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1.
目的 观察2型糖尿病视网膜病变(DR)患者经全视网膜激光光凝(PRP)治疗前后玻璃体后脱离(PVD)情况的变化,探讨PRP治疗对玻璃体后界膜脱离的影响.方法 前瞻性对照研究对2014年1月~2014年7月在安徽医科大学附属省立医院眼科经眼底荧光素血管造影(FFA)检查确诊为重度NPDR或PDR且符合PRP指征的患者25例46只眼纳入研究.与患者年龄匹配的正常人20名40只眼作为正常对照组.所有患眼均行常规PRP治疗前,采用眼科20M高频探头B超、光学相干断层扫描(OCT)、90D前置镜裂隙灯下观察Weiss环相结合的方法,对正常对照组及PRP术前及术后3月的患眼进行检测,对比观察治疗前后患眼的PVD形成情况.应用SPSS12.0软件进行统计分析,计量资料采用t检验,计数资料采用X2检验和Fisher's确切概率法.以P<0.05为差异有统计学意义.结果 两组患者在年龄、性别、眼轴长度组间差异均无统计学意义(P>0.05),PRP术后1周后,PRP组玻璃体脱离明显增加,与对照组差异有统计学意义(P<0.05);结论 DR患眼PRP术后1周PVD发生率明显增加,PRP是有效的促进玻璃体后界膜安全脱离的糖尿病视网膜病变患者的治疗方法.  相似文献   

2.
王群  刘丹 《国际眼科杂志》2014,14(12):2179-2181
在解剖上,玻璃体后皮质与视网膜相邻,玻璃体与视网膜的关系是既相互独立,又紧密联系的。病理状态时,玻璃体的改变为许多玻璃体视网膜疾病的发生、发展提供了一个良好的生长环境,玻璃体在许多玻璃体视网膜疾病的发生发展中起了关键性作用。消除玻璃体改变在疾病中的作用,是近年来眼科界极为关注的一个问题。本文通过对玻璃体和玻璃体视网膜交界面结构和黏连机制、玻璃体与视网膜界面变化的危险因素、对视网膜疾病影响的描述,阐述了玻璃体后脱离对玻璃体视网膜界面疾病的影响及采用的检测方法及意义。  相似文献   

3.
目的:探讨577 nm全视网膜光凝术对糖尿病视网膜病变黄斑中心凹厚度的影响。方法:应用optovue光学相干断层扫描仪分析37例45眼增殖前期糖尿病视网膜病变( preproliferative diabetic retinopathy, PPDR )和增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者接受577nm全视网膜光凝术前和术后1,3,6 mo黄斑中心凹视网膜神经上皮层的厚度。结果:全视网膜光凝术后1,3mo,黄斑中心凹视网膜神经上皮层的厚度与术前相比较明显增厚,两者比较具有统计学差异(P<0.05);随访至术后6mo逐步恢复至光凝前的水平,没有统计学差异(P>0.05)。结论:577 nm全视网膜光凝术能够引起糖尿病患者黄斑中心凹神经上皮层厚度一过性增加,术后6 mo时逐渐恢复到术前的水平。  相似文献   

4.
目的 探讨全玻璃体切除术联合超全视网膜光凝治疗增生性糖尿病性视网膜病变(PDR)的疗效.方法 PDR患者12例(13只眼),均行全玻璃体切除术联合超全视网膜光凝术.其中7只眼联合白内障超声乳化手术,3只眼硅油充填,10只眼C<,3>F<,8>气体填充.结果 术后3~10个月随访,13只眼视网膜平伏.2只眼视力无提高,11只眼视力均有不同程度的提高.有效率84.62%.结论 全玻璃体切除术联合超全视网膜光凝是治疗PDR安全有效的方法.  相似文献   

5.
目的 探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者全视网膜光凝(panretinal photocoagulation,PRP)治疗后黄斑区视功能的变化及其与黄斑形态改变的相关性.方法 选取DR患者24例(41眼),行PRP治疗后随访3个月,对比分析患者PRP治疗前后患眼的中心视力,多焦视网膜电图(multifocal electroretinography,mfERG)和光学相干断层扫描(optical coherence tomography,OCT)检测黄斑区视功能的变化与黄斑形态改变,探讨PRP治疗后黄斑区视功能的变化及其与黄斑形态改变的相关性.结果 DR患者PRP治疗后3个月的中心视力和黄斑中心凹厚度分别为0.52 ±0.28、(257.55±124.30)μm,与治疗前的0.57±0.32、(241.15±103.43)μm相比,差异均无统计学意义(t=1.27,P=0.22;t=-1.00,P=0.33).mfERG N波4、5环及P1波3、5环的反应密度较PRP治疗前明显降低,差异均有统计学意义(t=2.48、3.69、2.23、2.40,均为P<0.05),但各波潜伏期相比差异均无统计学意叉(均为P>0.05);黄斑中心凹厚度与mfERG的测量结果无相关性(均为P>0.05).结论 PRP治疗虽然没有引起DR患者中心视力及视网膜厚度的变化,但导致了邻近未接受光凝区域的视网膜功能障碍,表现为mfERG反应密度的降低.  相似文献   

