二极管激光治疗糖尿病视网膜病变的临床观察

目的；探讨二级管激光光凝治疗伴有—定程度屈光间质混浊的糖尿病视网膜病变患者的疗效。方法：用二级管激光光凝治疗36例40眼屈光间质混浊、不能用氩激光治疗的糖尿病视网膜病变患者．治疗前作视力、眼底和眼底荧光血管造影检查及照彩色眼底傀。随访以上项目8~14 月(平均11个月)． 结果：29眼(约73%)视力提高或维持不变，在34眼增殖性糖尿病性视网膜病变中25眼(约74%)新生血管部分或全部退行。 结论：二级管激光光凝对伴有一定程度屈光间质混浊的糖尿病视网膜病变疗效较为满意． （中华眼底病杂志，1996，12：111-113）     

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。     

二极管激光眼科临床应用初步报告

为了探讨二极管激光治疗眼病的方法及效果，对眼病患者７０例８１只眼进行了二极管激光治疗，其中各种眼底病的光凝４０眼，虹膜周切及虹膜周边成形术２４眼，经巩膜睫状体光凝５眼，瞳孔成形术４眼，光凝倒睫６眼，下睑色素痣２眼。结果显示青光眼组光凝治疗前后视力相同者７２．４％、视力提高者２４．１％、视力下降者３．４％。光凝后眼压正常者９６．６％。眼底病组光凝后渗出及出血吸收，新生血管及微血管瘤消失，黄斑水肿消退，视网膜裂孔封闭可靠，均无视力下降、眼底出血等并发症发生。认为二极管激光在眼科的应用范围较广，其穿透力强，介质吸收率低，能透过混浊的晶体及玻璃体进行治疗，并可经巩膜作睫状体光凝术，尤其对黄斑病变及中心凹下脉络膜新生血管具有保留中心视力的优点。因其安全、方便、有效，故具有广阔的应用前景     

氪红激光凝治疗增殖型糖尿病性视网膜病变

目的;观察氪红激光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伴有屈光间质混浊或轻度玻璃体积血的147例209眼进行了氪红激光全视网膜光凝治疗。结果：患者治疗前和治疗后视力无明显差异（P＞0．05）。全视网膜光凝术后视盘和视网膜的新生血管部分消退。结论：氪激光光凝对于那些氩激光无法治疗的伴有屈光间质混浊或轻度玻璃体积血的增殖型糖尿病性视网膜病变是有效的治疗方法,可使新生血管消退,有效地防止再出血的发生。     

半导体激光光凝治疗糖尿病视网膜病变的疗效观察

目的:观察半导体激光视网膜光凝术治疗增殖前期和增殖期糖尿病视网膜病变(diabeticretinopathy,DR)疗效。方法:对50例(92眼,其中增殖前期30眼,增殖期62眼)DR患者,依病变程度分别行次全视网膜光凝及全视网膜光凝治疗,术后随访视力、眼底、眼底荧光血管造影(FFA)。结果:光凝治疗后,视力增进25眼(27%),视力无变化48眼(52%),视力下降19眼(21%),FFA结果有效76眼,有效率83%,需补充光凝4眼。结论:半导体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,而且对屈光间质混浊的病例效果也较满意。     

倍频532激光光凝治疗糖尿病视网膜病变的临床观察

目的观察倍频532nm激光视网膜光凝术治疗糖尿病视网膜病变（DR）的临床效果。方法用倍频532nm激光对30例（54只眼）增生前期和增生期DR患者进行全视网膜光凝治疗,伴有临床意义黄斑水肿者,先行黄斑部光凝治疗。术前行视力、眼压、裂隙灯、眼底、荧光素眼底血管造影（FFA）检查。术后定期复查,并记录视力变化及视网膜病变进展程度。光凝术后平均随访10个月。结果治疗后18只眼（33．3％）视力提高,视力无变化32只眼（59．3％）,视力下降4只眼（7．4％）,有效45只眼（83．3％）,随病变程度加重疗效降低。经FFA检查,有临床意义黄斑水肿者16只眼,经光凝后水肿完全消退者10只眼（62．5％）,部分消退者5只眼（31．3％）,不变者1只眼（6．3％）。结论倍频532nm激光视网膜光凝术是治疗DR安全、有效的方法。     

