合并全身病的糖尿病视网膜病变患者的激光治疗

目的探讨合并全身病的糖尿病视网膜病变（DRP）患者进行激光治疗的适应证和安全性分析。方法对108例（216只眼）合并全身病的重度非增生性DRP患者进行激光治疗的情况进行统计分析，随访观察半年～1年，对激光的安全性和适应证进行讨论。结果91例（182只眼）激光前后均无不良反应和严重并发症；17例（34只眼）激光后出现视网膜出血，其中26只眼需再次补充光凝，2只眼因玻璃体出血而需行玻璃体切割术。术后视力提高2行以上有48例（96只眼），保持不变56例（112只眼），视力下降4例（8只眼）。结论只要严格掌握适应证，合并全身病的DRP患者进行激光治疗是安全的。其适应证有：①血压控制在140／90mmHg以下；②血糖控制在10mmol／l以下；③用药物能控制的心律失常和心功能不全；④近期无心绞痛和心肌梗塞发作史；⑤长期服用抗凝药者应酌情短期减量或停药，使出凝血时间正常或接近正常；⑥因尿毒症需做血液透析者，应选择在透析前1d进行激光，且以无肝素透析为宜。

The security of panretinal photocoagulation in diabetic retinopathy patients with systemic disease

Objective To evaluate the security of panretinal photocoagulation in diabetic retinopathy patients with systemic disease. Methods The authors performed a retrospective study of panretinal photocoagulation in 108 diabetic retinopathy patients with systemic disease. Results 91 cases （ 182eyes）did not have the complications. 17 cases （34 eyes） had the retinal hemorrhage. Among them,26 eyes were treated with the local photocoagulation again and 2 eye had to do the vitreous operation. After follow up for 6 - 12 months ,48cases （ 96 eyes ） had a better visual acuity. 56cases （ 112 eyes ） were equal and 4 cases （ 8 eyes）were lower than before. Conclusion Diabetic retinopathy patients with systemic disease could be safe after necessary preparation during the course of panretinal photocoagulation. The good control included： BP≤140/ 90mmHg, FBG≤10mmol/l,treated the heart disease, stop or reduced the anticoagulant to keep the blood parameter normal,one day before the blood dialysis and use the non-heparinize dialysis.