Extensive argon laser photocoagulation in the treatment of proliferative diabetic retinopathy.

A group of 20 patients (28 eyes) with proliferative retinopathy who required extensive argon laser photocoagulation to induce regression of new vessels is presented. The mean number of burns applied to each eye was 7225, with a maximum of 11,513. These were delivered in a mean of nine sessions over a mean period of 22.9 months. Twenty-five eyes (89%) had a final visual acuity of 6/18 or better. The remaining three eyes (11%) had severely reduced vision attributable to complications of proliferative diabetic retinopathy (traction retinal detachment involving the macula in two eyes and ischaemic maculopathy and a persistent vitreous haemorrhage in the third). Large amounts of confluent argon laser photocoagulation may be necessary for the elimination of new vessels in some patients, and it is our view that laser photocoagulation should be continued until regression of new vessels occurs. This is compatible with the retention of functional vision and good visual acuity.     

脉冲染料激光光凝治疗增殖型糖尿病视网膜病变的疗效观察

目的 研究增殖型糖尿病视网膜病变的治疗效果。方法 应用脉冲染料激光对８０年１３６眼增殖型糖尿病性视网膜病变患者进行（除黄斑区外）全视网膜光凝。结果 视网膜光凝术后新生血管消退,未再出现玻璃体出血者９４眼,总有效率６８．９％。其中视网膜新生血管占７１．５％,视盘新生血管有效率为４６．６％,两者比较差异非常显著（Ｐ〈０．０１）。视网膜新生血管合并视盘新生血管有效率占５０％,与视网膜新生血管组疗效比较,     

Macular edema after scatter laser photocoagulation for proliferative diabetic retinopathy

Fluorescein angiography showed perifoveal capillary leakage in three cases of macular edema after scatter laser photocoagulation for proliferative diabetic retinopathy. The scatter laser photocoagulation in these cases may have been an important factor inthe pathogenesis of macular edema.     

Treatment of proliferative diabetic retinopathy. Long-term results of argon laser photocoagulation

Panretinal photocoagulation (PRP) is the treatment of choice for proliferative diabetic retinopathy. Indications for treatment are the presence of disc new vessels or the presence of new vessels elsewhere with hemorrhage. Rubeosis iridis and retinal neovascularization undergo involution following panretinal photocoagulation. The long-term visual results are excellent excepting for eyes with diffuse diabetic retinal ischemia. Long-term follow-up and repeat photocoagulation as needed are advised.     

倍頻Nd:YAG激光治療糖尿病視網膜病變

目的探討倍頻NdYAG激光治療糖尿病視網膜病變(DR)的時機、療效及其影響因素.方法根據DR的不同時期及不同程度的眼底損害,制定不同的治療方案,對91例144眼DR采用倍頻NdYAG激光進行光凝治療.結果視力進步25%、穩定57.64%.總有效率82.64%,其中NPDR總效率爲100%,PPDR爲91.3%,PDR爲66.15%.結論 DR患者應提倡早期發現、早期光凝,只要把握好光凝時機和方法,倍頻NdYAG激光治療DR療效顯著,且保存視力比恢復已喪失視力更有效.     

Panretinal laser photocoagulation for proliferative diabetic retinopathy: the effect of laser wavelength on macular function.

The effect on macular function of the wavelength of laser light used to treat proliferative diabetic retinopathy was studied. Thirty-six eyes of 25 patients received panretinal photo-coagulation according to a standardised protocol and before and at intervals after the treatment were tested by a battery of macular function tests. Each eye was randomly assigned to treatment with blue-green, yellow, or orange laser. The tests included best corrected visual acuity, colour vision, contrast sensitivity, macular threshold, and central visual fields. There were no significant differences in the results of these tests between the three treatment groups, though there was wide scattering of baseline values within each group. Laser wavelength has not been shown to be an important determinant of central visual function following panretinal photo-coagulation in patients with proliferative diabetic retinopathy within the wavelengths tested.     

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。     

Incremental panretinal photocoagulation. Results in treating proliferative diabetic retinopathy

Since 1977, the author has treated proliferative diabetic retinopathy (PDR) under a protocol using DRS-style panretinal photocoagulation (PRP), with supplemental PRP, panretinal cryotherapy, and vitrectomy as needed. A total of 55 eyes (33 patients) were started on this protocol between 1/1/77 and 4/30/82. Follow-up averages 33 months (range: 12-80 months). Forty-nine eyes (89%) required PRP only; two eyes received panretinal cryotherapy, and four had vitrectomies. Visual acuity was maintained or improved in 44 eyes (80%); 48 eyes (87%) retained visual acuity of 20/100 or better. The major cause of visual loss was diabetic maculopathy.     

