氩激光治疗视盘新生血管型糖尿病视网膜病变的疗效观察

目的探讨氩激光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49例65眼视盘新生血管型糖尿病视网膜病变患者行超全视网膜光凝。激光治疗后3、6、12个月行荧光眼底血管造影,新生血管未消退者追加光凝。随访3~24个月(平均10.6个月)。结果超全视网膜光凝术后视力提高12眼(18.4%),视力不变36眼(55.4%),视力下降17眼(26.2%)。49眼(75.4%)新生血管消退或部分消退,16眼(24.6%)新生血管无变化或加重。47眼(72.3%)需要补充光凝。平均激光治疗量(2406±704)点。结论视盘新生血管型糖尿病视网膜病变较常规治疗需要更大的激光量,光凝术后应定期随访观察,必要时补充光凝。     

激光组织间照射治疗前列腺癌的实验研究与临床观察

本文报道了用Ｎｄ：ＹＡＧ激光组织间照射治疗前列腺癌的实验研究结果与临床观察。实验采用Ｔ７３Ｐ小鼠接种ＬＡ７９５肺腺癌细胞，Ｎｄ：ＹＡＧ激光肿瘤内照射２Ｗ、５００秒，其肿瘤内中心与边缘的温升曲线有较大差别并可观察到肿瘤生长延迟现象。临床治疗１例前列腺癌伴骨转移病人，随访３个月，病人仍健在，证实激光组织间照射是治疗前列腺癌可供参考的一种方法。     

缺血型视网膜中央静脉阻塞的氪离子激光治疗

目的 探讨缺血型视网膜中央静脉阻塞的氪离子激光治疗的疗效.方法 回顾性分析我院应用氪激光全视网膜光凝治疗的缺血型中央静脉阻塞102眼的临床资料.结果 102眼缺血型视网膜中央静脉阻塞中73眼有效,占71.56%;27眼好转,占26.47%;2眼因玻璃体出血,继发新生血管性青光眼或并发白内障失明而无效,占1.97%.结论 对于缺血型视网膜中央静脉阻塞的患者应尽早实行全视网膜光凝术治疗,确保有效光斑的总数与密度是全视网膜光凝术成功的关键.     

激光光凝治疗非典型缺血型视网膜静脉阻塞178例

目的：观察非典型性缺血型视网膜静脉阻塞(ischemic retinal vein occlusion，IRVO)激光光凝治疗的临床效果。方法：我院眼底病组门诊及住院的患经日产TRC-50VT相机眼底荧光血管造影(fundus fluorescein angiograph，FFA)确诊的非典型性IRVO患178例178眼。采用美国HGM激光器绿蓝混合光，光斑200～500μm，时间0．1～0．5s，功率0．3～1．0W，Ⅱ～Ⅲ级轻度反应，光凝覆盖全部无灌注区，并发黄斑水肿的69例采用格栅样光凝，光斑100μm，时间0．1～0．15s，功率0．2～0．4W，Ⅰ～Ⅱ级反应。随访6～30mo，在光凝术后8，12wk行FFA复查，如有新的或光凝不全的无灌注区进行补充光凝，0.5a后行枪眼镜及FFA观察。结果：激光光凝治疗178眼中，光凝后12眼产生了新生血管(6．7%)，发生≥2PD新的视网膜无灌注区23眼(12．9％)，无灌注区光凝斑覆盖充分，无血管荧光素渗漏112眼(62．9%)，无灌注区光凝斑稀疏，其内仍有血管荧光素渗漏31眼(17．3%)，有效率80．3％；伴有黄斑囊样水肿69例格栅样光凝后水肿基本消退52眼(75．4％)，水肿减轻17眼(24．6％)。结论：激光对非典型IRVO无灌注区光凝能降低新生血管的发生，光凝范围、反应级别、光斑密度的标准化是有效治疗的关键，对控制IRVO无灌注区的扩大和明显减轻视网膜水肿有积极作用。     

