不同分期糖尿病视网膜病变激光光凝疗效观察

目的 观察视网膜激光光凝治疗不同分期糖尿病视网膜病变(DR)患者的疗效.方法 经国际标准视力表检查视力、直接或间接检眼镜眼底检查和荧光素眼底血管造影(FFA)检查确诊的DR患者304例534只眼纳入研究.其中,非增生期(NPDR)组92只眼,平均视力0.52±0.32;增生前期(PPDR)组108只眼,平均视力0.49±0.23;早期增生期(早期PDR)组196只眼,平均视力0.20±0.31;高危增生期(高危PDR)组138只眼.平均视力0.17±0.22.参照ETDRS的规定,采用氩激光对NPDR期行次全视网膜激光光凝、PPDR期和早期PDR期行标准全视网膜激光光凝、高危PDR期行超全视网膜激光光凝.视网膜激光光凝治疗后,每隔3个月采用与治疗前相同的检查设备和方法复查视力、眼底、FFA.新生血管未消退和无灌注区残留补充激光光凝.随访观察10～18个月,平均随访时间11.6个月,以最后一次随访时的观察指标进行疗效评价.以视力提高≥2行为视力提高.视力变化2行以内为视力稳定,视力下降≥2行为视力下降,视力稳定或提高判定为有效.原有视网膜水肿消退,出血渗出吸收,微动脉瘤消失或减少;原有新生血管完全消退或部分减退,无灌注区消失或缩小,无新的新生血管或无灌注区出现判定为视网膜病变激光光凝治疗有效.结果 NPDR组、PPDR组、早期PDR组激光光凝治疗后平均视力分别为0.55士0.28、0.47±0.33、0.16±O.33.视力有效率分别为79.3%、76.9%、74.5%,三组间视力有效率比较,差异无统计学意义(χ2=0.180,0.811,0.209;P>0.05);高危PDR组平均视力为0.13±0.21,视力有效率为63.0%,与NPDR组、PPDR组、早期PDR期组视力有效率比较,差异有统计学意义(χ2=6.182,4.783,4.502;P<0.05).视网膜病变激光光凝治疗有效率NPDR组、PPDR组、早期PDR组分别为89.1%、85.2%、82.7%.三组治疗有效率比较,差异无统计学意义(χ2=0.684,2.030,0.325;P>0.05);高危PDR组治疗有效率为55.1%,与NPDR组、PPDR组、早期PDR组的治疗有效率比较.差异有统计学意义(χ2=28.212,23.999,28.746;P<0.05).结论 不同分期的DR视网膜激光光凝治疗后预后不同,早期、及时而有效的激光光凝治疗是稳定病变,降低致盲率的关键.

Therapeutic effect of laser photocoagulation on diabetic retinopathy at different stages

Objective To observe the therapeutic effect of laser photocoagulation on diabetic retinopathy (DR)at different stages.Methods A total of 534 eyes of 304 patients with DR diagnosed by fundus fluorescein angiography (FFA) were enrolled in this study.In the 534 eyes,92 with nonproliferative DR (NPDR) had the best-corrected visual acuity(BCVA) of 0.52±0.32,108 with preproliferative DR (PPDR) had the BCVA of 0.49±0.23,196 with early PDR had the BCVA of 0.20±0.31,and 138 with high-risk PDR had the BCVA of 0.17±0.22.According to the rules of ETDRS,retinal photocoagulation,pan-retinal photocoagulation or extra-panretinal photoeoagulation were performed on the paitents with NPDR,PPDR,and high-risk PDR,respectively.The patients were followed up for 10-18 months after the operations and the results of the examinations at the last time were regarded as the criteria for judgement.The examination of BCVA and ocular fundus and FFA were performed with the time interval of 3 months.The judgement for BCVA was (1)improved:improved ≥ 2 lines;(2) kept still:changed within 2 lines;(3)decreased:decreased ≥2 lines.And the effect on BCVA was positve when it was improved or kept still.The judgement for the therapeutic effect on DR was:retinal edeama was alleviated,leakage of hemorrhage was obsorbed,microaneurysm disappeared or decreased,neovascularization (NV) was relieved completely or partly,non-perfusion area disappeared or narrowed,and no new NV or non-perfusion area came into being.Results After the operations,BCVA in NPDR,PPDR and early PDR groups was improved or kept still in 73 (79.3%),83 (76.9%),and 146 eyes (74.5%),respectively,without any statistical difference among these three groups(P>0.05).BCVA in high-risk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P<0.05).The positive rate of therapeutic effect on DR was 89.1% 、85.2%.82.7% in NPDR,PPDR,and early PDR groups,respectively without any statistical difference among the groups(P>0.05).The positive rate of therapeutic effect on DR in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P<0.05).Conclusion The prognosis of DR at different stages after laser photocoagulation is different;timely and effective laser photocoagulation is important to prevent the development of the disease and decrease the blindness rate.