氩激光治疗视网膜周边裂孔和变性

目的 探讨氩激光光凝视网膜周边裂孔和变性的疗效。方法 对１５３例（１６５眼）视网膜周边裂孔和变性进行氩激光治疗。结果 随访２月至１年半者５０例（５３眼）中治愈４７眼占８８．７％,好转５眼占９．４％,无效１眼占１．９％视网膜脱离再次手术。５２眼无视网膜脱离,效果满意。结论 氩激光光凝是治疗视网膜周边裂孔和变性的安全有效方法。     

氪激光治疗视网膜裂孔临床疗效观察

目的观察氪激光治疗视网膜裂孔的疗效。方法回顾性分析78例(82只眼)视网膜周边裂孔及黄斑裂孔,选择不同波长激光对视网膜裂孔进行光凝治疗。结果78例(82只眼)视网膜裂孔封闭,未发生视网膜脱离。视力保持不变者67例(71只眼),视力提高的9例(9只眼),视力下降、治疗失败2例(2只眼)。结论氪激光有三种不同波长,对不同部位视网膜裂孔及屈光间质混浊者均可达到有效激光封闭,并发症少、视力损伤轻。     

二极管激光在治疗视网膜新生血管中的应用

目的 观察二极管激光在治疗视网膜新生血管伴有屈光间质浑浊中的光凝效果。方法 ５６例（６４眼）中糖尿病性视网膜病变２２例,视网膜静脉阻塞２０例,视网膜静脉周围炎１４例。４２眼伴有不同程度的晶状体、玻璃体浑浊,但能见眼底。治疗前常规行荧光素眼底血管造影。行全视网膜光凝或病变区限局性播散性光凝,一般做１～５次。有１０眼玻璃体浑浊重或伴有视网膜脱离术前无法光凝者在玻璃体视网膜手术的术中进行光凝。结果 光凝     

多波长氪离子激光治疗糖尿病视网膜病变

目的观察多波长氪离子激光对糖尿病视网膜病变的疗效。方法用多波长氪离子激光对35例糖尿病视网膜病变患者55只眼,根据病变性质、部位和屈光间质情况选择不同波长激光进行视网膜光凝,术前行视力、裂隙灯、 检眼镜、眼压、眼B型超声、视野、视觉诱发电位和荧光素眼底血管造影检查,术后随访1年 。结果20只眼视力提高,占36.4%,视力无变化34只眼,占61.8%,视力下降1只眼,占1.8%,其间未见严重并发症。结论多波长氪离子激光,可依实际需要组合使用不同波长治疗糖尿病视网膜病变,使部分患者视力提高。远期效果有待进一步观察。(中华眼底病杂志,2001,17:178-180)     

Transpupillary retinopexy of chorioretinal lesions predisposing to retinal detachment with the use of diode (810 nm) microlaser