玻璃体手术治疗增生性糖尿病视网膜病变的时机选择

目的探讨玻璃体手术治疗增生性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）的时机及疗效。设计回顾性、对照干预研究。研究对象118例（120眼）PDR患者，其中88例（90眼）行玻璃体手术，30例（30眼）行常规全视网膜光凝（panretinal photocoagulation，PRP）。方法患者分为三组，第一组为Ⅳ期PDR合并玻璃体积血50例（52眼），其病程在3个月以内行玻璃体手术者35例（37眼），病程≥6个月行玻璃体手术者15例（15眼）；第二组为Ⅴ期PDR无玻璃体积血60例（60眼），其中30例行玻璃体手术，30例行PRP治疗；第三组Ⅵ期PDR8例（8眼）行玻璃体手术。主要指标视力和术中、术后并发症。结果随访3～48个月，第一组中Ⅰ型糖尿病患者病程在3个月以内和6个月以上手术者相比，术后视力〉0．1者分别为10眼（83．3％）和2眼（33．3％），差异有显著性（P〈0．05）。2型糖尿病患者术后视力〉0．1者分别为9眼（36％）和3眼（33％），无显著性差异（P〉0．05）；第二组均为2型糖尿病患者，接受手术者术后视力〉0．1的10眼（33．3％），与术前比较差异有显著性（P〈0．01）。接受PRP者治疗前、后视力比较差异不显著；第三组手术前、后视力比较，差异无显著性。术中首要并发症为视网膜医源性裂孔，术后并发症为玻璃体再出血、视网膜脱离。结论PDR患者尤其是进行性加重者，早期行玻璃体手术联合PRP，视力预后优于保守治疗者。     

中药配合激光治疗糖尿病性视网膜病变临床分析

目的:观察中药配合激光治疗脾虚气虚型糖尿病视网膜病变的疗效。方法:90例(161只眼)脾虚气虚型糖尿病视网膜病变患者随机分为治疗组60例(107只眼)和对照组30例(54只眼)。治疗组用激光光凝治疗并加服中药,对照组仅用激光光凝治疗。结果:治疗组总有效率89.7%,对照组总有效率79.6%,两组比较有显著性差异(P<0.05)。两组治疗前后视力比较有显著性差异(P<0.05),治疗组全身症状及眼底出血、渗出、水肿改善情况均优于对照组(P<0.05)。结论:中药联合激光光凝治疗糖尿病视网膜病变的疗效比单纯激光光凝的疗效更好。     

Demarcation laser therapy in the management of macular-sparing persistent subretinal fluid after scleral buckling procedures

Background Persistent or recurrent macular-sparing subretinal fluid (SRF) can sometimes occur following scleral buckling procedures. Observation and reoperation have been used in the management of such cases. Demarcation laser therapy (DLT) has been used to treat macular-sparing retinal detachments in the context of cytomegalovirus retinitis and as primary treatment for selected rhegmatogenous retinal detachments. There are, however, scarce data in the literature regarding its use following primary scleral buckling procedures. The current study explores the use of DLT under the latter circumstances.Methods The medical records of all consecutive patients with persistent SRF sparing the macula following primary rhegmatogenous retinal detachment repair using a scleral buckling procedure were retrospectively reviewed. Only those patients in whom the breaks were localised to the area of indentation and, thus, seemed to be well supported by the buckle were included. Demographics, clinical characteristics of the retinal detachment prior to scleral buckling, extension of the residual SRF observed postoperatively, details of the laser procedure, anatomical and functional outcomes and complications were evaluated.Results Seven patients, all females, with a mean age of 47.9 years (range: 20–81) were included in the study. The retinal detachments were superior (n=3), inferior (n=3) and subtotal, affecting both superior and inferior retina (n=1). Scleral buckling procedures were used to treat the retinal detachments in all cases. Following demarcation laser therapy, the area of SRF remained stable in two patients, and flattened in four. In one patient, extension of SRF occurred requiring further surgery.Conclusions Demarcation laser therapy appears to be a reasonable option in the management of patients with persistent or recurrent SRF sparing the macula following scleral buckling surgery.The authors do not have any proprietary interests in the products or methods utilised in this study     

