A randomized clinical trial of feeder vessel photocoagulation of proliferative sickle cell retinopathy. I. Preliminary results

A randomized prospective clinical trial of feeder vessel photocoagulation for proliferative sickle cell retinopathy was performed. In Chicago there were 34 argon laser-treated eyes and 30 control eyes. In Kingston there were 53 xenon arc treated eyes and 50 control eyes. Prolonged loss of visual acuity was rare in both photocoagulated and control eyes. Argon laser and xenon arc feeder vessel photocoagulation reduced the incidence of vitreous hemorrhage and visual loss from vitreous hemorrhage. However, photocoagulation was associated with an increased risk of choroidal neovascularization (xenon arc greater than argon laser) and retinal detachment (argon laser), although visual loss from these complications has not been seen in these patients so far.     

视网膜静脉阻塞激光治疗后玻璃体出血的临床分析

目的：了解视网膜静脉阻塞(RVO)激光治疗后发生玻璃体出血的原因。方法：回顾分析2年来门诊11例(11眼，CRVO：2眼；BRVO：9眼)激光后的视网膜静脉阻塞发生玻璃体出血的病例。结果：11例RVO中：少量玻璃体出血5例；中-多量玻璃体出血6例，其中2例作玻璃体切除术，其余激光治疗后出血停止而治愈。由初次激光治疗到玻璃体出血时间6月-11年，再次激光或／和手术后视力均有改善。结论：不规范或不完全的视网膜光凝是导致RVO激光治疗发生玻璃体出血的主要原因，规范的视网膜光凝、定期随诊和眼底荧光造影是保证疗效的关键。     

Treatment of an avulsed retinal vessel with infrared diode laser photocoagulation

PURPOSE: To report the use of the infrared diode laser with long-duration pulses to successfully treat a patient with recurrent vitreous hemorrhages due to an avulsed retinal arteriole. DESIGN: Interventional case report. METHODS: A 70-year-old man presented with repeated, visually significant vitreous hemorrhages due to an avulsed retinal arteriole. Infrared diode laser photocoagulation with long-duration, large, overlapping spots was performed on either side of the avulsed segment. RESULTS: Resolution of the hemorrhage occurred within 1 month, without further episodes of bleeding. Two-year follow-up with fluorescein angiography showed complete cessation of blood flow through the treated segment. CONCLUSIONS: Infrared diode laser photocoagulation with long-duration pulses may be an effective, minimally invasive treatment of the avulsed retinal vessel syndrome.     

A randomized clinical trial of feeder vessel photocoagulation of sickle cell retinopathy. A long-term follow-up

Long-term follow-up of patients enrolled in a randomized prospective trial of feeder vessel photocoagulation for proliferative sickle retinopathy has been completed. Of the 44 patients enrolled in Chicago, nearly a decade follow-up has been achieved on 29 patients (45 eyes). There were 20 control untreated eyes and 25 argon laser-treated eyes. Prolonged loss of visual acuity was rare in both groups. Argon laser photocoagulation has had a sustained effect on reducing the incidence of vitreous hemorrhage and visual loss from vitreous hemorrhage. Nine (45%) of 20 control eyes had vitreous hemorrhage, and it was recurrent in six (66%) of these nine eyes. A single episode was the only hemorrhagic event in the treated eyes. The laser-induced complications of choroidal neovascularization or retinal detachment were not associated with long-term visual sequelae. New sea fan evolution in 47% of study eyes suggests that these patients require long-term surveillance.     

Argon laser treatment of retinal neovascularization associated with sarcoidosis

A 22-year-old Japanese woman with systemic sarcoidosis had retinal neovascularizations at seven loci with repeated vitreous hemorrhage in her right eye. Oral administration of prednisone was not effective. However, argon laser photocoagulation to the neovascularizations obliterated the neovascular fronds except at the optic nerve head; three months from the treatment, the neovascularization at the optic nerve head regressed spontaneously. No serious complications have occurred, and the vitreous hemorrhage has not recurred for the past two years. From these results, argon laser photocoagulation was thought to be effective for the treatment of retinal neovascularization in sarcoidosis.     

