One-year outcomes of panretinal photocoagulation in proliferative diabetic retinopathy

PURPOSE: To describe the clinical features and complications of diabetic retinopathy, visual acuity, and number of repeat treatments after panretinal photocoagulation for proliferative diabetic retinopathy in a tertiary care center. METHODS: A cohort study was conducted with data collection from medical records of patients undergoing panretinal photocoagulation between 1985 and 1995 at the Scheie Eye Institute; 297 eyes of 186 patients were eligible for study. RESULTS: The presence of neovascularization of the disk at baseline, an earlier onset of diabetes, and a shorter duration of disease before panretinal photocoagulation were the strongest risk factors for needing an additional panretinal photocoagulation treatment. Sixty-two percent of eyes with poor visual acuity (< or =20/200) at baseline still had poor visual acuity at 1 year, and 76% with good visual acuity (> or =20/40) at baseline maintained good visual acuity at 1 year. Poor vision at baseline was the only risk factor for having poor vision at 1 year. Vitreous hemorrhage was present in 44% of eyes at baseline. New vitreous hemorrhage developed in 37% of eyes during the first year after panretinal photocoagulation. A traction retinal detachment was present in 4% of eyes at baseline and newly developed in 6% of eyes during follow-up. A repeat panretinal photocoagulation treatment was performed in 39% of eyes after initial treatment. A vitrectomy was performed in 10% of eyes from baseline through the 1-year follow-up visit. CONCLUSIONS: The data from this study are useful for counseling patients with respect to likely visual outcome, possibility of major complications from proliferative diabetic retinopathy, and the chance of undergoing additional laser treatment after panretinal photocoagulation.     

The prognostic value of post-treatment retinopathy after panretinal photocoagulation for proliferative diabetic retinopathy in type 1 diabetes

PURPOSE: To study the prognostic value of post-treatment retinopathy after panretinal laser photocoagulation for proliferative diabetic retinopathy in type 1 diabetes mellitus. Proliferative diabetic retinopathy is treated with panretinal photocoagulation, which significantly reduces the risk of visual loss from this complication. However, no parameters are presently known that can be used to define an optimal control interval after the initial panretinal photocoagulation treatment that ensures enhancement of the treatment in cases where this is needed. METHODS: In this retrospective cohort study, 85 eyes from 56 type 1 diabetic patients were identified who had been subjected to panretinal photocoagulation for proliferative diabetic retinopathy before 1990. The patients were divided into two groups: Group 1 had four or fewer microaneurysms only at the first post-treatment examination whereas Group 2 had more retinopathy. RESULTS: At the first photographic examination after treatment the eyes in Group 1 had a significantly lower visual acuity (VA) (mean =0.23, range: 0.01-1.00) than the patients in Group 2 (mean=0.48, range: 0.01-1.6). During the follow-up period the VA was further reduced in Group 2 but not in Group 1. Three eyes out of six in Group 1 had improvement of VA from below to above 0.1, whereas 6 eyes out of 12 in Group 2 experienced progression of retinopathy with a consequent worsening of VA to below 0.1 after a mean of 10.8 years (range: 6.8-15.9) after treatment. CONCLUSIONS: The severity of post-treatment retinopathy can be used to assess the need for enhancing photocoagulation of proliferative diabetic retinopathy in type 1 diabetes. The interval between post-treatment examinations can be increased to several years when the initial treatment has reduced retinopathy to a minimal level.     

氩激光视网膜光凝治疗糖尿病性视网膜病变

目的观察糖尿病性视网膜病变的光凝治疗效果。方法对136例(261只眼)糖尿病性视网膜病变患者,根据病变的程度行氩激光视网膜光凝治疗,并随访1年,观察光凝治疗变后患者的视力、眼底及荧光血管造影的变化,并进行分析和比较。结果在136例(261只眼)糖尿病性视网膜病变中,有效226只眼,总有效率 86．5％,其中增生前期糖尿病视网膜病变64只眼,有效60只眼,有效率93．7％;增生期糖尿病视网膜病变197只眼,有效眼166,有效率84．2％％。经统计学检验P<0．01,两者有显著差异。讨论对早期糖尿病性视网膜病变患者,如有光凝指征,应尽早行氩激光视网膜光凝治疗,这对于控制或延缓糖尿病性视网膜病变的进展,稳定患者视力有重要意义。     