6.
目的 应用深层成像谱域光学相干断层扫描(enhanceddepthimagingspectral-domainopticalcoherencetomography,EDI-SDOCT)观察全视网膜光凝(panretinalphotocoagulation,PRP)对非增生性糖尿病视网膜病变(non-proliferativediabeticretinopa-thy,NPDR)患眼黄斑区脉络膜厚度的影响。方法 对35例(59眼)NPDR患者行PRP术,以42例(59眼)正常眼作为对照组。应用EDI-SDOCT分别在PRP术前和术后1周测量对照组和光凝组黄斑区各点位脉络膜厚度,比较术后1周较术前的变化,各点标记为:中心凹下脉络膜厚度(subfovealchoroidalthickness,SFCT),各扫描线上距离中心凹750μm、1500μm处的鼻侧脉络膜厚度(nasalchoroidalthickness,NCT)、颞侧脉络膜厚度(temporalchoroidalthickness,TCT)、上方脉络膜厚度(superiorchoroidalthickness,SCT)、下方脉络膜厚度(inferiorchoroidalthickness,ICT)、平均黄斑区脉络膜厚度(averagemacularchoroidalthickness,AMCT)。结果 光凝组术前、术后1周的SFCT、NCT750、TCT750、SCT750、ICT750、NCT1500、TCT1500、SCT1500、ICT1500、AMCT均明显低于对照组(均为P<0.05);术后1周SFCT和AMCT明显高于术前(均为P<0.05);除TCT750和TCT1500术后与术前无明显差异外(均为P>0.05),余各点位术后均明显高于术前(均为P<0.05)。其中10眼术后各值低于术前,2眼可观察到术后脉络膜血管孔径较术前增加。结论 NPDR会导致黄斑区脉络膜变薄,PRP术短期内能够明显增加黄斑区脉络膜厚度,同时一定程度上增加脉络膜的血管孔径。EDI-SDOCT是用于评价NPDR患者疗效和预后的有效无创检测手段。  相似文献   

7.
目的分析玻璃体不全后脱离的光学相干断层扫描(optical coherence tomography,OCT)图像特征,探讨玻璃体不全后脱离与所引发的玻璃体视网膜病变的关系。方法对81例(86只眼)玻璃体不全后脱离患者进行眼科常规检查、B型超声检查和OCT检查,并对所获得的OCT图像进行分析,观察玻璃体视网膜界面的异常图像特征。结果27只眼显示特发性玻璃体黄斑牵引综合征;25只眼显示特发性黄斑前膜;25只眼显示后界膜牵拉导致特发性黄斑板层裂孔及全层黄斑裂孔形成;9只眼显示玻璃体后界膜与黄斑部及视盘周视网膜神经上皮层多处牵拉粘连。结论OCT能够直观的显示玻璃体不全后脱离与所引发的黄斑部视网膜病变的进展变化,并可进行定量、定性分析与鉴别诊断。  相似文献   

8.
玻璃体后脱离(posterior vitreous detachment,PVD)在糖尿病视网膜病变(diabetic retinopathy,DR)的发展过程、手术治疗和转归等方面发挥了重要作用.部分PVD可以加重DR的病情,完全PVD可以消除新生血管生长支架,减少玻璃体出血,增加氧气浓度,使玻璃体手术简单化等.副作用小的纤溶酶等药物玻璃体内注射可以诱导PVD,其可改变DR的转归和减少玻璃体手术并发症.  相似文献   