卵磷脂络合碘合并视网膜光凝治疗糖尿病视网膜病变的临床疗效观察

目的:观察卵磷脂络合碘对糖尿病视网膜病变引起的玻璃体积血、混浊的治疗效果.方法:本研究选用的病例为2005年1～8月到中南大学湘雅二医院门诊就诊的37名(51眼)糖尿病视网膜病变的患者,使用卵磷脂络合碘(1.5mg/)片)的片剂,3次/日,2片/次,对病情严重者行令视网膜光凝配合药物进行治疗.服用时间最长3个月,最短2周.观察时间为2周～3个月.结果:治疗2周后视力提高2行及其以上者5眼,占9.8%(5/51);1月后玻璃体积血明显减少或眼底能见度明显提高数,并能行荧光素眼底血管造影(FFA)检查以及激光治疗的有27眼,占52 9%(27/51):2月后玻璃体积血明显减少或眼底能见度明显提高并能行FFA检查以及激光治疗的达到42眼,占82.3 %(42/51);51眼内玻璃体混浊等级下降1级以上45暇,总有效率为88.2%(45/51),无明显效果有6眼,占11.8%(6/51).结论:卵磷脂络合碘是一种有敛的治疗由糖尿病视网膜病变引起玻璃体积血、混浊的约物. 后视力提高2行及其以上者5眼,占9.8%(5/51);1月后玻璃体积血明显减少或眼底能见度明显提高数,并能行荧光素眼底血管造影(FFA)检查以及激光治 的有27眼,占52 9%(27/51):2月后玻璃体积血明显减少或眼底能见度明显提高并能行FFA检查以及激光治疗的达到42眼,占82.3 %(42/51);51眼内玻璃体混浊等级下降1级以上45暇,总有效率为88.2%(45/51),无明显效果有6眼,占11.8%(6/51).结论:卵磷脂络台碘是一种有敛的治疗由糖尿病视网膜病变引起玻璃体积血、混浊的约物. 后视力提高2行及其以上者5眼,占9.8%(5/51);1月后玻璃体积血明显减少或眼底能见     

The role of clinical drug trial methodology with respect to studies of new drugs. Clinical trials of timolol

The use of the Randomized Clinical Trial (RCT) to assess the safety and efficacy of a new drug or treatment can provide a clear evaluation of the relative benefits and risks of the new therapy as compared to the longer-established treatment methodology. In some cases, such as insulin, the benefits are immediately apparent; in other cases, such as photocoagulation for proliferative diabetic retinopathy, the consensus is not so easily obtained, and the clinical trial can supply the answer. Furthermore, the RCT provides the opportunity to identify adverse reactions, in particular those which present with a seemingly unrelated or unexpected set of symptoms. In conducting clinical trials of timolol, researchers must be alert for beta-adrenergic antagonist effects, such as were seen with practolol, and should be especially careful to note early, mild reactions which may be the forerunners of later, more severe or irreversible adverse effects.     

Laser-induced thermal injury to dermal blood vessels: analysis of wavelength (585 nm vs. 595 nm), cryogen spray cooling, and wound healing effects

BACKGROUND AND OBJECTIVES: Successful laser treatment of cutaneous hyper-vascular lesions requires appropriate laser irradiation parameters for selective photothermolysis of ectatic dermal blood vessels as well as appropriate cooling parameters for epidermal protection based on an individual patient basis. Using the rabbit ear as an in vivo model for dermal vasculature, we investigated the influences of laser wavelength (585 nm vs. 595 nm) and cryogen spray cooling with various spurt durations on the laser-induced thermal injury to dermal blood vessels. Wound healing response was also evaluated in 2 hours and 4 days. STUDY DESIGN/MATERIALS AND METHODS: Flashlamp-pumped pulsed dye laser ScleroPlus (operated at the wavelength of 585 or 595 nm) was used for the comparison between the influences of two wavelengths (585 nm vs. 595 nm). R134-a cryogen spurts with the durations from 50 to 300 milliseconds were sprayed onto the sites to be irradiated and terminated 20 milliseconds before the onset of the laser pulses. In vivo rabbit ear was used as the model for cutaneous hyper-vascular lesions. Totally 10 New Zealand Albino white rabbits were experimented and in each rabbit ear six to seven sites were irradiated. Five animals were sacrificed 2 hours after the irradiation, and the remaining five sacrificed 4 days after the irradiation. Thermal injury to the blood vessel was assessed by hematoxylin and eosin stained histological sections and confirmed by an apoptosis assay. RESULTS: When the radiant exposures were above 10 J/cm2, 595 nm wavelength induced equivalent or more severe thermal injury to dermal blood vessels than 585 nm. Cryogen spray cooling with the spurt durations above 100 milliseconds resulted in increased depth of the most superficial thermal injury to dermal blood vessels than without cooling, indicating that superficial blood vessels were non-specifically cooled by the cryogen spurts applied at these parameters. Laser-induced thermal injury was significantly healed in the rabbit ear vasculature at 4 days post irradiation. CONCLUSIONS: Given sufficient radiant exposure, 595 nm wavelength can induce equivalent or more severe vascular injury compared with 585 nm. Cryogen spray cooling with the spurt durations above 100 ms may impair the photocoagulation of superficial blood vessels. Irreversible thermal injury to blood vessel can be achieved only when the basement membrane of blood vessel wall is irreversibly damaged.