532nm激光治疗糖尿病视网膜病变的临床观察

目的:评估532nm激光治疗糖尿病视网膜病变(diabetic retinopathy,DR)的治疗效果。方法:应用532nm激光对糖尿病患者48例96眼包括增殖前期糖尿病视网膜病变(PPDR)54眼,增殖期糖尿病视网膜病变(PDR)42眼(包括高危PDR20眼,非高危PDR22眼),合并黄斑水肿21眼]行视网膜光凝术。根据DR分期及病变严重程度行次全视网膜光凝(Sub-PRP)、标准全视网膜光凝(S-PRP)和超全视网膜光凝(E-PRP)及局限光凝和格栅样光凝,随访3mo～4a,观察视力和视网膜病变进展情况。必要时再补充激光治疗。结果:视力:提高或不变为有效,其中PPDR组有效45眼(83%),非高危PDR组有效18眼(82%),高危PDR组有效12眼(60%)。视网膜病变进展情况:视网膜水肿、渗出、出血部吸收,视网膜新生血管部分或全部消退为有效,其中PPDR组有效50眼(93%),非高危PDR组有效19眼(86%),高危PDR组有效13眼(65%)。结论:倍频532nm激光治疗DR安全有效,早期病变治疗效果好。及早发现和治疗病变,注意光凝方法和技巧,以及随访和跟踪治疗,是提高视网膜光凝疗效的关键。

Clinical study on photocoagulation with 532nm laser for diabetic retinopathy

AIM: To evaluate the efficiency of 532nm laser photocoagulation in treating diabetic retinopathy.

METHODS: Totally 96 eyes in 48 diabetic cases, including 54 eyes with preproliferative diabetic retinopathy(PPDR), 42 eyes with proliferative retinopathy(PDR)(20 eyes with high-risk PDR, 22 eyes with non-high-risk PDR), and 21 eyes with macular edema, were treated with 532nm laser photocoagulation. According to DR stage and severity, the patients had received the treatment of subpanretinal photocoagulation(Sub-PRP), standard panretinal photocoagulation(S-PRP), extra panretinal photocoagulation(E-PRP), local photocoagulation and grid pattern photocoagulation. All cases were followed-up for 3 months to 4 years, and visual acuity and retinopathy changes were observed. Further photocoagulation was performed when necessary.

RESULTS: Visual acuity was improved or maintained in 45 eyes(83%)in the group of PPDR, 18 eyes(82%)in the group of non-high-risk PDR, 12 eyes(60%)in the group of high-risk PDR. As to the retinopathy development, edema, exudation and bleeding absorption in the retina, as well as partial or entire vanishment to retinal neovascularization, were considered as effective outcome. The effective data were 50 eyes(93%)in the group of PPDR, 19 eyes(86%)in the group of non-high-risk PDR, 13 eyes(65%)in the group of high-risk PDR.

CONCLUSION: In treating diabetic retinopathy, 532nm laser photocoagulation is effective and safe. Better effect can be achieved in early stage. Early discovery and treatment, attention to photocoagulation methods and skills, regular follow-ups and timely supplement of photocoagulation, are the key points for improving the effect of retinal photocoagulation.