Contrast sensitivity following focal laser photocoagulation in clinically significant macular oedema due to diabetic retinopathy

Purpose : To evaluate the influence of focal laser photocoagulation on contrast sensitivity in diabetic patients with clinically significant macular oedema (CSMO). Methods : A prospective non‐comparative interventional study was performed on a group of patients with CSMO at Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, a tertiary eye care centre. Thirteen diabetic patients (14 eyes) with CSMO and no history of prior photocoagulation were recruited for this study. Direct focal photocoagulation of all leaking microaneurysms was performed using an argon green laser (514 nm). A contact lens was used as a slit lamp delivery system. Evaluation of the best corrected Snellen visual acuity, contrast sensitivity, slit lamp biomicroscopy, macular status on direct ophthalmoscopy and fluorescein angiography was carried out 1 month and 3 months after laser photocoagulation. Results : Following direct focal laser photocoagulation, focal CSMO resolved completely in all but one eye, 4–8 weeks later, as seen on slit lamp biomicroscopy and/or fluorescein angiography. Post‐treatment, visual acuity remained stationary in eight eyes, improved by one line in three eyes, by two lines in two eyes and by three lines in one eye. The mean ± SD pretreatment and post‐treatment decimal visual acuities were 0.49 ± 0.30 and 0.59 ± 0.28, respectively. The mean ± SD pre‐laser contrast sensitivity score was 121.3 ± 83.6, which increased significantly to a mean ± SD of 151.6 ± 80.5 following direct focal photocoagulation. Conclusion : Focal argon laser photocoagulation in CSMO in diabetics helps in improving the contrast sensitivity and stabilizes the visual acuity. The changes in contrast sensitivity and visual acuity are independent of each other.     

多点与单点激光治疗增殖性糖尿病视网膜病变的疗效比较

目的:观察577-nm多点激光用于新近诊断的增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)行全视网膜光凝(panretinal photocoagulation,PRP)的疗效.方法:该前瞻性对照研究共纳入32例40眼PDR患者,随机分为2组,每组16例患者(20眼).第1组采用多点激光(pattern scan laser,PSL)行PRP治疗,第2组采用单点激光(single spot laser,SSL)治疗.所有患者在PRP治疗前与最后一次PRP治疗后3mo均行荧光素眼底血管造影检查(fundus fluorescein angiography,FFA),以判断是否存在无灌注区.激光点数、完成PRP的治疗次数、治疗时长以及患者在治疗时的疼痛程度均作为判断指标.结果:PSL组患者需3次治疗以完成PRP,而SSL组需4次完成.第1组每次治疗时间为7.3±2.3min,较第2组的时间(13.2±4.1min)明显缩短(t38=5.596,P＜0.01).第1组的治疗疼痛指数较第2组明显降低(P＜0.01).最后一次PRP治疗3mo后复查FFA,第1组有5眼(25％)出现无灌注区,而第2组有8眼(40％)出现无灌注区,需要进一步治疗.结论:多点激光用于PDR行PRP治疗较单点激光有着明显的优势.它具有效率高,治疗疼痛轻,疗效好的特点.     

Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

AIM: To assess the clinical efficacy and safety of combining panretinal photocoagulation (PRP) with intravitreal conbercept (IVC) injections for patients with high-risk proliferative diabetic retinopathy (HR-PDR) complicated by mild or moderate vitreous hemorrhage (VH), with or without diabetic macular edema (DME). METHODS: Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study. Upon establishing the patient’s diagnosis, an initial IVC was performed, followed by prompt administration of PRP. In cases who significant bleeding persisted and impeded the laser operation, IVC was sustained before supplementing with PRP. Following the completion of PRP, patients were meticulously monitored for a minimum of six months. Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography (FFA) results. Therapeutic effect and the incidence of adverse events were observed. RESULTS: Out of 42 patients (74 eyes), 29 were male and 13 were female, with a mean age of 59.17±12.74y (33-84y). The diabetic history was between 1wk and 26y, and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y. The affected eye received 2.59±1.87 (1-10) IVC injections and underwent 5.5±1.02 (4-8) sessions of PRP. Of these, 68 eyes received PRP following 1 IVC injection, 5 eyes after 2 IVC injections, and 1 eye after 3 IVC injections. Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment, with resolution of DME in 51 eyes 3-48wk after initial treatment. A newly developed epiretinal membrane was noted in one eye. Visual acuity significantly improved in 25 eyes. No complications such as glaucoma, retinal detachment, or endophthalmitis were reported. CONCLUSION: The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.     

