光凝治疗增殖型糖尿病性视网膜病变

目的 观察光凝治疗增殖型糖尿病性视网膜病变的疗效。方法 对患有增殖型糖尿病性视网膜病变的１４３例２６０眼光凝前和光凝后３～６个月进行眼底、视力和荧光血管造影检查,并对造影的特征指标静脉渗漏荧光、出血遮蔽荧光、视网膜微动脉瘤、无灌注区以及视力进行比较和统计分析。结果 光凝后视力较光凝前提高及荧光血管造影特征指标好转均非常明显,差异有极显著性（Ｐ〈０．０００１）。结论 全视网膜光凝对增殖型糖尿病性视网     

The subclassification and long-term prognosis of preproliferative diabetic retinopathy

PURPOSE: We followed up 54 patients (95 eyes) with preproliferative diabetic retinopathy (PPDR) for at least 2 years, and then evaluated the proportion developing proliferative diabetic retinopathy (PDR), and the period from diagnosis of PPDR until the development of PDR. METHODS: We divided the 95 eyes affected by PPDR into 75 eyes with mild-type and 20 eyes with moderate-type based on our previously proposed subclassification, and evaluated long-term (2 or more years) prognosis. RESULTS: The proportion developing PDR was 24% in mild-type and 60% in moderate-type. The average period from diagnosis of PPDR until the development of PDR was 6 years and 5 months in mild-type, 2 years in moderate-type. The cumulative occurrence rates of PDR at 2, 5, and 10 years were estimated to be 0%, 14%, and 39% in mild-type and 35%, 58%, and 79% in moderate-type, respectively. The proportion developing PDR was significantly higher and the average period until PDR development significantly shorter in moderate than in mild-type. In mild-type eyes, the rate of progression to moderate-type was 56% and further progression from moderate-type to PDR occurred in 43%. CONCLUSION: The above results again confirm the usefulness of our subclassification, and also provide valuable information about the long-term prognosis of PPDR.     

The sub-classification and long-term prognosis of preproliferative diabetic retinopathy]

PURPOSE: We followed eyes with preproliferative diabetic retinopathy(PPDR) for 2 or more years, and then evaluated the proportion of patients developing proliferative diabetic retinopathy(PDR) and the period from diagnosis of PPDR until development of PDR. SUBJECTS AND METHODS: We divided 95 eyes affected by PPDR into 75 eyes with mild type and 20 eyes with moderate type based on our previously proposed sub-classification, and evaluated the long-term prognosis of 2 or more. RESULTS: The proportion developing PDR was 24% in mild type and 60% in moderate type. The average period from diagnosis of PPDR until development of PDR was 6 years and 5 months in the mild type and 2 years in the moderate type. The accumulative occurrence rates of PDR at two, 5, and 10 years were estimated to be 0%, 14%, and 39% in the mild type and 35%, 58%, and 79% in the moderate type, respectively. The proportion developing PDR was significantly higher and the average period until PDR development significantly shorter in the moderate than in the mild type. In mild type eyes, the rate of progression to moderate type was 56% and further progression from moderate type to PDR was noted in 43%. CONCLUSION: The above results again verify the usefulness of our sub-classification, and also provide useful information about the long-term prognosis of PPDR.     

Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy

Purpose  

To evaluate the effectiveness of selective photocoagulation (S-PC) for nonperfusion areas (NPA) in preproliferative diabetic retinopathy (PPDR).     

Photocoagulation of nonproliferative exudative diabetic retinopathy

We conducted a study of 35 patients with exudative diabetic retinopathy who chose to have laser photocoagulation and 35 similar controls who did not. The mean follow-up period was 17 months. A trend toward stabilizing and improving visual acuity was noted in the treated group, but the difference between groups was not significant.     

视盘新生血管型糖尿病视网膜病变的治疗

目的：观察光凝治疗视盘新生血管型糖尿病视网膜病变的疗效。方法：使用氩激光对68例86眼高盘新生血管型糖尿病视网膜病变患者行全视网膜光凝,其中5眼联合周边视网膜冷冻术,5眼联合玻璃体切除术。结果：全视网膜光凝术前术后视力无显著差异。平均激光治疗量为2700灶,全视网膜光凝术后新生血管消退率为63.9%,激光联合周边视网膜冷冻术后新生血管消退率为67.4%,激光联合玻璃体切除术后新生血管消退率为72.1%,结论：视盘新生血管型糖尿病视网膜病变较常规治疗需更大的激光量,激光联合周边视网膜冷冻或玻璃体切除术可增加疗效。     