PURPOSE: To evaluate the clinical efficacy and safety of diode microlaser for transpupillary retinopexy in eyes with retinal degenerations and retinal tears in a prospective clinical study. METHODS: Twenty eyes (19 patients) with mid or peripheral degenerations and retinal tears were treated with infrared diode photocoagulation. A continuous-wave diode laser was used to create clinically just visible chororetinal bums. The follow-up period was extended to 3 months. Color photographs of the coagulated retina were taken 24 hours after laser retinopexy and at 1 month and 3 months postoperatively. RESULTS: Acute chorioretinal burns appeared gray-white on the midperiphery, not sharply defined and sometimes somewhat difficult to detect during photocoagulation. Power levels ranged from 110 to 640 mW (mean +/- SD 384+/-133.47 mW). In eyes with dark brown irises, the mean laser power was significantly lower than in eyes with blue-green irises (325.83+/-117.90 mW versus 471.25+/-109.60 mW, P < 0.05). At the 1 -month postoperative follow-up examination, all eyes showed chororetinal scarring with pigmentary mottling. At 3 months, the diode lesions' appearance was that of a marked atrophic chonoretinal scar. There were no adverse side effects in the laser-treated eyes except for a small choroidal-retinal-vitreal bleeding in 1 (5%) of the eyes. CONCLUSIONS: Transpupillary photocoagulation to mid or peripheral retina with diode microlaser has proven to be effective at providing retinopexy of retinal degenerations and retinal tears. The long wave 810 nm can also be used successfully and safely for the prophylaxis of retinal detachment because it can create a strong adhesion between the retina and choroid. However, diode laser should not be employed routinely for treating patients with clear media or fundus hypopigmentation. The use of diode is preferably indicated in eyes with media opacities because infrared light has the advantage of a better transmission through lens opacity or vitreous hemorrhage. As diode laser energy can produce variable tissue effects, there may be some difficulty in obtaining reproducible bums because of unpredictable changes in melanin density of the retinal pigment epithelium and choroid.     

532nm倍频激光治疗高原血管性眼底病变的临床研究

目的：观察532nm倍频激光视网膜光凝(panretinal photocoagulation, PRP)治疗高原地区糖尿病视网膜病变(diabetic retinpathy, DR)及视网膜静脉阻塞(retinal vein occlusion,RVO)的临床疗效,评价氩激光治疗眼底血管病的安全性、有效性。

方法：选择DR患者122例227眼,其中增殖前期糖尿病性视网膜病变(preproliferative diabetic retinopathy, PPDR)51例90眼、增殖期糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)71例137眼; RVO患者120例124眼,其中中央静脉阻塞(central retinal vein occlusion,CRVO)27例27眼,分支静脉阻塞(branch retinal vein occlusion,BRVO)93例97眼,进行532nm底激光视网膜光凝治疗。每位患者在结束最后一次治疗后1,3,6mo复查眼底、视力、FFA检查。

结果：DR患者行视网膜光凝术后,PPDR有效81眼(90.0%)、无效9眼(10.0%); PDR有效98眼(71.5%),无效39眼(28.5%),总有效率78.9%; RVO患者行视网膜光凝术后, BRVO有效者90眼(92.8%),CRVO有效者22眼(81.5%)。532nm倍频激光治疗眼底血管性疾病的总有效率为82.9%。

结论：532nm倍频激光光凝治疗高原地区眼底血管性疾病是一种安全有效的治疗方法,糖尿病视网膜病变增殖前期激光治疗的有效率高于增殖期,治疗时机的合理选择可有效阻止DR的进展,防止失明的严重后果; 对RVO及时进行视网膜激光光凝的干预治疗,可以加速出血水肿吸收,防止新生血管的产生,降低并发症。     

特发性视网膜血管炎综合治疗的疗效分析

目的分析特发性视网膜血管炎的治疗效果。方法对126例（197眼）确诊为特发性视网膜血管炎的患者进行药物、激光或玻璃体手术治疗进行回顾性分析,包括1年内的视力、光学相干断层扫描（OCT）检查、荧光素眼底血管造影（FFA）结果。结果早期药物治疗110眼,其中视力改善者61眼（55．5％）,需激光或手术治疗者36眼（32．7％）。激光治疗累计71例（119眼）,视力改善者88跟（73．9％）。20眼接受玻璃体手术,视力改善者9眼（45％）。接受激光与玻璃体手术治疗的疗效比较差异有统计学意义（x^2=6．80,P〈0．05）。非玻璃体出血与玻璃体出血者激光治疗后视力改善眼数的差异有统计学意义（x^2=6．53,P〈0．05）。对视力改善者,OCT和FFA均提示黄斑水肿明显改善。结论视网膜激光光凝对特发性视网膜血管炎是重要的治疗手段,不同治疗方法适应证的选择和治疗期间的密切随访对于改善治疗效果至关重要。     

