非超声乳化小切口白内障术后糖尿病视网膜病变的激光治疗

目的:探讨非超声乳化小切口白内障摘除人工晶状体植入术后糖尿病视网膜病变激光治疗的时机及效果。方法:对41例68眼行非超声乳化小切口白内障摘除人工晶状体植入术后的糖尿病视网膜病变患者在眼底荧光血管造影(FFA)指导下早期予以激光光凝。结果:光凝治疗后41例68眼术后随访均满1a,其中视力提高19眼(28%);视力不变40眼(59%);视力下降9眼(13%),总有效率为87%。由于先处理已存在的黄斑水肿,未见全视网膜光凝术后黄斑水肿加重。结论:适时的白内障非超声乳化摘除人工晶状体植入术后合理及时的进行激光光凝,能有效的控制糖尿病视网膜病变的进展,稳定视力。FFA是进行正确有效激光重要参考依据。     

糖尿病视网膜病变视网膜光凝治疗疗效观察

目的：观察氩激光视网膜光凝（Panretinal photocoagulation,PRP)治疗糖尿病视网膜病变（diabetic retinpathy,DR)的临床疗效。方法：根据眼底荧光血管造影（Fundus fluorescence angiography,FFA)的结果。对87例143眼分别为增殖前期糖尿病性视网膜病变（Preproliferative diabetic retinopathy,PPDR)79眼，增殖期糖尿病性视网膜病变（Proliferative diabetic retinopathy,PDR)64眼，进行氩激光视网膜光凝治疗，治疗前及完成最后一次光凝后3个月对患者的视力，眼底，FFA进行检查并追踪观察6个月-2年。结果：本组143眼经视网膜光凝治疗后122眼有效，总有效率为85.31%，其中PPDR79眼有效73眼，有效率为92.41%;PDR64眼有效49眼，有效率为76.56%，光凝治疗后视力提高有32眼，占23.38%;87眼视力稳定不变，占60.84%；视力下降24眼，占16.78%。本组病例治疗过程及治疗后无发生并发症。结论：氩激光视网膜光凝术治疗糖尿病性视网膜病变是安全。有效的方法。     

糖尿病视网膜病变的白内障手术及视网膜光凝时机探讨

目的 观察糖尿病视网膜病变患者早期行白内障人工晶状体植入术后视网膜病变的发展情况,以及氩激光光凝治疗糖尿病视网膜病变(DR)的远期效果,探讨该类患者白内障手术和视网膜光凝治疗的时机,分析其联合治疗的效果.方法 对合并白内障的糖尿病视网膜病变患者,符合纳入标准的病人共67例,以未手术眼作为对照.白内障术后经眼底荧光造影(FFA)随访观察,随访时间1年.当检查具有光凝指征时,均行氩激光视网膜光凝.对比观察手术眼和对照眼视网膜光凝前后的视网膜病变发展程度.结果 白内障术后手术眼和对照眼经FFA随访观察需行视网膜光凝分别为26只眼(41.94%)及24只眼(38.71%),其视网膜病变发展程度基本一致;白内障人工晶状体植人手术后及时光凝的病人,DR病情稳定或减慢发展,黄斑水肿消退或减轻,视力稳定,手术眼比未手术眼获得更充分的视网膜光凝及稳定的视力和视觉质量,2例患者拒绝接受视网膜光凝治疗,晚期发生新生血管性青光眼及玻璃体出血.结论 完美的无并发症的白内障人工晶状体植入手术不会加速DR的发展;及时充分地视网膜光凝治疗,将减缓DR的发展及减少其并发症(新生血管性青光眼、玻璃体出血)的发生,稳定视力.     