Photocoagulation of diabetic macular oedema--complications and visual outcome

PURPOSE: To describe complications and visual outcome of photocoagulation for clinically significant macular oedema. SUBJECTS AND METHODS: Evaluation of macular oedema and complications of photocoagulation in 194 eyes, defined as subretinal fibrosis, atrophic creep of the pigment epithelium and subretinal neovascularization was based on stereo fundus photo grading. The study included 25 patients with type 1 and 93 patients with type 2 diabetes (age 32 +/- 10 and 65 +/- 9 years, respectively). The statistical evaluations were based on one eye per patient. RESULTS: Follow-up time was 5.5 +/- 2.4 years (mean +/- SD). Complications within 1/3 ODD from the centre of the macula were seen in 4% (1/23) of eyes of patients with type 1 diabetes, compared to 26% (20/76) of eyes among patients with type 2 diabetes (p=0.02). Hard exsudates before treatment were more common in type 2 than in type 1 diabetic eyes, 70/82 vs. 11/23 (p<0.001). In all eyes, hard exsudates were more often associated with subretinal fibrosis or atrophic creep (35/133 eyes) than diffuse oedema (5/44 eyes) (p=0.04). CONCLUSION: Photocoagulation for clinically significant macular oedema with hard exudates, particularly when subfoveally located, was more often associated with subretinal fibrosis or atrophic creep of the pigment epithelium than photocoagulation of oedema without hard exudates. Hard exudates as well as complications after photocoagulation were more common in type 2 than in type 1 diabetes, resulting in poorer visual outcome in this group of patients.     

非增生型糖尿病视网膜病变黄斑水肿伴发浆液性黄斑脱离的脉络膜微结构改变

[目的]观察非增生型糖尿病视网膜病变(NPDR)黄斑水肿(DME)伴发浆液性黄斑脱离(SMD)的脉络膜微结构改变的光相干断层扫描图像(OCT)特征.[方法]NPDR单眼发生DME伴SMD(SMD组)的9只眼以及对侧只有DME而无SMD(无SMD组)的9只眼纳入研究.患者中,既往行全视网膜激光光凝(PRP)治疗6只眼,按是否行PRP治疗分为PRP治疗组和非PRP治疗组,分别为6、12只眼.均行增强深部成像技术(EDI)频域光相干断层扫描(EDI-OCT)和眼底彩色照相检查.测量中心凹处脉络膜厚度,应用Image Plus Pr0 6.0软件计算以中心凹为中心的EDI-OCT水平扫描所提示的脉络膜模拟面积.采用配对t检验对比分析有无SMD眼检测结果的差异;F检验对比分析PRP治疗组与非PRP治疗组间差异.[结果]SMD组视网膜神经上皮脱离区域呈梭型或圆顶状的低信号暗区,外界膜均保持完整,光感受器内外节连接层与视网膜色素上皮-Bruch膜之间发生分离.SMD组中心凹脉络膜平均厚度和脉络膜平均模拟面积均高于无SMD组,差异有统计学意义(t=2.306、2.306,P＜0.05).PRP治疗组脉络膜平均模拟面积大于非PRP治疗组脉络膜平均模拟面积,差异有统计学意义(F=5.227,P＜0.05);两组间中心凹脉络膜平均厚度比较,差异无统计学意义(F=3.276,P＞0.05).[结论]NPDR中DME伴发SMD眼脉络膜微结构改变的OCT图像特征是视网膜神经上皮脱离区域呈梭型或圆顶状的弱信号暗区.     

Advances in retinal imaging for diabetic retinopathy and diabetic macular edema

Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness throughout the world, and cause significant visual morbidity. Ocular imaging has played a significant role in the management of diabetic eye disease, and the advent of advanced imaging modalities will be of great value as our understanding of diabetic eye diseases increase, and the management options become increasingly varied and complex. Color fundus photography has established roles in screening for diabetic eye disease, early detection of progression, and monitoring of treatment response. Fluorescein angiography (FA) detects areas of capillary nonperfusion, as well as leakage from both microaneurysms and neovascularization. Recent advances in retinal imaging modalities complement traditional fundus photography and provide invaluable new information for clinicians. Ultra-widefield imaging, which can be used to produce both color fundus photographs and FAs, now allows unprecedented views of the posterior pole. The pathologies that are detected in the periphery of the retina have the potential to change the grading of disease severity, and may be of prognostic significance to disease progression. Studies have shown that peripheral ischemia may be related to the presence and severity of DME. Optical coherence tomography (OCT) provides structural detail of the retina, and the quantitative and qualitative features are useful in the monitoring of diabetic eye disease. A relatively recent innovation, OCT angiography, produces images of the fine blood vessels at the macula and optic disc, without the need for contrast agents. This paper will review the roles of each of these imaging modalities for diabetic eye disease.