532nm倍频激光治疗高原血管性眼底病变的临床研究

目的：观察532nm倍频激光视网膜光凝(panretinal photocoagulation， PRP)治疗高原地区糖尿病视网膜病变(diabetic retinpathy， DR)及视网膜静脉阻塞(retinal vein occlusion，RVO)的临床疗效，评价氩激光治疗眼底血管病的安全性、有效性。

方法：选择DR患者122例227眼，其中增殖前期糖尿病性视网膜病变(preproliferative diabetic retinopathy， PPDR)51例90眼、增殖期糖尿病性视网膜病变(proliferative diabetic retinopathy，PDR)71例137眼； RVO患者120例124眼，其中中央静脉阻塞(central retinal vein occlusion，CRVO)27例27眼，分支静脉阻塞(branch retinal vein occlusion，BRVO)93例97眼，进行532nm底激光视网膜光凝治疗。每位患者在结束最后一次治疗后1，3，6mo复查眼底、视力、FFA检查。

结果：DR患者行视网膜光凝术后，PPDR有效81眼(90.0%)、无效9眼(10.0%)； PDR有效98眼(71.5%)，无效39眼(28.5%)，总有效率78.9%； RVO患者行视网膜光凝术后， BRVO有效者90眼(92.8%)，CRVO有效者22眼(81.5%)。532nm倍频激光治疗眼底血管性疾病的总有效率为82.9%。

结论：532nm倍频激光光凝治疗高原地区眼底血管性疾病是一种安全有效的治疗方法，糖尿病视网膜病变增殖前期激光治疗的有效率高于增殖期，治疗时机的合理选择可有效阻止DR的进展，防止失明的严重后果； 对RVO及时进行视网膜激光光凝的干预治疗，可以加速出血水肿吸收，防止新生血管的产生，降低并发症。

Observation on clinical effects of panretinal photocoagulation for vascular fundus diseases in highland area

AIM: To observe clinical efficacy of argon laser photocoagulation or panretinal photocoagulation(PRP)therapy on plateau diabetic retinopathy(DR), retinal vein occlusion(RVO), and to evaluate security and effectiveness of argon laser treatment of fundus diseases.

METHODS: Totally 122 cases(227 eyes)of DR were selected, including 51 cases(90 eyes)of preproliferative diabetic retinopathy(PPDR), 71 cases(137 eyes)of proliferative diabetic retinopathy(PDR), 120 cases(124 eyes)of RVO, 27 cases(27 eyes)of central vein occlusion(CRVO), 93 cases(97 eyes)of branch retinal vein occlusion(BRVO). They were performed argon laser photocoagulation treatment. The fundus examination, visual acuity and fundus fluorescein angiography(FFA)examination of each patient were taken in the end after the last treatment 1 month, 3 months and 6 months postoperatively.

RESULTS: After the retinal photocoagulation on DR patients, operation were effective in 81 eyes(90.0%), ineffective in 9 eyes(10.0%)in PPDR cases; effective in 98 eyes(71.5%), ineffective in 39 eyes(28.5%)in PDR cases, and the total effective rate was 78.9%. After the retinal photocoagulation on RVO patients, operation was effective in 90 eyes(92.8%)in BRVO cases; effective in 22 eyes(81.5%)in CRVO cases. The total effective rate of argon laser(532nm)treatment on retinal vascular disease was 82.9%.

CONCLUSION: Fundus argon laser photocoagulation(532nm)for the vascular fundus diseases in highland area is a safe and effective method in the treatment of DR. The effective rate of laser therapy on PPDR was higher than the proliferative phase, timing of treatment selection can effectively prevent the progression of DR to prevent blindness in serious consequences; timing retinal laser photocoagulation therapeutic intervention on RVO can accelerate hemorrhage and absorption of edema, prevent forming neovascularization and reduce complications.