TA玻璃体腔注射结合玻璃体切割术治疗PDR

目的:探讨曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射联合玻璃体切割术治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的优点和并发症。方法:对36例48眼具有玻璃体积血的PDR眼,术前5～7d玻璃体腔内注入TA0.1mL(40g/L)后行玻璃体切割术,术中玻璃体腔内注入TA0.3～0.5mL以帮助辨认玻璃体后皮质。结果:炎症反应程度:有4眼(8%)术后瞳孔区可见少量渗出膜,术后5～7d渗出吸收;15眼(31%)房水闪辉,术后3～5d,房水闪辉消失。所有病例都没有发现手术后感染。视力改善情况:39眼(81%)视力较手术前有不同程度提高(大于2行),7眼(15%)手术后视力较术前没有改善。眼压变化:玻璃体腔注入TA前后平均眼压比较其差异没有显著性;手术后1wk内监测平均眼压比术前高,其差异有显著性。手术后第3mo和术前相比,其差异没有显著性。结论:TA玻璃体腔注射联合玻璃体切割在治疗PDR中有较好的效果,临床上没有严重的并发症。     

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Purpose

To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injections for the treatment of proliferative diabetic retinopathy (PDR) with new dense vitreous hemorrhage (VH) after previous full panretinal photocoagulation (PRP).

Methods

Prospective study of consecutive PDR with prior complete PRP patients, who presented with new dense VH, were treated with IVB injection. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and 1, 6, and 12 weeks and 6, 9, and 12 months after the first injection. Reinjection was done in non-clearing and recurrent VH.

Results

Eighteen eyes of 18 patients, mean age 47.7±12.69 years were included. In all, 14 (77.78%) patients had type 2 diabetes mellitus. Systemic hypertension and dyslipidemia were the most common systemic diseases. All cases were phakic eye with previous complete PRP. Patients received 1.6±0.42 intravitreal injections over a 12-month period. VH cleared completely in 7 (38.89%), 9 (50%), and 13 (72.22%) eyes after 6 weeks, 6 months, and 12 months, respectively. Re-bleeding, however, occurred in 10 (56%) eyes during the follow-up period, and 5 (28%) eyes still had residual VH at the last visit. Statistically significant visual gain was observed in 9 (50%) eyes. Unfortunately, 2 (11%) eyes had severe visual loss because of the tractional retinal detachment (TRD). Mild ocular complication was detected in one patient.

Conclusion

IVB injection had good efficacy and safety for treatment of new VH in patients with PDR and prior complete PRP. This procedure may be especially relevant for diabetic patients at high-risk for surgical intervention.     

Intravitreal triamcinolone for treatment of complicated proliferative diabetic retinopathy and proliferative vitreoretinopathy

