氩激光凝固法对糖尿病性视网膜病变的疗效观察  

Effect of argon laser photocoagulation on diabetic retinopathy

作　　者：魏湛云[1] 胡世兴[2] 唐娜[1] 吴京[1] 王洁 

机构地区：[1]南方医科大学南方医院眼科,广东广州510515 [2]中山大学中山眼科中心,广东广州510060 [3]解放军159医院,河南驻马店46300

出　　处：《第一军医大学学报》2004年第11期1313-1315,共3页Journal of First Military Medical University

摘　　要：目的观察糖尿病性视网膜病变(DR)不同分期者接受氩激光治疗的临床效果。方法采用科以人2000型氩激光组合激光机对170例263只患眼分别做如下处理:(1)对非增殖期糖尿病视网膜病变(NPDR) 30眼行局部氩激光凝固术(光凝);(2)对增殖前期糖尿病视网膜病变(PPDR) 156眼行次全视网膜光凝;(3)对增殖期糖尿病视网膜病变(PDR ) 77眼行全视网膜光凝,对合并黄斑局限或弥漫性水肿者给予局灶性光凝或格栅样光凝。于光凝后3个月检查,进行视力、眼底、视网膜荧光血管造影,并与治疗前各项结果对比。结果视力提高92眼(35%)、无变化144眼(55%)、下降27眼(10%)。眼底检查、荧光血管造影复查示:NPDR、PPDR眼视网膜微血管瘤、水肿、渗出消退,荧光渗漏消退占89%,其余11%需补充光凝。PDR眼视网膜、视盘新生血管消退占67%,33%为部分消退需补充光凝。黄斑水肿完全或部分消退占91%,光凝后出现视网膜前灶性出血占8%,玻璃体积血为1%。结论氩激光对不同分期DR均有效。NPDR、PPDR效果好于PDR眼,后者光凝后荧光血管造影复查以及补充光凝对提高疗效非常必要。Objective To observe the clinical effect of argon laser photocoagulation on diabetic retinopathy (DR) in different stages. Methods A total of 263 eyes in 170 patients with DR in different stages were photocoagulated using argon laser machine 2000. Thirty eyes in non-proliferative stage received focal photocoagulation, 156 pre-proliferative eyes received subtotal panretina photocoagulation, and 77 proliferative eyes were treated with panretinal photocoagulation. Additional focal or grid treatment was given for the eyes with localized or difused macular edema. The visual acuity, eye fundus examination and retinal fluorescein angiography were carried out 3 months after the treatment and the results compared with the preoperative findings. Results Improvement of visual acuity by at least one row on the visual chart was achieved in 92 eyes (35%), 144 eyes (55%) exhibited no changes, and 27 eyes (10%) deteriorated. Microaneurysm, retinal edema, exudates and fluorescence leakage were reduced in 89% of the eyes, with the rest eyes requiring additional treatment in the non-proliferative and pre-proliferative stages. For the retina in proliferative stage, neovascularization on the disc resolved completely in 67% eyes, whereas partially in 33% eyes which needed additional photocoagulation. The eyes with partial and complete resolvtion of macular edema accounted for 91% of the total eyes. Postoperative pre-retinal hemorrhage and vitreous hemorrhage occurred at the rates of 8% and 1%, respectively. Conclusion Argon laser therapy is effective for the eyes with DR in different stages, but produces better efficacy in non- and pre-proliferative stages than in proliferative stage. Follow-up and additional photocoagulation are necessary for the eyes in proliferative stage to ensure better outcome.

关 键 词：氩激光凝固法 糖尿病性视网膜病变 氩激光凝固术 血管造影 

分 类 号：R587.2[医药卫生—内分泌] R454.2[医药卫生—内科学]