9.
目的 观察全视网膜光凝术对增生性糖尿病视网膜病变(proliferativediabeticretinopathy,PDR)患者黄斑区视网膜功能的影响。方法 选取2011年1月至2013年12月我院收治的60例(72眼)PDR患者作为观察组,同时选取60例(60眼)正常志愿者作为对照组。观察组患者均应用全视网膜光凝术进行治疗。两组均行裂隙灯、验光、眼压、眼底等常规眼部检查,利用光学相干断层扫描(opticalcoherencetomography,OCT)检查黄斑区视网膜厚度,同时利用多焦视网膜电图(multifocalelectroreti-nogram,mf-ERG)检查P1波、N1波5环的振幅密度及潜伏期等。结果 观察组患眼术前、术后黄斑中心凹视网膜厚度分别为(349.3±118.9)μm和(262.2±28.2)μm,差异有统计学意义(P<0.05);对照组黄斑中心凹视网膜厚度为(136.4±17.8)μm,均显著低于观察组患眼手术前后黄斑中心凹视网膜厚度,差异均有统计学意义(均为P<0.05)。观察组患眼的1环、2环的术后P1波振幅密度较术前显著提高,差异均有统计学意义(均为P<0.05),而3环、4环、5环较术前显著降低,差异均有统计学意义(均为P<0.05)。观察组术后P1波潜伏期较术前均有一定程度的下降,差异均有统计学意义(均为P<0.05)。与对照组比较,观察组术后1环、2环的P1波潜伏期差异均有统计学意义(均为P<0.05);3环、4环、5环差异均无统计学意义(均为P>0.05)。观察组术后1环、2环的N1波振幅较术前显著提高,差异均有统计学意义(均为P<0.05);术后3环、4环、5环较术前显著降低,差异均有统计学意义(均为P<0.05)。观察组患眼术后3环的N1波潜伏期与术前比较,差异无统计学意义(P>0.05),术后1环、2环、4环、5环的N1波潜伏期均显著低于术前,差异均有统计学意义(均为P<0.05)。观察组术前和术后的N1波潜伏期均显著低于对照组,差异均有统计学意义(均为P<0.05)。结论 全视网膜光凝术治疗PDR患者可显著改善视网膜的感光和传导功能,降低黄斑中心凹视网膜厚度,从而达到部分改善视力的目的。  相似文献   

10.
糖尿病视网膜病变全视网膜光凝术后中长期随诊结果   总被引:9,自引:2,他引:7  
孙心铨  王燕琪  李爱红 《眼科》2003,12(3):134-137
目的:进一步了解糖尿病视网膜病变(DR)全视网膜光凝术(PRP)后中、长期随诊的激光量和疗效的临床结果。方法:63例增殖期糖尿病视网膜病变(PDR)PRP术后随诊12—132个月(平均43.2个月)的临床资料回顾分析。结果:63例PDR患者PRP术的平均视网膜光凝斑总数975个。视力改变:提高者占24.2%,不变者占35%,下降者占40.8%。主要晚期并发症是程度不等的玻璃体视网膜纤维膜形成及少数病例(4例5只眼)发生1—3次不同程度的玻璃体出血。结论:PDR眼病例PRP术后中、长随诊的激光量——平均总视网膜光斑数1000个左右;60%的病例视力保持不变或改善,40%的病例视力下降,病情控制。强调了适宜的视网膜光凝范围、适宜的激光波长和适宜的视网膜有效光斑是PRP术成功的关键。还讨论了DR激光治疗后视力下降的因素和主要晚期并发症。  相似文献   

11.

目的:观察前后段联合手术对增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者的脉络膜厚度的影响。

方法:采用回顾性病例对照研究。将在青岛市市立医院确诊为PDR且具备前后段联合手术条件的患者60例60眼纳入研究。并根据是否伴有有临床意义的黄斑水肿(clinical significant macular edema,CSME)将PDR组分为CSME(+)组31例31眼和CSME(-)组29例29眼。将27例27眼与患者年龄及性别匹配的正常眼作为对照组。所有PDR患眼均行前后段联合手术。使用频域光学相干断层扫描的增强深部成像技术(enhanced depth imaging spectral domain optical coherence tomography,EDI-SDOCT)对对照组和PDR组术后1wk,1、3、6mo进行扫描,并测量黄斑中心凹(subfoveal choroidal thickness,SFCT)及距黄斑中心凹鼻侧(nasal choroidal thickness,NCT)、颞侧(temporal choroidal thickness,TCT)各1 500μm的脉络膜厚度。比较前后段联合手术后患眼脉络膜厚度的变化。