BACKGROUND: We present a retrospective evaluation of the clinical outcome and complications associated with intravitreal injection of unaltered triamcinolone acetonide in conjunction with pars plana vitrectomy and silicone oil injection for the treatment of complicated proliferative diabetic retinopathy with tractional retinal detachment and severe proliferative vitreoretinopathy. METHODS: Thirteen eyes of 12 consecutive patients were identified from a computerized patient database. All eyes were operated on by the same surgeon and received 4 mg of unaltered, commercially available triamcinolone acetonide intravitreally, before silicone oil injection. The patients were followed for a mean of 4.7 months (range 1-15 months), and demographic as well as pertinent preoperative and postoperative clinical information was gathered. RESULTS: At the last follow-up visit, vision had improved in 4 eyes, remained stable in 5 eyes, and worsened in 4 eyes. The retina was attached at the end of follow-up in 10 of the 13 eyes. Eight of the 13 eyes did not show any clinical signs of re-roliferation or redetachment during the course of follow-up. The mean intra-ocular pressure did not increase (preoperative value was 10.8+/- 6.22 mm Hg with a range of 0-22 mm Hg; at last follow-up, mean pressure was 9.6 +/-3.86 mm Hg with a cumulative postoperative range of 0-26 mm Hg). Steroid crystals were visible at 1 month postoperatively in 3 eyes and did not hinder fundus examination significantly. Interpretation: The intravitreal injection of low-dose, unaltered triamcinolone acetonide in the setting of pars plana vitrectomy and silicone oil injection for the treatment of proliferative vitreoretinopathy and complicated proliferative diabetic retinopathy appears to be well tolerated. Further controlled study is needed to clearly define the potential beneficial effects of intravitreal steroids in these 2 disease processes.     

玻璃体内注射曲安奈德联合黄斑部格栅样光凝治疗弥漫性糖尿病性黄斑水肿

目的　评价玻璃体内注射曲安奈德（ｔｒｉａｍｃｉｎｏｌｏｎｅａｃｅｔｏｎｉｄｅ,ＴＡ）联合黄斑部格栅样光凝治疗弥漫性糖尿病性黄斑水肿（ｄｉａｂｅｔｉｃｍａｃｕｌａｒｅｄｅｍａ,ＤＭＥ）短期的临床疗效和安全性。方法　将３５例（３９眼）弥漫性ＤＭＥ患者根据治疗方法不同分为２组,分别为单纯ＴＡ治疗组（２４眼）和联合治疗组（ＴＡ注射联合黄斑部格栅样光凝术,１５眼）。其中联合治疗组在ＴＡ注射１个月后行黄斑部格栅样光凝术,距ＴＡ注射术后３个月、６个月分别观察２组患者最佳矫正视力、眼压、裂隙灯显微镜、彩色眼底照相、ＯＣＴ及并发症情况。结果　治疗后３个月,单纯ＴＡ治疗组和联合治疗组最佳矫正视力分别为０．１６±０．０８、０．１６±０．１７,黄斑中心凹视网膜厚度分别为（２７２．２±５９．４）μｍ、（２７９．０±９８．９）μｍ,眼压分别为（１５．４±４．３）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、（１４．９±３．２）ｍｍＨｇ,２组间最佳矫正视力、黄斑中心凹视网膜厚度和眼压比较差异均无统计学意义（均为Ｐ＞０．０５）;治疗后６个月,单纯ＴＡ治疗组和联合治疗组最佳矫正视力分别为０．２７±０．０３、０．２８±０．１５,黄斑中心凹视网膜厚度分别为（２８９．２±３３．９）μｍ、（２４８．０±１０２．７）μｍ,眼压分别为（１５．５±２．３）ｍｍＨｇ、（１５．１±３．５）ｍｍＨｇ,２组间最佳矫正视力、黄斑中心凹视网膜厚度和眼压比较差异亦均无统计学意义（均为Ｐ＞０．０５）。与治疗前视力相比,两组在治疗后３个月、６个月均有所提高,与治疗前黄斑中心凹视网膜厚度相比,两组均有所下降,与治疗前眼压相比,两组无明显变化。结论　与单纯ＴＡ注射相比,玻璃体内注射ＴＡ联合黄斑部格栅样光凝治疗弥漫性ＤＭＥ短期内疗效和安全性并不占据明显优势。鉴于本次病例观察时间较短,尤其再次治疗的患者例数较少,故其远期疗效、安全性仍有待大样本的长期观察。     