A randomized clinical trial of feeder vessel photocoagulation of proliferative sickle cell retinopathy. II. Update and analysis of risk factors

Follow-up of patients enrolled in a randomized prospective trial of feeder vessel photocoagulation for proliferative sickle cell retinopathy has shown that photocoagulation is effective in preventing vitreous hemorrhage and visual loss from vitreous hemorrhage. In addition, a reduction of visual loss from all causes in photocoagulated eyes approaches statistical significance. Analysis of control eyes shows that there are three independent risk factors for the occurrence of vitreous hemorrhage: (1) the presence of the SC genotype, (2) the presence of vitreous blood at the initial evaluation and, (3) the presence of greater than 60 degrees of perfused neovascularization.     

Diode laser photocoagulation for retinopathy of prematurity: a histopathologic study

Laser photocoagulation has largely supplanted cryotherapy as an effective treatment for retinopathy of prematurity. This case describes the ocular histopathologic findings of a pair of eyes in a severely premature male infant treated with diode laser photocoagulation for bilateral stage 3 retinopathy of prematurity (ROP) for 360 degrees in zone 1 with severe plus disease. The right eye responded to treatment; the left eye developed persistent vitreous hemorrhage and total retinal detachment. The histopathologic examination of laser burns in the right eye disclosed segmental areas of chorioretinal scarring with retinal atrophy and gliosis, loss of RPE and extensive atrophy of the choroid and its vasculature, which involved both the choriocapillaris and larger vessels. The left eye had iris neovascularization, a chronic organized vitreous hemorrhage and a totally detached retina. The histopathologic findings in an eye of a premature infant with threshold ROP treated with diode laser photocoagulation resembled those reported after transsceral cryotherapy. Diode laser photocoagulation may produce less severe chorioretinal damage.     

532nm激光光凝治疗视网膜前出血的临床观察

目的　探讨５３２ｎｍ激光光凝治疗视网膜前出血的临床疗效。方法　收集我院２０１０年１月至２０１３年１０月确诊为视网膜前出血的患者１３例（１３眼）,对其临床资料进行回顾性分析。８眼行激光爆破模式引流失败,改行激光光凝模式治疗;５眼视网膜前出血病程超过２周者直接行激光光凝模式治疗。所有患者均接受视网膜激光光凝模式治疗１～２次,术后随访１个月,观察视力、眼底彩照及并发症情况。结果　接受激光治疗的１３眼患者,６眼（４６．２％）行１次视网膜激光光凝术、７眼（５３８％）行２次视网膜激光光凝术。所有病例经治疗后出血均明显吸收,平均吸收时间１８．９２ｄ;视力都有不同程度提高,１个月后随访视力平均提高６．０行。视网膜前出血吸收后激光光凝处未遗留激光斑痕迹,亦无色素增生,所有病例无其他激光并发症发生。结论　５３２ｎｍ激光光凝模式治疗视网膜前出血简单实用、安全有效,且可重复实施,在激光引流视网膜前出血失败后或对于病程较长者可作为有效治疗手段。     

Risk stratifying retinal breaks

Objective

Argon laser retinopexy has been the primary treatment for retinal breaks for many decades. Prevention of progression to retinal detachment (RD) is the main objective. The benefit of laser retinopexy is well documented, although little has been reported on the risk factors for progression to RD. By addressing this issue, patients at high risk can be identified, and more timely specialist retinal input can be sought.

Methods

Data over a 6-month period from 45 consecutive patients undergoing laser retinopexy were reviewed. Patients were categorized into complete success (no more than 1 laser treatment), qualified success (no more than 3 laser or cryotherapy treatments), and treatment failure (more than 3 laser or cryotherapy treatments or progression to RD).

Results

Complete success was observed in 53.5% of patients, a further 34.9% of patients achieved a qualified success, and the remainder of the patients (11.6%) fell into the treatment failure category. About 9.3% of patients required cryotherapy, and 7.0% of patients underwent RD surgery. Patients with a bridging blood vessel and vitreous hemorrhage were significantly more likely to be in the treatment failure category than those without. RD was significantly associated with the presence of vitreous hemorrhage.