术后激光对巩固玻璃体切割治疗增殖性糖尿病视网膜病变手术效果的观察

目的:观察玻璃体切割结合氩激光治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的效果,探讨术后激光治疗对于巩固手术效果的作用。方法:49例53眼PDR病例均行玻璃体切割结合术中眼内氩激光全视网膜光凝治疗,延长术后观察时间至12~36mo,复查时及时行荧光眼底血管造影(fundus fluorescein angiography,FFA)检查后补打激光,临床观察术后12~36mo中视力的恢复情况及PDR控制情况。结果:行玻璃体切割结合术中全视网膜光凝的53眼中,视力有不同程度提高者42眼(79%),视力不变者5眼(10%),视力下降者6眼(11%)。在观察的12~36mo中,47例51眼补打激光,53眼视力稳定,未出现糖尿病视网膜病变的进展。结论:玻璃体切割结合眼内氩激光全视网膜光凝是治疗与控制PDR行之有效的方法,延长术后观察时间并及时补打激光对巩固手术效果起到一定的作用。     

高原地区糖尿病性视网膜病变激光光凝治疗的疗效观察

目的:观察氩激光视网膜光凝(panretinal photocoagulation,PRP)治疗高原地区糖尿病视网膜病变(diabetic retinopathy,DR)的临床疗效。方法:根据眼底荧光血管造影(fundus fluorescence angio-graphy,FFA)的结果,对176例257眼分别为增殖前期糖尿病性视网膜病变(preproliferative diabetic retinopathy,PPDR)62眼、增殖期糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)195眼进行氩激光视网膜光凝治疗。治疗前、完成最后一次光凝后3mo分别对患者的视力、眼底、FFA进行检查并追踪观察6mo～2a。结果:本组257眼经视网膜光凝治疗后215眼有效,总有效率为83.7%。其中PPDR62眼,有效57眼(91.9%);PDR195眼,有效158眼(81.0%),经统计学检验,两者有显著差异(P<0.01)。光凝治疗后视力提高有59眼(23.0%);155眼视力稳定不变(60.3%);视力下降43眼(16.7%)。本组病例治疗后有28眼(10.9%)出现黄斑水肿加重,视力下降,经2～3wk后均恢复至光凝治疗前水平。结论:氩激光视网膜光凝术治疗DR是安全、有效的方法,尽早行氩激光视网膜光凝治疗,对于控制或延缓DR的进展,稳定患者视力有重要意义,并可以有效防止DR致盲。     

白内障超声乳化术后糖尿病视网膜病变的激光治疗

目的 观察白内障超声乳化术后糖尿病视网膜病变激光治疗的时机及疗效。方法 对58例102只眼行白内障超声乳化术的糖尿病视网膜病变患者，在眼底荧光血管造影（FFA）指导下，早期予以激光光凝。结果 光凝治疗后，58例102眼术后随访均满1y。其中视力提高25眼，占24．50％，视力不变64眼，占62．75％，视力下降13眼，占12．75％，总有效率87．25％。由于先处理已存在的黄斑水肿，未见全视网膜光凝术后黄斑水肿加重。结论 适时的白内障超声乳化摘除，术后早期进行激光光凝，能有效的控制糖尿病视网膜病变的进展，稳定视力。FFA是进行正确有效激光重要参考依据。     

氪黄绿激光治疗糖尿病视网膜病变疗效分析

目的：研究氪黄绿激光全视网膜光凝术治疗糖尿病视网膜病变的疗效。方法：根据眼底荧光血管造影（FFA）的结果。用氪黄绿激光全视网膜光凝术治疗1998年3月至2001年1月在我中心确诊为糖尿病视网膜病变的患者212例330眼,轻度白内障95眼,轻度白内障伴玻璃体混浊76眼,随访视力、眼底,FFA。结果：视力增进62眼占18.8%;视力无变化167眼占50.9%;视力下降101眼占30.6%,FFA结果有效246眼,有效率74.5%,需补充光凝78眼,4眼光弹簧过程中眼底出血,改行玻璃体切割手术。结论：氪黄绿激光全视网膜光凝治疗糖尿病视网膜病变不仅对屈光间质清晰者效果好,而且对屈光间质轻度混浊的病例效果也较满意。     

白内障术后糖尿病视网膜病变的激光时机及疗效分析

目的：观察白内障超声乳化及非超声乳化小切口摘出人工晶状体植入术后糖尿病视网膜病变（DR）的光凝治疗效果,进一步探讨光凝治疗的时机及影响光凝的因素。方法：对60例108眼行超声乳化或非超声乳化小切口白内障摘出人工晶状体植入术后的糖尿病视网膜病变患者在眼底荧光血管造影（FFA）指导下根据DR分期,早期予局限性视网膜光凝、格栅样光凝或标准全视网膜光凝治疗。结果：术后随诊1a,所有患者视力提高30眼（27.8%）,视力不变71眼（65.7%）,视力下降7眼（6.5%）,光凝术后FFA随访检查显示,视网膜水肿消退,新生血管大部分萎缩,出血、渗出部分吸收,18例合并有黄斑水肿眼光凝术后完全消退。结论：白内障术后合理及时的进行氩激光视网膜光凝治疗,能有效控制糖尿病视网膜病变的进展,对于改善糖尿病视网膜病变的视功能,稳定视力有重要作用。     