增殖型糖尿病性视网膜病变行全视网膜光凝后5a随访观察

目的:观察增殖型糖尿病性视网膜病变(proliferativediabetic retinopathy,PDR)行全视网膜光凝术(panretinalphotocoagulation,PRP)后5a的疗效及预后分析。方法:对92例149眼PDR患者行PRP治疗后的1,3,6,12mo进行复查,以后每6mo进行复查,并在3mo后均复查FFA,必要时补充光凝,随访5a。结果:视力提高52眼,保持不变71眼,下降26眼。5a后患者的最终矫正视力情况:≤0.01者19眼,～0.1者64眼,～0.5者58眼,>0.5者8眼。在激光后的随访期间血糖水平基本控制在正常范围内的63眼中,5a后只有6眼发生玻璃体积血、牵拉性视网膜脱离等严重并发症,占9.5%,而在血糖水平控制不满意的29眼中,有9眼(31%)发生上述情况。结论:通过早期发现、及时治疗和定期随访观察而减少糖尿病性盲是完全可能的。对于PDR患者,确诊后应立即进行PRP治疗,并制定定期随访计划,必要时应复查FFA或补充激光,同时,要向患者阐明,严格正规的内科治疗,将血糖控制在正常范围内,可有效地降低或延缓PDR发展的倾向。     

Visual loss following panretinal photocoagulation for proliferative diabetic retinopathy

We reviewed the preoperative, postoperative, and follow-up examinations, fundus photographs, and fluorescein angiograms of 175 eyes of 134 patients with proliferative diabetic retinopathy treated with panretinal photocoagulation. Forty-four (25%) of these eyes lost two or more lines of vision by the time of the last follow-up examination. Follow-ups ranged from 3 to 48 months, with a median follow-up of 15 months. The most common cause of decreased visual acuity was chronic macular edema that had developed following laser treatment, occurring in 14 (8%) eyes. The causes of visual loss following panretinal photocoagulation are discussed.     

全视网膜光凝联合雷珠单抗与曲安奈德治疗糖尿病黄斑水肿的疗效及费用比较

目的：比较分析全视网膜光凝联合雷珠单抗与曲安奈德(TA)玻璃体腔注射治疗糖尿病黄斑水肿的疗效及医疗费用。

方法：收集我院糖尿病视网膜病变伴黄斑水肿患者48例48眼。所有患者行全视网膜激光光凝后随机分为两组。雷珠单抗组：玻璃体腔注射雷珠单抗0.5mg,4wk 1次。共3次。TA组：注射曲安奈德4mg/0.1mL。治疗12wk后若黄斑中心凹视网膜厚度(CMT)≥400μm,则再次注射各组对应药物。随访6mo,对比观察两组患者治疗前及注射药物后的最佳矫正视力(BCVA)、CMT、眼压及相关治疗费用。

结果：两组患者BCVA和CMT均无显著统计学差异(P>0.05),不同测量时间点BCVA和CMT具有显著统计学差异,不同治疗方法和时间点BCVA及CMT均存在交互作用(P<0.05)。除了TA组注药后1wk时BCVA较治疗前无明显提高(P=0.33),其余各时间点两组BCVA均较治疗前提高(P<0.05)。治疗12、16wk雷珠单抗组BCVA提高较TA组明显,两组差异有统计学意义(P=0.03、0.045)。雷珠单抗组及TA组CMT注药后较注药前均有降低(P<0.05)。注射后1wk两组之间CMT差异有统计学意义(P<0.01)。除了1例患者需使用降眼压药物,其余两组患者眼压均在正常范围内。治疗12wk内本研究相关诊疗平均费用雷珠单抗组患者为38 736元,TA组为5 790元。治疗24wk两组平均费用分别为42 564元及7 053元。

