cholesterol and abnormal carotid in B-ultrasound. Conclusion The concept of HR-PDR has important clinical significance , these patients need close follow-up after PRP.because the retinopathy progresses rapidly. The timely additional laser or a combination of other treatment options must be paid more attention.