白内障人工晶状体植入术后糖尿病性视网膜病变的激光治疗

目的探讨白内障人工晶状体植入术后糖尿病性视网膜病变（diabetic retinopathy．DR）激光光凝治疗的时机及疗效。方法对48例（82眼）行白内障人工晶状体植入术后的糖尿病性视网膜病变患者,在眼底荧光素血管造影（fundus fluorescein angiography,FFA）的指导下,采用Zeiss Visulas532s眼科激光治疗仪予以早期激光光凝。82眼中．65眼行全视网膜光凝（pan—retinal photocoagulation,PRP）治疗,17眼行局部视网膜光凝术,其中12眼黄斑区还行格栅样光凝。术后随访6～18个月,观察其视力、黄斑水肿情况及并发症。结果经光凝治疗后,22眼（26．8％）视力提高,51眼（62．2％1视力无变化,9眼（11．0％）视力下降。在31眼黄斑水肿中,9眼（29．0％）黄斑水肿消退,14眼（45．2％）黄斑水肿部分吸收．8眼（25．8％）黄斑水肿不变,无光凝并发症。结论适时的白内障人工晶状体植入,以及术后早期合理的激光光凝能有效地控制DR的进展,稳定视力。FFA检查是进行正确、有效的激光光凝治疗的重要参考依据。     

白内障术后糖尿病性视网膜病变多波长激光治疗

目的 回顾性分析评价白内障超声乳化人工晶状体植入后糖尿病性视网膜病变的多波长激光治疗时机及疗效.方法 白内障术后糖尿病性视网膜病变患者35例(47只眼),所有病例均在植入人工晶状体术后二周行眼底全视网膜镜检查和FFA、OCT检查,行DR分期,第三周根据病变部位和分期,依次采用氪黄光、氪红光、氪绿光进行局灶光凝,格珊样光凝,全视网膜光凝.结果 光凝后随访3～12个月,视力提高11只眼,占23.40%,视力稳定30只眼占63.83%,视力下降6只眼占12.77%,FFA示黄斑水肿完全消退23只眼占48.94%,部分消退16只眼占34.04%,不变甚至加重8只眼占17.02%,激光治疗前OCT示黄斑部中央凹平均厚度为(390.35±102.53)μm,治疗后1个月平均厚度(287.67±82.81)μm,治疗后3个月平均厚度(208.47±56.72)μm,治疗后6个月平均厚度(168.38±42.56)μm,差异有统计学意义(P＜0.05).FFA示视网膜毛细血管渗漏广泛消退或视网膜新生血管完全萎缩20只眼,无效4眼.结论 糖尿病性白内障摘除人工晶体植入术后早期进行眼底全视网膜镜、FFA、OCT检查,根据病变分期及部位采用多波长激光治疗,能有效控制白内障术后DR的进一步发展,保护视功能.     

Comparative study of postoperative complications in primary and secondary implantation of posterior chamber intraocular lens in cataract surgery for diabetic patients]

Postoperative complications of diabetic cataract cases with active stage diabetic retinopathy, which underwent simultaneous extracapsular lens extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation in 84 eyes, ECCE only in 38 eyes and secondary implantation of PC-IOL after ECCE in 23 eyes, were studied. In the eyes of the primary PC-IOL implantation group, fibrous response in 35 eyes (42%), posterior iris synechia in 10 eyes (12%), progression of diabetic retinopathy in 13 eyes (16%), after cataract in 11 eyes (13%), pupil capture in 4 eyes (5%) and decentration of lens optics in 3 eyes (4%) were appeared, while in the ECCE only group, fibrous response in 11 eyes (29%), posterior iris synechia in 4 eyes (11%), after cataract in 11 eyes (29%), progression of diabetic retinopathy in 6 eyes (16%) were observed. On the other hand, in the secondary PC-IOL implantation group, only fibrous response was appeared in 1 eye (4%), Although PC-IOL implantation has been so far considered contraindication in cases with cataract combined with active stage retinopathy, the present studies strongly suggest that secondary PC-IOL implantation would be good indication in these cases whose blood sugar was properly controlled and the retinopathy was burned out by panretinal photocoagulation soon after ECCE.     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