结论：短期内全视网膜光凝联合雷珠单抗与曲安奈德玻璃体腔注射均能有效控制DME,两组治疗方法无显著差异,但全视网膜激光联合玻璃体腔注射曲安奈德治疗DME更经济。     

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。     

贝伐单抗联合全视网膜光凝治疗增生型糖尿病视网膜病变的疗效观察

目的　检测贝伐单抗玻璃体内注射疗法（ｂｅｖａｃｉｚｕｍａｂｉｎｊｅｃｔｉｏｎｓｉｎｖｉｔｒｅｏｕｓ,ＩＶＢ）对增生型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａ-ｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）中视网膜新生血管（ｒｅｔｉｎａｌｎｅｏｖａｓｃｕｌａｒｉｚａｔｉｏｎ,ＲＮＶ）的消退作用;评估ＩＶＢ联合全视网膜光凝（ｐａｎ-ｒｅｎｔｉｎａｌｐｈｏｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）对ＰＤＲ的临床疗效和安全性。方法　本研究收集行ＰＲＰ的ＰＤＲ患者７２例（７２眼）,根据术前是否ＩＶＢ分为注射组和对照组,注射组在完成ＩＶＢ１．２５ｍｇ后第７天行眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查,并于当天开始第一个象限的ＰＲＰ,每周１次,共４次完成ＰＲＰ;对照组每周１次,共４次完成ＰＲＰ。两组患者均于ＰＲＰ后４周、８周、１２周复诊,并复查最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）、眼压、ＦＦＡ、光学相干断层扫描、眼前节及眼底。结果　注射组ＩＶＢ后１周,ＢＣＶＡ提高,ＲＮＶ渗漏面积减少,与治疗前差异有统计学意义（Ｐ＜０．０５）;注射组各时间点ＢＣＶＡ、ＲＮＶ消退情况均显著优于对照组（均为Ｐ＜０．０５）。注射组各时间点黄斑中心凹视网膜厚度均较治疗前显著下降（均为Ｐ＜０．０５）,对照组各时间点黄斑中心凹视网膜厚度均较治疗前显著降低（均为Ｐ＜０．０５）,两组之间各时间点比较,差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＰＲＰ能延迟单纯ＩＶＢ后ＲＮＶ的复发;联合治疗可更有效地推动ＰＤＲ中ＲＮＶ消退,安全可靠,可以更好地保护患者的视觉功能。     

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。     

全视网膜光凝术对增生性糖尿病视网膜病变患者黄斑区视网膜功能的影响

目的　观察全视网膜光凝术对增生性糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）患者黄斑区视网膜功能的影响。方法　选取２０１１年１月至２０１３年１２月我院收治的６０例（７２眼）ＰＤＲ患者作为观察组,同时选取６０例（６０眼）正常志愿者作为对照组。观察组患者均应用全视网膜光凝术进行治疗。两组均行裂隙灯、验光、眼压、眼底等常规眼部检查,利用光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）检查黄斑区视网膜厚度,同时利用多焦视网膜电图（ｍｕｌｔｉｆｏｃａｌｅｌｅｃｔｒｏｒｅｔｉ-ｎｏｇｒａｍ,ｍｆ-ＥＲＧ）检查Ｐ１波、Ｎ１波５环的振幅密度及潜伏期等。结果　观察组患眼术前、术后黄斑中心凹视网膜厚度分别为（３４９．３±１１８．９）μｍ和（２６２．２±２８．２）μｍ,差异有统计学意义（Ｐ＜０．０５）;对照组黄斑中心凹视网膜厚度为（１３６．４±１７．８）μｍ,均显著低于观察组患眼手术前后黄斑中心凹视网膜厚度,差异均有统计学意义（均为Ｐ＜０.０５）。观察组患眼的１环、２环的术后Ｐ１波振幅密度较术前显著提高,差异均有统计学意义（均为Ｐ＜０．０５）,而３环、４环、５环较术前显著降低,差异均有统计学意义（均为Ｐ＜０．０５）。观察组术后Ｐ１波潜伏期较术前均有一定程度的下降,差异均有统计学意义（均为Ｐ＜０．０５）。与对照组比较,观察组术后１环、２环的Ｐ１波潜伏期差异均有统计学意义（均为Ｐ＜０．０５）;３环、４环、５环差异均无统计学意义（均为Ｐ＞０．０５）。观察组术后１环、２环的Ｎ１波振幅较术前显著提高,差异均有统计学意义（均为Ｐ＜０．０５）;术后３环、４环、５环较术前显著降低,差异均有统计学意义（均为Ｐ＜０．０５）。观察组患眼术后３环的Ｎ１波潜伏期与术前比较,差异无统计学意义（Ｐ＞０.０５）,术后１环、２环、４环、５环的Ｎ１波潜伏期均显著低于术前,差异均有统计学意义（均为Ｐ＜０．０５）。观察组术前和术后的Ｎ１波潜伏期均显著低于对照组,差异均有统计学意义（均为Ｐ＜０．０５）。结论　全视网膜光凝术治疗ＰＤＲ患者可显著改善视网膜的感光和传导功能,降低黄斑中心凹视网膜厚度,从而达到部分改善视力的目的。     

