两种光凝术治疗糖尿病视网膜病变的非随机对照研究

目的:研究全视网膜光凝术(panretinal photocoagulation,PRP)和次全视网膜光凝术(sub-panretinal photocoagulation,sub-PRP)对重度非增殖期糖尿病视网膜病变(pre-proliferative diabetic retinopathy,PPDR)的疗效及其对黄斑的影响.方法:选取2014-01/12在上海交通大学附属同仁医院眼科接受sub-PRP的PPDR患者24例43眼作为观察组,同期接受PRP的PPDR患者37例66眼作为对照组.观察治疗前后视力和视网膜变化情况,并用OCT观察治疗前后黄斑厚度和容积变化情况.结果:观察组治疗6mo后视力有效率和视网膜有效率分别为77％和81％,对照组视力有效率和视网膜有效率分别为76％和80％,两组无统计学差异(P＞0.05).观察组与对照组黄斑子区厚度及黄斑容积术后1 mo达到最高,与术前相比均有统计学差异(P＜O.05),且观察组黄斑子区厚度及黄斑容积均明显低于对照组(P＜0.05).术后3 mo观察组的黄斑子区厚度及黄斑容积已回落到术前(P＞0.05),对照组的黄斑子区厚度及黄斑容积仍高于术前,且高于观察组(P＜0.05).术后6mo两组的黄斑子区厚度及黄斑容积均低于术前(P＜0.05).结论:sub-PRP对PPDR的疗效与PRP相当,并且对黄斑的影响较小.

Sub-panretinal photocoagulation vs panretinal photocoagulation for pre-proliferative diabetic retinopathy: a prospective non-randomized study

AIM: To evaluate the efficacy and safety of panretinal photocoagulation(PRP)and sub-panretinal photocoagulation(sub-PRP)for pre-proliferative diabetic retinopathy(PPDR)and its effect for macular.

METHODS: From January to December 2014, 61 patients with PPDR were divided into observation group(24 patients with 43 eyes who received sub-PRP)and control group(37 patients with 66 eyes who received PRP). Their clinical data and follow-up results were reviewed.

RESULTS: The efficiency rate of visual acuity and of retinopathy were 77% and 81% in observation group at 6mo after treatments. The two indicators in control group were 76% and 80% and the difference on the two indicators between the two groups were not statistically significant(P>0.05).The central macular thickness and volume of macula reached peak in both group at 1mo after photocoagulation and compared to those before treatments, the differences were statistically significant(P<0.05). The central macular thickness and volume of macula in observation group was significantly lower than those of control group(P<0.05). At 3mo after treatments, the central macular thickness and volume of macula in sub-panretinal photocoagulation group had returned to the level before treatments(P>0.05), while those of panretinal photocoagulation group were higher than those before treatments and those of observation group(P<0.05). At 6mo after photocoagulation, the central macular thickness and volume of macula were lower in both groups compared to those before treatments(P<0.05).

CONCLUSION: The effect of sub-PRP on PPDR is comparable to that of PRP, while the effect on the macula is smaller.