糖尿病视网膜病变激光治疗后玻璃体出血的临床分析

目的:探讨糖尿病视网膜病变(diabetic retinopathy,DR)激光光凝术后玻璃体出血的发生率、临床特点及疗效。方法:本研究对1996-2005年598例949眼DR患者行激光光凝术。术后追踪随访6-38个月,平均18个月。结果:Ⅰ型糖尿病患者在激光光凝术后玻璃体出血的发生率为28.77%,Ⅱ型糖尿病患者的发生率为8.22%。Ⅰ型糖尿病患者激光光凝术后发生玻璃体出血的几率明显高于Ⅱ型糖尿病患者(P<0.01)。Ⅲ期DR患者在激光光凝术后玻璃体出血的发生率为6.83%,Ⅳ期DR患者的发生率为14.29%。Ⅲ期DR患者激光光凝术后发生玻璃体出血的几率显著低于Ⅳ期患者(P<0.01)。75.27%的玻璃体出血患者经过保守治疗和补充激光光凝后,玻璃体出血吸收,24.73%的患者需行玻璃体视网膜手术。结论:DR达Ⅲ期以上者激光光凝术后仍可发生玻璃体出血,并发玻璃体出血的患者经过积极治疗,可获得较好的疗效。

The Clinic Analysis of Vitreous Hemorrhage after Laser Photocoagulation for Diabetic Retinopathy

Objective To investigate the incidence rate and the clinic characteristic of vitreous hemorrhage after laser photocoagulation for diabetic retinopathy(DR).Methods 949 eyes of 598 DR patients had undergone laser photocoagulation in our research from 1996 to 2005.Median follow-up was 18 months(range of 6-38 months).Results The incidence rate of vitreous hemorrhage after laser photocoagulation was 28.77% in the type 1 diabetic patients,and 8.22% in the type 2 diabetic patients.The incidence rate of vitreous hemorrhage after laser photocoagulation in the type 1 diabetic patients was significantly higher than that in the type 2 diabetic patients(P<0.01).The incidence rate of vitreous hemorrhage after laser photocoagulation was 6.28% in patients with DR stage Ⅲ,and 14.29% in patients with DR stage Ⅳ.The incidence rate of vitreous hemorrhage after laser photocoagulation in patients with DR stage Ⅲ was lower than that in patients with DR stage Ⅳ(P<0.01).The vitreous hemorrhage was absorbed after medicine therapy and added laser photocoagulation in 75.27%,and vitreoretinal surgery was required in 24.73%.Conclusions The vitreous hemorrhage occurred in patients with DR stage Ⅲ upwards after laser photocoagulation sometimes.These patients with vitreous hemorrhage may attain a better outcome after active therapy.