Panretinal photocoagulation versus panretinal photocoagulation plus intravitreal bevacizumab for high-risk proliferative diabetic retinopathy

AIM: To evaluate the effects of panretinal photocoagulation (PRP) compared with PRP plus intravitreal bevacizumab (IVB) in patients with high-risk proliferative diabetic retinopathy (PDR) according to the Early Treatment Diabetic Retinopathy Study criteria. METHODS: The data were collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. After treated with standard PRP, the eyes were randomly assigned to receive only PRP (PRP group) or PRP plus intravitreal injection of 1.25 mg of bevacizumab (PRP-Plus group). Patients underwent complete ophthalmic evaluation, including best corrected visual acuity (BCVA), intraocular pressure (IOP), and new vessel size in fluorescein angiography (FA) and optical coherence tomography for the assessment of central subfield macular thickness (CSMT) at baseline and at weeks 12 (±2), 16 (±2), 24 (±2) and 48 (±2). Main outcome measures also included vitreous clear-up time and neovascularization on the disc (NVD) regression time. Adverse events associated with intravitreal injection were investigated. RESULTS: Thirty consecutive patients (n=36 eyes) completed the 48-week follow-up. There was no significant difference between the PRP and PRP-Plus groups with respect to age, gender, type or duration of diabetes, area of fluorescein leakage from active neovascularizations (NVs), BCVA or CSMT at baseline. The mean vitreous clear-up time was 12.1±3.4wk after PRP and 8.4±3.5wk after PRP combined with IVB. The mean time interval from treatment to complete NVD regression on FA examination was 15.2±3.5wk in PRP group and 12.5±3.1wk in PRP-Plus group. No significant difference in CSMT was observed between the groups throughout the study period. However, the total area of actively leaking NVs was significantly reduced in the PRP-Plus group compared with the PRP group (P<0.05). Patients received an average of 1.3 injections (range: 1-2). Ten eyes (27.8%) underwent 2 injections. Two eyes had ocular complication of PDR progression to dense vitreous hemorrhage (VH). No major adverse events were identified. CONCLUSION: The adjunctive use of IVB with PRP is associated with a greater reduction in the area of active leaking NVs than PRP alone in patients with high-risk PDR. Short-term results suggest combined IVB and PRP achieved rapid clearance of VH and regression of retinal NV in the treatment of high-risk PDR. Further studies are needed to determine the effect of repeated intravitreal bevacizumab injections and the proper number of bevacizumab injections as an adjuvant.     