结果:CSME(+)组和CSME(-)组前后段联合术后1mo SFCT、NCT、TCT较术后1wk,3、6mo均增加,且差异有统计学意义(均P<0.05),术后6mo SFCT、NCT、TCT较术后1wk,1、3mo均减少,且差异具有统计学意义(均P<0.05)。CSME(+)组和CSME(-)组术后1wk,1、3mo的SFCT、NCT、TCT均大于对照组,且差异有统计学意义(均P<0.05),术后6mo的SFCT、NCT、TCT与对照组相比差异均无统计学意义(P>0.05)。分别比较CSME(+)组与CSME(-)组术后1wk,1、3、6mo SFCT、NCT、TCT差异均无统计学意义(均P>0.05)。

结论:PDR患者前后段联合术后1mo内脉络膜厚度是增加的,1mo之后脉络膜厚度是降低的,术后6mo脉络膜厚度接近正常状态。PDR是否伴有CSME对术后脉络膜厚度无明显影响。  相似文献   


12.
目的:研究全视网膜光凝术(panretinal photocoagulation,PRP)和次全视网膜光凝术(sub-panretinal photocoagulation,sub-PRP)对重度非增殖期糖尿病视网膜病变(pre-proliferative diabetic retinopathy,PPDR)的疗效及其对黄斑的影响.方法:选取2014-01/12在上海交通大学附属同仁医院眼科接受sub-PRP的PPDR患者24例43眼作为观察组,同期接受PRP的PPDR患者37例66眼作为对照组.观察治疗前后视力和视网膜变化情况,并用OCT观察治疗前后黄斑厚度和容积变化情况.结果:观察组治疗6mo后视力有效率和视网膜有效率分别为77%和81%,对照组视力有效率和视网膜有效率分别为76%和80%,两组无统计学差异(P>0.05).观察组与对照组黄斑子区厚度及黄斑容积术后1 mo达到最高,与术前相比均有统计学差异(P<O.05),且观察组黄斑子区厚度及黄斑容积均明显低于对照组(P<0.05).术后3 mo观察组的黄斑子区厚度及黄斑容积已回落到术前(P>0.05),对照组的黄斑子区厚度及黄斑容积仍高于术前,且高于观察组(P<0.05).术后6mo两组的黄斑子区厚度及黄斑容积均低于术前(P<0.05).结论:sub-PRP对PPDR的疗效与PRP相当,并且对黄斑的影响较小.  相似文献   

13.

Purpose

To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injections for the treatment of proliferative diabetic retinopathy (PDR) with new dense vitreous hemorrhage (VH) after previous full panretinal photocoagulation (PRP).

Methods

Prospective study of consecutive PDR with prior complete PRP patients, who presented with new dense VH, were treated with IVB injection. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and 1, 6, and 12 weeks and 6, 9, and 12 months after the first injection. Reinjection was done in non-clearing and recurrent VH.

Results

Eighteen eyes of 18 patients, mean age 47.7±12.69 years were included. In all, 14 (77.78%) patients had type 2 diabetes mellitus. Systemic hypertension and dyslipidemia were the most common systemic diseases. All cases were phakic eye with previous complete PRP. Patients received 1.6±0.42 intravitreal injections over a 12-month period. VH cleared completely in 7 (38.89%), 9 (50%), and 13 (72.22%) eyes after 6 weeks, 6 months, and 12 months, respectively. Re-bleeding, however, occurred in 10 (56%) eyes during the follow-up period, and 5 (28%) eyes still had residual VH at the last visit. Statistically significant visual gain was observed in 9 (50%) eyes. Unfortunately, 2 (11%) eyes had severe visual loss because of the tractional retinal detachment (TRD). Mild ocular complication was detected in one patient.

Conclusion

IVB injection had good efficacy and safety for treatment of new VH in patients with PDR and prior complete PRP. This procedure may be especially relevant for diabetic patients at high-risk for surgical intervention.  相似文献   

14.
Yao Xu  Qing Ye  Wei Shen 《国际眼科》2024,17(6):1066-1072
AIM: To assess the clinical efficacy and safety of combining panretinal photocoagulation (PRP) with intravitreal conbercept (IVC) injections for patients with high-risk proliferative diabetic retinopathy (HR-PDR) complicated by mild or moderate vitreous hemorrhage (VH), with or without diabetic macular edema (DME). METHODS: Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study. Upon establishing the patient’s diagnosis, an initial IVC was performed, followed by prompt administration of PRP. In cases who significant bleeding persisted and impeded the laser operation, IVC was sustained before supplementing with PRP. Following the completion of PRP, patients were meticulously monitored for a minimum of six months. Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography (FFA) results. Therapeutic effect and the incidence of adverse events were observed. RESULTS: Out of 42 patients (74 eyes), 29 were male and 13 were female, with a mean age of 59.17±12.74y (33-84y). The diabetic history was between 1wk and 26y, and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y. The affected eye received 2.59±1.87 (1-10) IVC injections and underwent 5.5±1.02 (4-8) sessions of PRP. Of these, 68 eyes received PRP following 1 IVC injection, 5 eyes after 2 IVC injections, and 1 eye after 3 IVC injections. Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment, with resolution of DME in 51 eyes 3-48wk after initial treatment. A newly developed epiretinal membrane was noted in one eye. Visual acuity significantly improved in 25 eyes. No complications such as glaucoma, retinal detachment, or endophthalmitis were reported. CONCLUSION: The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.  相似文献   