Conclusions

Patients with retinal breaks associated with bridging blood vessels and vitreous hemorrhage are at greater risk for poorer outcome. The area of subretinal fluid was not linked to failure. If complete laser of a tear is not possible or if concerns remain regarding treatment efficacy, prompt referral to a retina specialist for further management is recommended.     

视网膜大动脉瘤合并玻璃体积血的手术疗效

目的：分析评价视网膜大动脉瘤合并玻璃体积血行玻璃体切割术联合眼内视网膜光凝治疗的临床疗效。 方法：回顾分析2009-01/2011-02在我院住院治疗的11例11眼视网膜大动脉瘤合并玻璃体积血的患者,给予玻璃体切割术联合眼内激光治疗;并对其手术疗效、视力和并发症进行观察分析。 结果：术后随访6～24mo,11例患者玻璃体腔均无再次出血,视网膜大动脉瘤周边血管闭塞,瘤体萎缩、瘢痕化;术后视力0.05～0.4,均有不同程度提高;其中2例2眼术后眼压一过性升高,局部给予降眼压药物治疗后恢复正常。 结论：玻璃体切割术联合眼内视网膜光凝治疗,对视网膜大动脉瘤合并玻璃体积血患者是一种疗效确切的治疗方法。     

Photocoagulation in Eales' disease

Between 1970 and 1991 the authors examined 466 cases with Eales' disease. 359 eyes of 295 of these 466 cases received photocoagulation treatment. The mean age was 30.4, ranging between 14 and 55 years. Ten eyes with persistent vitreous hemorrhage underwent pars plana vitrectomy before photocoagulation. 210 eyes were treated with xenon arc, 135 with argon laser, 12 with krypton laser and two with yellow dye laser. Hypoxic areas and retinal neovascularizations were closed completely in 298 eyes. In 21 eyes with elevated neovascularizations intruding into the vitreous cavity feeder vessel photocoagulation was used. 24 eyes with disc neovascularization were treated with panretinal photocoagulation. 12 eyes with branch vein occlusion and four eyes with central vein occlusion received photocoagulation treatment to areas of non-perfusion and retinal neovascularization. At a mean follow-up of 43 months, seven new retinal neovascularizations and three new disc neovascularizations developed in eyes which previously had received photocoagulation for retinal neovascularization and hypoxia. Nine out of 21 eyes with elevated neovascularizations developed vitreous hemorrhage. Disc neovascularization resolved completely in 13 out of 24 eyes, it partially regressed in eight eyes and did not respond to treatment in three eyes. The visual acuities were improved in 12.3%, maintained in 77.4% and deteriorated in 10.3% of the eyes after treatment. Periodic follow-up and early photocoagulation treatment is useful in stabilizing the retinal lesions and in maintaining functional levels of vision in Eales' disease.     

Photocoagulation in Eales' disease

Between 1970 and 1991 the authors examined 466 cases with Eales' disease. 359 eyes of 295 of these 466 cases received photocoagulation treatment. The mean age was 30.4, ranging between 14 and 55 years. Ten eyes with persistent vitreous hemorrhage underwent pars plana vitrectomy before photocoagulation. 210 eyes were treated with xenon arc, 135 with argon laser, 12 with krypton laser and two with yellow dye laser. Hypoxic areas and retinal neovascularizations were closed completely in 298 eyes. In 21 eyes with elevated neovascularizations intruding into the vitreous cavity feeder vessel photocoagulation was used. 24 eyes with disc neovascularization were treated with panretinal photocoagulation. 12 eyes with branch vein occlusion and four eyes with central vein occlusion received photocoagulation treatment to areas of non-perfusion and retinal neovascularization. At a mean follow-up of 43 months, seven new retinal neovascularizations and three new disc neovascularizations developed in eyes which previously had received photocoagulation for retinal neovascularization and hypoxia. Nine out of 21 eyes with elevated neovascularizations developed vitreous hemorrhage. Disc neovascularization resolved completely in 13 out of 24 eyes, it partially regressed in eight eyes and did not respond to treatment in three eyes. The visual acuities were improved in 12.3%, maintained in 77.4% and deteriorated in 10.3% of the eyes after treatment. Periodic follow-up and early photocoagulation treatment is useful in stabilizing the retinal lesions and in maintaining functional levels of vision in Eales' disease.     