激光联合雷珠单抗治疗增殖型糖尿病视网膜病变

目的：回顾分析对于增殖型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者进行激光联合或者不联合雷珠单抗治疗的临床效果。方法：收集整理并分析2009-08/2015-02间我院33例66眼仅有新生血管(包括视乳头或者视网膜上)不伴有视网膜纤维增殖膜以及玻璃体积血的PDR病历及随访资料。治疗方法一：全视网膜激光光凝在1 mo内分次进行完成;治疗方法二：先玻璃体内注射雷珠单抗,5 d后进行激光,1 mo内完成全视网膜光凝。随访患者治疗前、激光治疗后1、2、3wk,1、2、3mo的视力、眼压、眼底、眼B超等检查。结果：在33例66眼患者中,男16例32眼,女17例34眼,年龄23~65岁。观察在激光期间以及之后3 mo随访中,视力以及发生玻璃体积血和黄斑水肿的情况。治疗一组的患者18例36眼,治疗前视力低于0.3者10眼(28％),0.3~0.6者20眼(56％),0.8~1.0者6眼(17％)。治疗期间发生玻璃体积血22眼(61％);发生黄斑水肿或者加重10眼(28％)。治疗二组的患者15例30眼,治疗前视力低于0.3者9眼(30％),0.3~0.6者15眼(50％),0.8~1.0者6眼(20％)。发生玻璃体积血6眼(20％);发生黄斑水肿或者加重4眼(13％)。两组间治疗前视力等基本情况差别无明显统计学意义(P>0.05),在两种不同治疗方式后,两组间最后视力的差异有统计学意义(P<0.05)。结论：通过在激光前玻璃体内注射雷珠单抗的治疗,可以明显降低PDR患者的玻璃体积血以及黄斑水肿等并发症的发生。眼内雷珠单抗联合激光是治疗仅有新生血管不伴有纤维增殖膜以及玻璃体积血的PDR有效手段,可减少玻璃体积血和黄斑水肿等严重并发症的发生,降低对患者视功能的损伤的同时,增强患者治疗的依从性。     

不同方法治疗全视网膜光凝后黄斑水肿的疗效比较

目的:研究玻璃体腔注射曲安奈德(TA)与口服羟苯磺酸钙在治疗全视网膜激光光凝引起的黄斑水肿方面的疗效及安全性的差异.方法:前瞻性研究.分析2012-01/2015-01在我院眼科治疗的全视网膜激光光凝后继发黄斑水肿患者72例72眼的临床资料.所有患者均因患有严重的糖尿病视网膜病变而行全视网膜激光光凝治疗,治疗后出现不同程度的视网膜黄斑区水肿,或原有黄斑水肿加重.按照随机原则分为2组:行玻璃体腔注射TA(0.025 mL,1mg),简称注射组36眼;口服羟苯磺酸钙胶囊,简称口服组36眼.观察两组治疗前,治疗后1、3、6mo的最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹厚度(central macular thickness,CMT)、眼压(intraocular pressure,IOP)及并发症情况.结果:两组患者的基线特征相比,差异无统计学意义(P＞0.05).注射组治疗后1、3、6mo BCVA、CMT均明显改善,与治疗前相比,差异均有统计学意义(均P＜0.05);眼压无明显变化,与治疗前相比,差异均无统计学意义(均P＞0.05).口服组治疗后1、3、6mo BCVA、CMT均无明显改善,与治疗前相比,差异均无统计学意义(均P＞0.05);眼压无明显变化,与治疗前相比,差异均无统计学意义(均P＞0.05).治疗后1、3、6mo,注射组的BCVA、CMT均明显优于同时间段口服组的BCVA、CMT,差异均有统计学意义(均P＜0.05);而两组治疗后同时间段的眼压相比,差异均无统计学意义(均P＞0.05).两组治疗后均未见严重的眼部及全身并发症.结论:玻璃体腔注射1mg的TA在改善全视网膜激光光凝后继发黄斑水肿患者的BCVA、CMT方面明显优于口服羟苯磺酸钙,两种药物治疗后均未引发明显的副作用及严重并发症,治疗安全性较好.     