Long-term stability and visual outcome after favorable initial response of proliferative diabetic retinopathy to panretinal photocoagulation

The authors assessed the relationship between early objective response to panretinal photocoagulation (PRP) and the subsequent long-term visual outcome in 59 eyes of 59 consecutive patients who developed proliferative diabetic retinopathy while under the care of a retinal specialist. Thirty five eyes (59%) had regression of high-risk retinopathy characteristics within 3 months of treatment. Eighteen of these eyes (52%) had a final visual acuity of 20/20 or better with a mean follow-up of more than 4 years. Only 2 of the 24 nonresponder eyes (8%) had visual acuity of 20/20 or better. Thirteen of the responder eyes (37%) sustained a delayed vitreous hemorrhage, which was usually self-limited. Three responders underwent vitrectomy with excellent visual results. The authors conclude that the beneficial effect of PRP on visual outcome is directly related to the regression of retinopathy risk factors and that the long-term visual prognosis in high-risk eyes manifesting a favorable initial response to PRP is excellent.     

Retinopathy risk factor regression after laser panretinal photocoagulation for proliferative diabetic retinopathy

Fifty eyes of patients with proliferative diabetic retinopathy were followed at frequent intervals to determine the rapidity and stability of retinopathy risk factor regression after argon laser panretinal photocoagulation. Retinopathy risk factors regress rapidly after laser photocoagulation. The incidence of eyes at high risk for severe visual loss (eyes with 3 or more retinopathy risk factors) decreased from 100% prior to treatment to 28% three weeks after treatment. The early response to treatment was a good prognostic indicator of longer term results. Seventy-two percent of eyes which improved from a high- to a low-risk category by three weeks continued to remain at low risk at six months. Sixty-four percent of eyes which failed to improve to a low-risk category by three weeks continued to remain at high risk at six months. The early response to laser panretinal ablation may be used to predict longer-term results.     

Visual prognosis after panretinal photocoagulation for proliferative diabetic retinopathy

INTRODUCTION: Proliferative diabetic retinopathy is treated with panretinal photocoagulation, which improves the visual prognosis in this complication considerably. The visual acuity (VA) and grade of retinopathy before treatment are known indicators of the visual prognosis after treatment, but the prognostic value of other clinical background and treatment parameters is unknown. METHODS: The study reports predictors for visual outcome identified among retrospective clinical background data and treatment parameters from 4422 panretinal photocoagulation sessions for proliferative diabetic retinopathy in 1013 eyes of 601 patients performed at the Department of Ophthalmology, Arhus University Hospital between 1985 and 2002. RESULTS: High pretreatment VA and low age were strong positive predictors of post-treatment VA (p < 0.0001). However, diabetes type, diabetes duration and calendar year of treatment showed no influence on post-treatment VA (p = 0.7829, 0.1782, and 0.3747, respectively). The visual prognosis was inversely related to the number of treatment sessions (p = 0.0259) and the number of vitrectomies (OR = 2.66 [1.24; 5.69], p = 0.0117, for more than two operations). However, the visual prognosis was unrelated to any of the other parameters studied. CONCLUSIONS: Pretreatment VA, age and the number of panretinal photocoagulation treatment sessions and vitrectomies necessary to halt the disease are indicators of the visual prognosis after panretinal laser photocoagulation for proliferative diabetic retinopathy.     

Combined modified grid and panretinal photocoagulation for diffuse diabetic macular edema and proliferative diabetic retinopathy

PURPOSE: To determine the effectiveness of combined macular modified grid and peripheral panretinal photocoagulation in diabetic eyes with both macular edema and proliferative retinopathy. MATERIAL AND METHODS: We evaluated 52 eyes with diffuse diabetic macular edema and proliferative diabetic retinopathy. Treatment was performed in two sessions consisting of initial modified grid to the macula and panretinal photocoagulation to the inferior half of the peripheral retina, followed 2 to 4 weeks later by panretinal photocoagulation to the superior half. RESULTS: At one year, visual acuity was improved in 8%, stable in 79%, and worse in 13%. At two years, visual acuity was improved in 4%, stable in 72%, and worse in 24%. Macular edema resolved in 43 of 46 eyes (93%), and proliferative retinopathy was reduced in 25 of 29 eyes (86%) at last examination. CONCLUSION: Combined macular modified grid and peripheral panretinal photocoagulation is an effective treatment approach in diabetic eyes with both macular edema and proliferative retinopathy. Laser photocoagulation in those diabetic eyes with diffuse diabetic macular edema and proliferative diabetic retinopathy can be completed in less number of treatment sessions with this method, compared to conventional treatment techniques.     