玻璃体切除术治疗视网膜静脉阻塞所致的玻璃体出血

报告应闭合式玻璃体切除术治疗７例（７眼）因视网膜静脉阻塞所致的玻璃体出血。所有病人术后眼底清晰可见，视力明显提高。术后４例出现再出血，经药物治疗后出血吸收，加用氩离子激光视网膜光凝，无再出血。随访３至１８个月所有病人无新生血管性青光眼及牵引性视网膜脱离出现。认为玻璃体切除术不但能使屈光间质恢复透明，视力提高，预防牵引性视网膜脱离，而且为明确诊断和进一步激光治疗提供条件。     

基层医院视网膜静脉阻塞致玻璃体积血的治疗

目的:分析基层医院视网膜静脉阻塞致玻璃体积血的治疗方法。方法:将50例视网膜静脉阻塞患者随机分成两组:治疗组(药物治疗)和联合治疗组(药物及激光治疗),各25例,观察玻璃体积血的发生率。结果:治疗组发生玻璃体积血的病例数明显高于联合治疗组。结论:注重造影检查,应用药物联合激光光凝治疗对防止基层医院视网膜静脉阻塞致玻璃体积血有明显的治疗作用。     

氩激光治疗视网膜分支静脉阻塞的视网膜新生血管

报告氩激光治疗视网膜分支静脉阻塞新生血管30例，对照组34例。激光散点光凝无灌注区和新生血管可使新生血管消退，玻璃体出血发生率降低。本组治疗后新生血管完全消退者23例，缩小者7例。玻璃体出血者对照组为70.6%，激光组在治疗前为43.3%，治疗后尚无一例发生。激光组视力比对照组者明显进步(P<0.005)。激光治疗效果与新生血管的大小，位置及是否突入玻璃体内有关。我们还讨论了激光治疗的方法、时机和预后。 （中华眼底病杂志，1994，10：195-198）     

Cryoapplication in diabetic retinopathy

Thirty-five patients with diabetic retinopathy were treated with cryoapplication. This was used as an alternative to Argon laser or Zenon photocoagulation because the media was opaque from vitreous hemorrhage or cataract. It was difficult or impossible to treat with photocoagulation.The clinical impression indicates that cryoapplication is effective, showing adequate pigmentation and chorioretinal scarring with regression of diabetic retinopathy changes. However patients with vitreo-retinal fibrosis became frequently worse weeks later. This is considered a contraindication.The use of cryoapplication in diabetic retinopathy is recommended in situations where the ocular media is not clear, such as vitreous hemorrhage and cataract. It can also be used if there is difficulty with laser photocoagulation following lens implantation.It may be valuable in some developing countries where photocoagulation is not available. Cryomachines are frequently used in eye camps. It is inexpensive and does not necessarily require electricity.     

玻璃体手术中超全视网膜光凝对增生性糖尿病视网膜病变疗效影响

目的：探讨玻璃体手术中超全视网膜光凝对增生性糖尿病视网膜病变(proliferative diabetic retinopathy, PDR)疗效的影响。

方法： 回顾性分析2011-03/2013-03因玻璃体积血或玻璃体视网膜牵拉改变在我院接受玻璃体手术的糖尿病视网膜病变患者70例70眼,根据患者视网膜光凝范围不同将其分为超全视网膜光凝组40眼和全视网膜光凝组30眼,分别观察两组患者的最佳矫正视力、眼压及视网膜血管变化等情况,并对结果进行统计学分析。

结果：两组患者术前眼部状况、术后3mo最佳矫正视力及眼压,差异均无统计学意义(均P>0.05)。两组患者视网膜血管渗漏、后极部硬性渗出和后极部出血点的发生率比较,差异有统计学意义(均P<0.05)。两组患者视网膜无灌注区、视盘血管渗漏的发生率比较,超全视网膜光凝组均优于全视网膜光凝组,差异有统计学意义(P=0.04、0.02)。术后两组患者黄斑水肿发生情况比较,差异无统计学意义(P=1.00),黄斑水肿消失时间比较,超全视网膜光凝组优于全视网膜光凝组,差异有统计学意义(P<0.05)。