Bevacizumab-augmented retinal laser photocoagulation in proliferative diabetic retinopathy: a randomized double-masked clinical trial

PURPOSE: To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy. METHODS: A prospective, fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics. All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol. Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab (Genentech Inc., San Francisco, CA) on the first session of their laser treatments. Fluorescein angiography was performed at baseline and at weeks 6 and 16, and proliferative diabetic retinopathy regression was evaluated in a masked fashion. RESULTS: The median age was 52 years (range: 39-68) and 30% of the participants were male. All patients were followed for 16 weeks. A total of 87.5% of Avastin-injected eyes and 25% of sham group showed complete regression at week 6 of follow-up (p<0.005). However, at week 16, PDR recurred in a sizable number of the Avastin-treated eyes, and the complete regression rate in the two groups became identical (25%; p=1.000); partial regression rates were 70% vs 65%. In the subgroup of Avastin-treated eyes, multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence (p=0.033). CONCLUSIONS: Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived, as many of the eyes showed rapid recurrence. Alternative dosing (multiple and/or periodic intravitreal Avastin injections) is recommended for further evaluation.     

氩激光治疗增殖型糖尿病性视网膜病变

目的　观察氩激光光凝术治疗增殖型糖尿病性视网膜病变 (Proliferativediabeticretinopathy ,简称PDR)的疗效。 方法　 78眼分三组 ,增殖前期组、视网膜新生血管 (Neovasculariza tionelsewhere ,简称NVE)组、视盘新生血管 (Neovascularizationondisc ,简称NVD)组 ,行氩激光全视网膜光凝术 (黄斑区除外 ) ,观察术前、术后新生血管性病变及视力的变化 ,及光凝术后的并发症。结果　光凝术后增殖前期组 18眼 (81 8% )未发生新生血管 ,且无并发症 ;NVE组新生血管完全消退为 2 8眼 (71 8% ) ,NVD组为 7眼 (4 1 2 % ) ,两者比较差异具有显著性 (P <0 0 5 ) ;经追加光凝后仍持续存在新生血管的NVE组 6眼 (15 4% ) ,NVD组 8眼 (4 7 1% ) ,两者比较差异具有显著性 (P <0 0 5 )。各种严重并发症NVE组共 6眼 (15 4% ) ,NVD组 6眼 (3 5 2 % ) ,两者无显著性差异。三组视力术前、术后的差异无显著性。结论　氩激光全视网膜光凝术可有效阻止和治疗PDR的发展 ;对NVE的疗效优于NVD。     

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.     

雷珠单抗联合激光治疗糖尿病视网膜病变的疗效

目的：探讨雷珠单抗联合激光治疗增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效。

方法：本研究观察对象为2014-10/2016-10我院眼科接诊的80例101眼PDR患者,按照治疗方式不同分为观察组与对照组。对照组40例50眼只采用全视网膜激光光凝(panretinal photocoagulation,PRP)治疗,观察组40例51眼在此基础上术前使用雷珠单抗治疗。比较术前、术后1、3、6mo最佳矫正视力(best corrected visual acuity,BCVA),光学相干断层成像技术(optical coherence tomography,OCT)检查各时期黄斑中心凹厚度(central macular thickness,CMT)以及各时间视网膜新生血管面积,并比较两组患眼使用激光能量、光斑数以及能量密度,记录不良反应发生情况。

结果：两组患者术后BCVA均显著改善,且观察组术后1、3、6mo均显著高于对照组,差异有统计学意义(P<0.05); 两组患者治疗后CMT、新生血管面积较治疗前显著降低,且观察组术后1、3、6mo均显著低于对照组,差异均具有统计学意义(P<0.05); 观察组使用激光能量、光斑数以及能量密度均显著低于对照组,差异具有统计学意义(P<0.05); 观察组2例2眼,对照组1例1眼出现超过28mmHg眼压,卡替洛尔降压治疗3d后恢复正常,两组均未出现青光眼、视网膜脱离,眼内炎等其他并发症。

结论：雷珠单抗联合激光治疗PDR能显著改善BCVA,降低CMT,消除新生血管,所需激光能量更低,安全有效。     

Trans-scleral diode laser photocoagulation in proliferative sickle cell retinopathy.

OBJECTIVE: To demonstrate the feasibility of trans-scleral diode laser photocoagulation for the treatment of proliferative sickle cell retinopathy. DESIGN: Interventional case report. INTERVENTION: Trans-scleral diode laser scatter photocoagulation was applied to both eyes of a 30-year-old man with hemoglobin SC disease. MAIN OUTCOME MEASURES: Regression of retinal vascular proliferation and of dye leakage on fluorescein angiography. RESULTS: After coagulation, vascular proliferation receded completely. Vitreous bleeding was absorbed. There were no side effects during follow-up (22 months). CONCLUSION: Trans-scleral diode laser photocoagulation proved to be an effective and safe treatment in a case of proliferative sickle cell retinopathy with vitreous bleeding.     

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.     

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。