Intraocular lenses and diabetes mellitus

I reviewed the records of 74 consecutive, unselected diabetic patients (91 eyes) who had cataract extraction with intraocular lens implantation. The retinopathy status remained unchanged in 79 eyes. Of the 12 in which retinopathy status changed, four eyes without previous retinopathy developed mild background retinopathy, seven eyes that had had mild background retinopathy progressed to moderate background retinopathy, and one eye that had had background retinopathy developed mild proliferative retinopathy. Sixty-four eyes (70.3%) achieved visual acuities of 20/40 or better. The examination, photography, and photocoagulation treatment of the retina were not affected by the presence of an intraocular lens.     

玻璃体联合手术治疗并发白内障的增生性糖尿病视网膜病变

目的：探讨伴有严重晶状体混浊的增生性糖尿病视网膜病变的玻璃体手术联合白内障吸除及人工晶状体植入的疗效及并发症。方法：需行玻璃体手术且伴有白内障的增生性糖尿病视网膜病变38例(41只眼)，行超声乳化白内障吸除联合玻璃体切割、膜剥离、眼内激光、或长效气体填充、及人工晶状体植入。观察病人手术前后视力变化，裂隙灯下检查眼前段情况，眼底荧光造影检查病人视网膜情况及分析并发症。结果：平均随访9个月。术后36只眼视力提高，占87．8％。眼前节反应轻，并发症少。主要并发症有：高眼压1只眼，角膜水肿1只眼，虹膜红变1只眼。视网膜脱离1只眼。结论：玻璃体联合手术治疗并发白内障的增生性糖尿病视网膜病变是一种方便、安全、有效的手术。     

Extracapsular cataract extraction in diabetic eyes

Cataract surgery may exacerbate preexisting diabetic retinopathy. Especially diabetics with active retinal neovascularisation are at high risk of rubeosis iridis after intracapsular cataract extraction. Thirty-five eyes previously treated with panretinal photocoagulation underwent extracapsular cataract extraction with posterior chamber lens implantation. Twenty-eight eyes with retinal neovascularisation required further Argon laser PRP after surgery. Fourteen eyes required YAG-laser capsulotomy. From the group of eyes without YAG-laser capsulotomy none developed neovascular glaucoma. From the YAG laser capsulotomy group six eyes developed rubeosis iridis and neovascular glaucoma. Our results indicate that eyes in which PRP has been performed, have an excellent prognosis after ECCE with posterior chamber lens implantation only if YAG Laser posterior capsulotomy is not performed.     

不同方法治疗增生性糖尿病视网膜病变合并白内障的疗效比较

目的：比较不同方法治疗增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)合并白内障患者的疗效。

方法：选取 2014-01/2016-01本院收治PDR合并白内障患者261例266眼,随机分为对照组和研究组,对照组130例133眼,研究组131例133眼。对照组患者行玻璃体切割联合光激光凝治疗及超声乳化人工晶状体植入术,研究组先玻璃体腔注射贝伐单抗再行玻璃体切割联合激光光凝治疗及超声乳化人工晶状体植入术,术后对两组患者临床疗效进行对比分析。

结果：对照组患者术后并发症均比研究组高,差异有统计学意义(P<0.05)。研究组67眼进行了补光凝,无1眼发生虹膜新生血管; 对照组76眼进行了补光凝,有17眼发生虹膜新生血管,发生率为22.4%,差异有统计学意义(P<0.05)。两组患者术后视力比较差异有统计学意义(P<0.05); 对照组患者术后黄斑水肿发生率比研究组高,差异有统计学意义(P<0.05)。

结论：玻璃体腔内注贝伐单抗后再行玻璃体切割联合超声乳化人工晶状体植入术治疗PDR合并白内障临床效果良好。