结论：治疗PDR患者时,在玻璃体手术中采用超全视网膜光凝在视网膜无灌注区、视网膜血管渗漏、视盘血管渗漏等方面的疗效好于全视网膜光凝,但过量的视网膜光凝对视网膜及脉络膜有明显的损伤,因此治疗过程中在尽可能覆盖视网膜病变区的同时,掌握好激光能量及光斑数量对预防并发症的发生同样重要。     

视网膜血管瘤分期及治疗效果观察

目的观察不同临床分期的视网膜血管瘤采用激光光凝、冷冻、玻璃体视网膜手术以及瘤体切除等方法治疗的临床效果，探讨玻璃体视网膜手术治疗的适应证 。方法回顾分析22例视网膜血管瘤33只患眼治疗前后的临床资料。治疗前按照视网膜血管瘤有无明显扩张供养血管、周围渗出、局限性视网膜脱离、广泛视网膜脱离至晚期并发症的过程,将本病分为5期。其中13只患眼主要采用单纯激光光凝治疗；5只 患眼主要采用冷冻联合激光光凝治疗；11只眼患眼采用玻璃体视网膜手术治疗，其中3只眼同时进行了视网膜血管瘤瘤体切除治疗。治疗后平均随访时间46个月，对比分析患者治疗前 后视力、视网膜血管瘤以及视网膜等情况。结果单纯激光光凝治疗的1 3只眼视网膜血管瘤均退行萎缩，视网膜平伏，视力提高2只眼，不变11只眼；冷冻联合激光光凝治疗的5只眼中，4只眼视网膜血管瘤退行萎缩，未见血管瘤复发，1只眼出现玻璃体视 网膜增生及玻璃体积血需进一步采用玻璃体视网膜手术治疗，视力提高2只眼，不变2只眼，下降1只眼；玻璃体视网膜手术治疗的11只眼中，1只眼出现新的血管瘤，2只眼血管瘤引起 渗出性视网膜脱离，2只眼再次出现玻璃体视网膜增生，8只眼视网膜平伏，视力提高3只眼，不变3只眼，下降5只眼。同时进行视网膜血管瘤瘤体切除治疗的3只眼中均未见血管瘤复发，2只眼视网膜平伏，1只眼出现渗出性视网膜脱离，视力提高2只眼，下降1只眼。结论单纯激光光凝或联合冷冻治疗对早期视网膜血管瘤患者有效；对伴有玻璃体积血、视网膜前膜形成、增生明显、视网膜脱离范围大的晚期视网膜血管瘤病变宜采用玻璃体视网膜手术治疗，视网膜血管瘤瘤体切除可有选择性应用，其远期效果仍有待观察。  （中华眼底病杂志，2008，24：107-110）     

Two cases of isolated avulsed retinal vessels]

Two cases of isolated avulsed retinal vessels without retinal breaks or any other vitreoretinal disorders are reported. Case 1: a 57-year-old woman developed acute vitreous hemorrhages in the right eye associated with an avulsed retinal artery in the superior equatorial region. Case 2: a 74-year-old man had an asymptomatic avulsed retinal vein in the superior midperiphery. Repeat argon laser photocoagulation resulted in uncomplicated occlusion of the avulsed retinal vessels and reduced the risk of recurrent vitreous hemorrhage.     

激光光凝治疗糖尿病视网膜病变疗效观察

目的探讨激光光凝治疗糖尿病视网膜病变（DR）的治疗效果。方法 89例（178只眼）DR患者行激光光凝治疗后,定期观察视力,进行眼底及荧光素眼底血管造影（FFA）检查,记录眼底新生血管、视网膜出血渗出、玻璃体积血等情况,观察4个月至2年。结果激光治疗1个月后视力提高≥2行69只眼（38.7%）,无变化63只眼（35.3%）,视力下降≥2行35只眼（26%）。视网膜及视盘新生血管消退170只眼（95.5%）。8只眼（4.5%）发生玻璃体积血,行玻璃体切割术,术中璃体腔曲安奈德注射,补充激光治疗。结论激光光凝是治疗DR的有效方法 。