激光光凝辅助角膜原位磨镶术前眼底病变分析及治疗

目的探讨近视LASIK术前眼底病变及治疗方法.方法对385例(721只眼)LASIK术前患者行散瞳眼底三面镜检查并作详细眼底记录.结果发现各种视网膜变性136只眼(18.86%),视网膜干性裂孔16只眼(2.22%),亚临床视网膜脱离(RD)5只眼(0.69%).其中37只眼严重视网膜变性、16只眼干孔和4只眼亚临床RD行氩激光光凝治疗,仅1例亚临床RD需行视网膜脱离手术.结论近视LASIK术前及术后眼底常规检查和病变治疗是必要的.同时本文提出眼底病变光凝的指征.     

LASIK前眼底三面镜检查及其意义

目的：探讨散瞳眼底三面镜检查在LASIK术前的重要意义。方法：对385例（721眼）LASIK术前患者行散瞳眼底三面镜检查并作详细眼底记录。结果：发现各种视网膜变性136眼（18.86%),视网膜干性裂孔（干孔）16眼（2.22%）,亚临床视网膜脱离（RD）5眼（0.69%)。其中37眼严重视网膜变性、16眼干孔和4眼亚临床RD行氩激光光凝治疗,仅1例亚临床RD需行视网膜脱离手术。结论：将散瞳眼底三面镜检查作为LASIK术前常规检查是必要的,同时提出眼底病变光凝的指征。     

A New Microsurgical Technique to Correct Retinal Detachment

Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods: Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy (≤ C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy.Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in31 eyes (86%) during the primary surgery and in three eyes after a second surgery(94% total). The best-corrected visual acuity was ＜0.1 in 6 eyes (16.7%), 0.1～0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy.Conclusions: This microsurgical procedure to correct RD is simple, convenient,reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.     

眼B超诊断早期视网膜裂孔

目的 探讨利用眼B超技术早期发现视网膜裂孔的临床价值.方法 收集2008年9月至2009年5月期间采用全方位纵向扫描B超探查首诊发现的可疑视网膜干性裂孔68只眼,经三面镜散瞳眼底检查进一步明确诊断.分析B超判断早期视网膜裂孔的正确性,及其图像特征.确诊为裂孔者行激光封孔术,术后一月随访裂孔封闭情况.结果 B超可疑视网膜裂孔 68只眼中,经眼底检查确诊视网膜裂孔44只眼,阳性率66%.其中有突发性视糊、闪光主诉者24只眼(55%),近视屈光度≥-6D者14只眼(32%).裂孔均为马蹄形,大多位于赤道部之前(63只眼,占93%),颞上象限多见(23只眼,占50%).B超表现为周边部球壁前中粗短弧形或短带状回声,带宽类似视网膜厚度或略粗,游离端多见玻璃体后脱离的细带状回声与之牵引.非裂孔24只眼(35%),病变处可见积血机化、变性区或玻璃体混浊黏连.所有裂孔均即刻行激光封孔术,2例因裂孔过于周边和视网膜下积液转行巩膜冷冻外加压手术.术后一月复查,所有术眼裂孔封闭良好,视网膜平伏.结论 全方位纵向扫描眼B超探查,有助于早期发现周边部视网膜裂孔,对其及时激光治疗和预防孔源性视网膜脱离具有重要价值.     

A New Microsurgical Technique to Correct Retinal Detachment

Purpose: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. Methods : Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy ( ≤C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy. Results: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in 31 eyes (86%) during the primary surgery and in three eyes after a second surgery (94% total). The best-corrected visual acuity was <0.1 in 6 eyes (16.7%) , 0.1-0.4 in 15 eyes (41.7%) and ≥ 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy. Conclusions : This microsurgical procedure to correct RD is simple, convenient, reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.