玻璃体手术中超全视网膜光凝对增生性糖尿病视网膜病变疗效影响

目的：探讨玻璃体手术中超全视网膜光凝对增生性糖尿病视网膜病变(proliferative diabetic retinopathy， PDR)疗效的影响。

方法： 回顾性分析2011-03/2013-03因玻璃体积血或玻璃体视网膜牵拉改变在我院接受玻璃体手术的糖尿病视网膜病变患者70例70眼，根据患者视网膜光凝范围不同将其分为超全视网膜光凝组40眼和全视网膜光凝组30眼，分别观察两组患者的最佳矫正视力、眼压及视网膜血管变化等情况，并对结果进行统计学分析。

结果：两组患者术前眼部状况、术后3mo最佳矫正视力及眼压，差异均无统计学意义(均P>0.05)。两组患者视网膜血管渗漏、后极部硬性渗出和后极部出血点的发生率比较，差异有统计学意义(均P<0.05)。两组患者视网膜无灌注区、视盘血管渗漏的发生率比较，超全视网膜光凝组均优于全视网膜光凝组，差异有统计学意义(P=0.04、0.02)。术后两组患者黄斑水肿发生情况比较，差异无统计学意义(P=1.00)，黄斑水肿消失时间比较，超全视网膜光凝组优于全视网膜光凝组，差异有统计学意义(P<0.05)。

结论：治疗PDR患者时，在玻璃体手术中采用超全视网膜光凝在视网膜无灌注区、视网膜血管渗漏、视盘血管渗漏等方面的疗效好于全视网膜光凝，但过量的视网膜光凝对视网膜及脉络膜有明显的损伤，因此治疗过程中在尽可能覆盖视网膜病变区的同时，掌握好激光能量及光斑数量对预防并发症的发生同样重要。

Curative effect of extra-panretinal photocoagulation on proliferative diabetic retinopathy during vitreous operation

AIM: To discuss the curative effect of extra-panretinal photocoagulation on proliferative diabetic retinopathy(PDR)during vitreous operation.

METHODS: We conducted a retrospective analysis of 70 diabetic retinopathy patients(70 eyes)who accepted vitreous surgery in our hospital due to vitreous hemorrhage or vitreous retina traction change from March 2011 to March 2013. In follow-up clinics, according to the difference of patient''s retinal photo-coagulation range, we divided it into extra-panretinal photocoagulation group(40 patients)and panretinal photocoagulation(30 patients), respectively observed the best corrected visual acuity, intraocular pressure and retinal vessel changes in two groups and made statistical analysis.

RESULTS: Through comparing the eye condition, visual acuity after 3mo, intraocular pressure between the two groups patients, the difference had no statistical significance(all of the P>0.05). Comparing the incidence of retinal blood vessel leak, posterior pole exudate, and posterior pole bleeding points in two groups patients, the difference had statistically significant(all of the P<0.05). Comparing the incidence of no-perfusion area of retina, prepapillary vascular leak in two groups patients, the difference had statistically significant(P=0.04, 0.02). Comparing the incidence of macular edema in two groups patients after operation, the difference had no statistically significance(P=1.00). Comparing the extinction time of macular edema, the difference had statistically significant(P<0.05), extra-panretinal photocoagulation group was better than panretinal photocoagulation.

CONCLUSION: To cure proliferation diabetic retinopathy, adopting the extra-panretinal photocoagulation has a better curative effect than panretinal photocoagulation on curing no-perfusion area of retina, retinal blood vessel leak, prepapillary vascular leak in operation on vitreous. However, the excessive retinal photocoagulation has a clear damage on retina and choroid. Therefore, in the treatment, while covering the retinopathy as far as possible, it is important to master the laser energy and spot number preventing the complications.