DR患者玻璃体切割术后黄斑水肿的治疗

目的:观察增生性糖尿病视网膜病变（proliferative diabetic retinopathy, PDR)玻璃体切割术后球周注射曲安奈德（triamcinolone acetonide, TA)联合黄斑区补充光凝治疗黄斑水肿的临床疗效。方法:PDR患者43例行玻璃体切割术及眼内全视网膜光凝术毕球周注射TA 40mg/mL,术后1wk选择有黄斑水肿患者32例,术后2wk行黄斑区补充532nm激光,术后1wk;1,3,6mo随访最佳矫正视力（best-corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度（central macular thickness, CMT)、并发症。结果:术后1mo视力提高28例（88%),视力不变4例（12%）,与术后1wk比较差异有显著性（P< 0.05）;术后3,6mo检查BCVA变化不大,与术后1mo比较均无显著性差异（P>0.05）;术后1wk CMT明显增厚,术后1mo黄斑水肿均不同程度减轻,与术后1wk比较差异有显著性（P<0.05）,术后3,6mo CMT变化不大,与术后1mo比较均无显著性差异（P> 0.05）。所有患者术后反应较轻,未出现严重并发症。结论:术后球周注射TA与黄斑区补充光凝结合起来治疗PDR患者术后糖尿病黄斑水肿取得了满意持久的临床效果。     

严重PDR玻璃体切除术和全视网膜光凝的视力对比

目的：观察严重增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）患者玻璃体手术和全视网膜光凝的视力对比。方法：将我院93例严重PDR患者随机分为两组,一组接受玻璃体切除＋剥膜＋全视网膜光凝＋黄斑光凝;另一组接受全视网膜光凝＋黄斑光凝,随访1a。结果：术后1a,第一组,视力提高12眼（27.9%）,不变11眼（25.6%）,下降20眼（46.5%）。第二组,提高14眼（28.0%）,不变24眼（48.0%）,下降12眼（24.0%）。两组间视力提高比例无差异。但不变和下降比例差异有显著意义。结论：对于严重的PDR患者,玻璃体切除术可能会带来更高视力下降的风险。     

Intravitreal triamcinolone injection for chronic diffuse diabetic macular oedema

PURPOSE: To determine the efficacy and safety of intravitreal triamcinolone in chronic diffuse diabetic macular oedema. METHODS: This prospective, interventional consecutive case series study consisted of 59 eyes (36 patients) with chronic diffuse diabetic macular oedema, which received an intravitreal injection of 4 mg triamcinolone acetonide. The results were evaluated by clinical examination and fluorescein angiography. Potential complications such as a rise in intraocular pressure, cataract progression and endophthalmitis were recorded. RESULTS: All patients completed at least 6 months follow up. The mean visual acuity improved significantly from 0.17 +/- 3.4 to a maximum of 0.30 +/- 3.3 at the third postinjection month (P < 0.01). Mean improvements in visual acuity measured were 2.15 +/- 1.66, 2.42 +/- 2.66, 1.13 +/- 2.74, 0.96 +/- 2.01 and 0.08 +/- 2.34 lines at the 1, 3, 6, 9 and 12 months follow-up intervals, respectively. In all eyes in fluorescein angiography, macular oedema was resolved (63%) or decreased (37%) during the follow up. However, the macular oedema reached the pretreatment level in 29 (49%) of the eyes at 6 months and 15 of 21 eyes (71%) at 9 months after injection. Intraocular pressure exceeded 21 mmHg in 10 eyes, which were controlled by topical medication. Four eyes showed cataract progression. Endophthalmitis was not observed in any of the eyes. CONCLUSIONS: Intravitreal injection of 4 mg triamcinolone acetonide appears to be an effective and relatively safe therapeutic method for diffuse diabetic macular oedema. Further studies are warranted to assess the long-term efficacy, safety and the need for reinjection.