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。     

Photocoagulation treatment of radiation retinopathy

We studied the visual and anatomic effects of focal photocoagulation for clinically significant radiation macular edema in five eyes of four patients and panretinal photocoagulation for proliferative radiation retinopathy in six eyes of three patients. Focal and limited scatter photocoagulation was successful in preventing further vision loss in all five eyes treated for macular edema. Three eyes treated with panretinal photocoagulation had regression of neovascularization. The other three eyes treated for proliferative retinopathy subsequently had dense vitreous hemorrhages that required vitrectomy for restoration of useful vision.     

糖尿病视网膜病变患者PRP术后预后的相关影响因素

目的：探讨糖尿病视网膜病变(DR)患者全视网膜激光光凝术(PRP)术后预后相关影响因素。

方法：收集2015-09/2017-09来我院就诊的DR患者182例301眼,根据病变分期给予患者不同的治疗方式,增殖前期患者进行次全视网膜光凝治疗,DR增殖早期患者进行标准全视网膜光凝治疗,高危患者进行超全视网膜光凝治疗。对患者随访6mo,记录患者的预后情况,筛选对视力变化有影响的相关因素。

结果：对单因素有意义的因素进行多因素Logistic回归分析可以得出,年龄、初诊视力、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、糖化血红蛋白、黄斑水肿严重程度、血压与预后具有相关性(P<0.05)。

结论：高血压、年龄大、高血脂、初诊视力差、糖化血红蛋白水平高、黄斑水肿严重对DR患者激光光凝术后的预后造成一定影响。     

Macular edema and pregnancy in insulin-dependent diabetes

Seven women with insulin-dependent diabetes (mean age, 26 years; mean duration of diabetes, 15.4 years) had minimal or no retinopathy before becoming pregnant but developed severe macular edema associated with preproliferative or proliferative retinopathy during the course of their pregnancies. The edema was associated with significant macular capillary nonperfusion, and often with significant proteinuria and mild hypertension. Although proliferation was controlled with panretinal photocoagulation, the macular edema continued to worsen until delivery in all cases and was often aggravated by the photocoagulation. Macular edema and retinopathy both regressed after delivery in some patients but persisted in others, causing significant visual loss. Pregnant women with retinopathy, nephropathy, or hypertension should undergo ophthalmoscopy at least once a month. If proliferative retinopathy develops, panretinal photocoagulation should be applied even if the macular edema is aggravated.     

增殖型糖尿病视网膜病变玻璃体切割术后视力不良的相关因素研究

目的 调查增殖型糖尿病视网膜病变玻璃体切割术后视力低于0.1的发生频率及相关因素.方法 回顾性分析95例120只眼增殖型糖尿病视网膜病变行玻璃体切割手术治疗患者的临床资料,在术后视力低于0.1和大于等于0.1两群间,对可能影响术后视力的相关因素进行比较.结果 37只眼(31%)术后视力低于0.1.根据单变量分析,术后视力不良与术前黄斑脱离、眼内填充物填充、术后高眼压及术前未进行全视网膜光凝治疗具有较高的相关性.根据多变量分析,术后视力不良与术前黄斑脱离及术后高眼压的关系更为密切.结论 增殖型糖尿病视网膜病变玻璃体切割术后视力低于0.1与术前黄斑脱离及术后高眼压密切相关.     

Contrast sensitivity and visual recovery time in diabetic patients treated with panretinal photocoagulation

PURPOSE: To study patients treated with panretinal photocoagulation regarding contrast sensitivity and visual recovery time after exposure to glare. METHODS: To compare contrast sensitivity and visual recovery-time after exposure to glare in eyes (n=20) from 20 type 1 diabetic patients treated with panretinal photocoagulation for proliferative retinopathy with eyes (n= 19) from 19 un-treated type 1 diabetic patients. Contrast sensitivity was tested with a low contrast acuity chart, before and during exposure to either a uniform background illumination or a spotlight. Visual recovery time was defined as the time required to regain baseline visual acuity during light exposure. RESULTS: Contrast thresholds values were higher in eyes treated with panretinal photocoagulation compared to un-treated eyes before illumination 4.2 +/- 1.2% vs. 3.1 +/- 1.7% (p=0.006), during background illumination 5.8 +/- 5.1% vs. 3.9 +/- 4.8% (p=0.001), and during spotlight exposure 5.6 +/- 2.2% vs. 3.2 +/- 1.8% (p<0.001). Furthermore, recovery time was longer both during background illumination, 20; 5-50 sec vs. 2; 2-80 sec. (md;range), (p<0.001) and during spotlight illumination 27; 5-70 sec vs. 2;1-60 sec. (md;range) (p<0.001). CONCLUSION: Eyes treated with panretinal photocoagulation had higher contrast threshold levels at baseline and during glare, as well as a prolonged visual recovery time compared to un-treated eyes with mild background retinopathy.     