15.
目的 通过荟萃分析系统评价糖尿病性视网膜病变(DR)患者在常规全视网膜光凝(PRP)后黄斑中心凹下脉络膜厚度(SFCT)的变化.方法 检索PubMed、EM-BASE、Web of Science及Cochrane Library英文数据库和万方数据知识服务平台、维普中文期刊服务平台及中国知网中文数据库,搜集行PRP术...  相似文献   

16.
目的:观察增殖型糖尿病性视网膜病变(proliferativediabetic retinopathy,PDR)行全视网膜光凝术(panretinalphotocoagulation,PRP)后5a的疗效及预后分析。方法:对92例149眼PDR患者行PRP治疗后的1,3,6,12mo进行复查,以后每6mo进行复查,并在3mo后均复查FFA,必要时补充光凝,随访5a。结果:视力提高52眼,保持不变71眼,下降26眼。5a后患者的最终矫正视力情况:≤0.01者19眼,~0.1者64眼,~0.5者58眼,>0.5者8眼。在激光后的随访期间血糖水平基本控制在正常范围内的63眼中,5a后只有6眼发生玻璃体积血、牵拉性视网膜脱离等严重并发症,占9.5%,而在血糖水平控制不满意的29眼中,有9眼(31%)发生上述情况。结论:通过早期发现、及时治疗和定期随访观察而减少糖尿病性盲是完全可能的。对于PDR患者,确诊后应立即进行PRP治疗,并制定定期随访计划,必要时应复查FFA或补充激光,同时,要向患者阐明,严格正规的内科治疗,将血糖控制在正常范围内,可有效地降低或延缓PDR发展的倾向。  相似文献   

17.
We reviewed the preoperative, postoperative, and follow-up examinations, fundus photographs, and fluorescein angiograms of 175 eyes of 134 patients with proliferative diabetic retinopathy treated with panretinal photocoagulation. Forty-four (25%) of these eyes lost two or more lines of vision by the time of the last follow-up examination. Follow-ups ranged from 3 to 48 months, with a median follow-up of 15 months. The most common cause of decreased visual acuity was chronic macular edema that had developed following laser treatment, occurring in 14 (8%) eyes. The causes of visual loss following panretinal photocoagulation are discussed.  相似文献   

18.
Purpose: To examine macular function and its correlation to macular thickness before and after panretinal photocoagulation for proliferative retinopathy in diabetic patients. Methods: Ten diabetic patients (aged 57 ± 10 years, diabetes duration 21 ± 10 years) treated with panretinal photocoagulation outside the great vascular arcade underwent multifocal electroretinography (mfERG) and optical coherence tomography (OCT) before and 6 months after treatment. When focal treatment in the macular region was performed prior to panretinal photocoagulation the investigations took place 3 weeks after this treatment but before the panretinal photocoagulation. One eye per patient was examined. Amplitudes and implicit times of the mfERG response were analyzed within the four innermost (27°) of the six concentric rings registered by the mfERG, which corresponds to the area measured by the OCT (Ø 3.5 mm). Results: Visual acuity was similar before and after photocoagulation, 1.0; 0.7–1.0 (md, range) versus 1.0; 0.6–1.0 (md, range). The mean values of the ring average amplitudes were reduced in the first and second, third and fourth concentric rings from foveola after photocoagulation, p= 0.001, p= 0.011 and p= 0.004, respectively. No change was seen in implicit time after treatment. OCT values were similar before and after photocoagulation. There was no correlation between retinal thickness assessed with OCT and amplitudes measured by the mfERG. Conclusion: In spite of unchanged values of retinal thickness and visual acuity, panretinal photocoagulation seems to cause a functional impairment in the adjacent untreated macula, shown by reduced amplitudes measured by the mfERG.  相似文献   

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