糖尿病视网膜病变黄斑水肿不同光凝顺序治疗近期疗效的观察

目的 观察增生前期或增生期糖尿病视网膜病变(diabetic retinopathy，DR)有临床意义黄斑水肿(clinical significant macular edema，CSME)的患者不同光凝顺序治疗后的近期疗效。 方法 门诊由三面镜及荧光素眼底血管造影(fundus fluorescence angiography，FFA)检查确诊的DR有CSME的连续病例63例103只眼，分为A、B 2组。A组(54只眼)先行黄斑局部光凝(macular local photocoagulation，MLP)，1个月后再行全视网膜光凝(panretinal photocoagulation，PRP)；B组(49只眼)先行PRP，1个月后再行MLP。随访3～13个月，观察2组患者治疗前后视力、中心 5°光敏感度、FFA的变化。 结果 治疗完成后 2个月，A组视力恢复明显好于B组(P<0.01)，其余各时间段 2组患眼视力变化差异无显著性意义(P>0.05)。3～4个月时2组患眼中心5°光敏感度改变差异亦无显著性意义(P>0.05)。2组患眼中59只眼(A组32只眼，B组27只眼)黄斑渗漏得到有效控制。 结论 对于CSME的增生期或增生前期DR患者，先行MLP后行PRP比先行PRP后行MLP视力恢复较快；不同光凝顺序对中心 5°黄斑光敏感度没有明显影响。 (中华眼底病杂志,2000,16:150-152)

The short-term effect of changing sequence of PRP and MLP on the diabetic retinopathy patients with CSME

Objective
To observe the short-term effect of changing the sequence of PRP and MLP on the pre-proliferative or proliferative diabetic retinopathy patients with clinical significant macular edema (CSEM).

Methods
Sixty-three consecutive pre-proliferative or proliferative diabetic retinopathy outpatients (103 eyes) with clinical significant macular edema were selected and divided into two groups: 54 eyes in patients of group A accepted MLP one month prior to PRP and 49 eyes in patients of group B accepted the photocoagulative therapies in a contrary sequence. All the patients were followed up for 3 to 13 months and visual acuity. Light sensitivity of 5°macular threshold, and FFA were performed pre- and post-photocoagution.

Results
The improvement of visual acuity was found to be better in group A than that of group B (P<0.01) 2 months after the therapy, since then, there was no significant defference (P>0.05) in both groups. Three and 4 months after the treatment, there was no significant difference in change of light sensitivity of 5°macular threshold in both groups. The macular leakages of 59 eyes, 32 ingroup A and 27 in group B, were well controlled.

Conclusion
Among the pre-proliferative or proliferative diabetic retinopathy patients with CSEM, visual acuity of those who accept MLP prior to PRP more rapidly than those who accept contrary sequence of photocoagulation, but the changing of therapeutic sequence might have no dramatic influence on light sensilivity of 5°macular threshold.

(Chin J Ocul Fundus Dis,2000,16:150-152)