基层医院激光治疗糖尿病视网膜病变临床观察

目的：探讨基层医院全视网膜光凝治疗糖尿病视网膜病变的疗效。

方法：对55例92眼分别为增殖前期糖尿病视网膜病变(PPDR)、增殖期糖尿病视网膜病变(PDR)患者进行全视网膜光凝术,术后3, 6, 12mo行眼底荧光血管造影(FFA)及彩色眼底像, 新生血管未消退者和无灌注区尚存者追加光凝, 随访3～12mo。

结果：全视网膜光凝术后PPDR视力提高和视力不变者23眼(77%),视力下降者7眼(23%); PDR视力提高和视力不变者44眼(71%),视力下降者18眼(29%)。经过一次全视网膜光凝后,3mo复查FFA,新生血管未退、无灌注区未消失者追加光凝,PPDR有效率为29 眼(97%),PDR有效率为50 眼(81%); 13眼(14%)出现玻璃体出血转上级医院行玻璃体切割术。

结论：基层医院全视网膜光凝治疗糖尿病视网膜病变疗效良好。     

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。     

Subthreshold diode micropulse panretinal photocoagulation for proliferative diabetic retinopathy

PURPOSE: To report the visual acuity and clinical outcomes of a pilot study of subthreshold diode micropulse (SDM) panretinal photocoagulation (PRP) for treatment of diabetic retinopathy.METHODS: A retrospective chart review of all patients undergoing PRP for diabetic retinopathy between April 2000 and February 2003 was performed. Treated conditions ranged from severe non-proliferative to severe proliferative diabetic retinopathy. An SDM PRP protocol designed to avoid detectable laser lesions was employed. Treatment failure end points included the development of vitreous haemorrhage or the performance of vitrectomy.RESULTS: Ninety-nine eyes of 63 patients undergoing SDM PRP were identified. Median follow-up was 1.0 year (range of 0.3-2.7 years). Treatment sessions per eye ranged from 1 to 6 (with a median of two sessions per eye). Overall visual acuity remained unchanged. The probability of treatment failure end points at 12 months post-treatment was 12.5% for vitreous haemorrhage and 14.6% for vitrectomy (from Kaplan-Meier survival analysis). Age, sex, diabetes type, and baseline retinopathy status were not significantly associated with the risk of either failure event. No treatment complications were observed. No eye demonstrated any laser lesion detectable clinically or by fluorescein angiography postoperatively.CONCLUSION: SDM pan retinal photocoagulation minimized retinal damage and treatment complications in the management of high-risk non proliferative and proliferative diabetic retinopathy. Visual loss was prevented with a low rate of vitreous haemorrhage and vitrectomy postoperatively. Further study of the safety, efficacy, and optimal treatment parameters of SDM pan retinal photocoagulation for diabetic retinopathy is warranted.     

氩激光治疗糖尿病视网膜病变的疗效观察

目的:观察氩激光视网膜光凝治疗糖尿病视网膜病变的治疗效果.方法:选择经眼底血管荧光造影(FFA)确诊为增殖前期及增殖期的糖尿病视网膜病变患者56例(81眼),根据眼底荧光造影(FFA)的结果行标准全视网膜光凝,有临床意义的黄斑水肿者先行格栅样光凝,再行全视网膜光凝,治疗后3～12 mo分别行眼底荧光造影,对需要者进一步补充光凝.观察治疗前后的视力、眼底荧光造影了解视网膜血管渗漏情况以及新生血管的变化.结果:全视网膜光凝81眼治疗后视力提高者22眼,占27%,视力不变52眼,占64%,有效率达91%,视力下降7眼,占9%.增生性糖尿病视网膜病变有6眼新生血管完全消退,占23%,15眼部分消退,占57%,增殖前期视网膜出血、渗出完全吸收13眼,23%,部分吸收35眼,64%,7眼不变,占13%.13眼合并有黄斑水肿者部分或完全消退7眼,占54%.结论:及时行氩激光全视网膜光凝治疗对于改善糖尿病视网膜病变的视功能有重要作用,无明显并发症发生.     

Type 1 diabetes patients with severe non-proliferative retinopathy may benefit from panretinal photocoagulation

PURPOSE: To examine whether panretinal photocoagulation for severe non-proliferative retinopathy in type 1 diabetes patients could halt the progression of retinopathy with subsequent vitreous haemorrhages and visual impairment. METHODS: During a 10-year follow-up study period of 344 type 1 diabetes patients, 81 subjects went through panretinal photocoagulation. Forty patients were treated for severe non-proliferative retinopathy (age at onset of diabetes 14 +/- 8 years, diabetes duration 18 + 10 years) and 41 for proliferative retinopathy (age at onset 15 +/- 10 years, diabetes duration 22 + 13 years). One randomly selected eye per patient forms the basis for the study. Metabolic control, systolic and diastolic blood pressure, serum creatinine and urinary albumin levels were measured and analysed yearly during the follow-up period. RESULTS: A total of 35% (14/40) of eyes treated for severe non-proliferative retinopathy developed neovascularizations during a mean time of 2.9 +/- 1.5 years. Vitreous haemorrhages were more frequent in eyes with proliferative retinopathy at treatment than in eyes with severe non-proliferative retinopathy (12/41 versus 2/40; p = 0.007). The number of vitrectomies due to vitreous haemorrhages in eyes treated for severe non-proliferative retinopathy tended to be lower (1/40 versus 6/41; p = 0.052). Before photocoagulation, visual acuity (VA) was similar in eyes with severe non-proliferative retinopathy and in those with proliferative retinopathy (1.0, 0.4-1.0 versus 1.0, 0.1-1.0; median and range). Visual impairment and blindness tended to develop more often in eyes treated for proliferative retinopathy compared to those treated for severe non-proliferative retinopathy (10/40 versus 4/40; p = 0.056). Eyes with neovascularizations at follow-up were more often visually impaired (VA < 0.5) than eyes without neovascularizations (15/55 versus 1/26; p = 0.016). CONCLUSION: In type 1 diabetes, panretinal photocoagulation may be beneficial even at the severe non-proliferative retinopathy stage in terms of preventing vitreous haemorrhage, subsequent vitrectomy and visual impairment.     

行全视网膜光凝时不同象限顺序对治疗效果影响的临床研究

目的:利用光学相干断层扫描仪(OCT)视网膜地形图,探讨糖尿病性视网膜病变患者行不同顺序全视网膜光凝术前后对黄斑水肿的影响。方法:随机选择发生糖尿病性视网膜病变Ⅲ和Ⅳ期患者共19例(30眼),按不同象限顺序行全视网膜光凝。分成3组,每组10眼。第1组光凝顺序鼻侧、下方、上方、颞侧象限;第2组下方、鼻侧、上方、颞侧象限;第3组颞侧、下方、鼻侧、上方象限。每周一个象限,共4周完成。分别在术前、术后1,2,3,4,8wk测量视网膜地形图,比较各组间黄斑水肿程度及视力有无差异。结果:第1组和第2组术后8wk视力较术前轻度提高,第3组术后8wk视力较术前轻度下降,差异无统计学意义(P>0.05);第1组和第2组术后4wk黄斑视网膜厚度较术前增加,差异有统计学意义(P<0.05);第3组术后4wk黄斑视网膜厚度较术前增加,差异有统计学意义(P<0.01);术后8wk3组黄斑视网膜厚度均较术前变薄,前两组比第3组减轻幅度大,第1组、第2组在中心环处视网膜水肿减轻同术前比差异有统计学意义(P<0.05),第3组中心环处视网膜厚度同术前相比差异无统计学意义(P>0.05),余各处3组较术前相比差异均无统计学意义(P>0.05)。结论:对于Ⅲ期和Ⅳ期糖尿病性视网膜病变全视网膜光凝时,第2组获得较好视力,引起黄斑水肿较轻;通过OCT检查视网膜地形图是观察糖尿病性视网膜病变激光手术前后黄斑水肿的一种有效、敏感方法。