全视网膜激光光凝顺序差异对重度非增殖期糖尿病视网膜病变的效果影响  

The effect of different sequence of panretinal photocoagulation on severe non-proliferation diabetic retinopathy

作　　者：田蓓[1] 魏文斌[1] 朱晓青[1] 胡庆军 李蕊[2,3] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]北京大学民航临床医学院 [3]民航总医院眼科,100123

出　　处：《眼科》2011年第4期240-243,共4页Ophthalmology in China

摘　　要：目的介绍一种新的全视网膜光凝(PRP)方法并比较其与传统PRP方法对重度非增殖期糖尿病视网膜病变的远期效果。设计治疗新技术评价。研究对象100例(200眼)FFA诊断重度非增殖期视网膜病变伴黄斑区微动脉瘤且OCT检查无临床意义黄斑水肿者。方法患者左眼常规PRP光凝(自颞下、鼻下、颞上分四次行全视网膜光凝),右眼采用新光凝方法(全视网膜镜黄斑C型光凝联合黄斑区微动脉瘤封闭,而后行赤道部光凝、下方远周边部、上方远周边部光凝)。术后2周、1个月、3个月、6个月,而后每年随诊1次直至5年。主要指标视力及黄斑厚度,视网膜无灌注区情况以及玻璃体积血、牵拉性视网膜脱离、新生血管性青光眼发生率。结果随诊5年者82例(164眼,82%)。到最后随诊时传统光凝法及新方法的平均视力分别为(0.45±0.02)、(0.62±0.04)(P<0.05);黄斑厚度分别为(182.32±32.31)、(158.49±42.06)μm(P<0.05)。传统光凝法70眼发生黄斑水肿,新方法为28眼。传统光凝法15眼发生玻璃体积血,新方法为3眼。传统光凝法10眼发生牵拉性视网膜脱离,新方法为1眼。传统光凝法12眼5年后可见视网膜新生血管,新方法为3眼。其中传统光凝法1眼发展为新生血管性青光眼。结论新的PRP光凝方法较常规方法可显著减轻黄斑水肿、再次玻璃体积血、牵拉性视网膜脱离及新生血管发生率,更好地保留患者中心视力。Objective To compare the long-time effect of traditional PRP and modified PRP on the treatment of diabetic retinopathy. Design Evaluation of a new treatmental technique. Participants 100 cases （200 eyes） with severe non-proliferation diabetic retinopathy and macular microaneurysms diagnosed by fundus fluorescein angiography （FFA） and without clinical significant diabetic macular edema diagnosed by optical coherence tomography （OCT）. Methods The left eye was performed with traditional PRP. Goldmann three-mirror lens was used to treat temporal-inferior, nasal-inferior, nasal-superior, and temporal-superior areas sequentially. About 500 laser spots were given in each session. The right eye was performed with modified PRP. Retinoscope was used to give direct laser coagulation on the microaneurysm and macular photoeoagulation in a C pattern. Then laser coagulation was placed over the equator retina, the superior and inferior peripheral retina. Follow-ups lasted for 60 months were designed at 2 weeks, 1 month, 3 months, 6 months, 1 year and every year after PRP. Main Outcome Measures Visual acuity, macular thickness, vitreous hemorrhage, tractional retinal detachment, retinal neovascularization and neovascular glaucoma were observed. Results There were 82 cases （164 eyes） completed 5-year follow-up. The mean visual acuity was 0.45±0.02 in the left eye and was 0.62±0.04 in the right eye （P〈0.05）. The mean macular thickness was 182.32±32.31μm in the left eye and 158.49±42.06 μm in the right eye （P〈0.05）. Macular edema occurred in 70 left eyes and 28 right eyes. Vitreous hemorrhage occurred in 15 left eyes and 3 right eyes. Tractional retinal detachment occurred in 10 left eyes and 1 right eye. Retinal neovascularization was observed in 12 left eyes and 3 right eyes. In 1 left eye, neovascular glaucoma de- veloped. Conclusions The modified PRP may be a recommended photocoagulation method that may significantly alleviate macular edema, maintain better visual acuity, and reduce the rate of

关 键 词：糖尿病视网膜病变 激光凝固术 

分 类 号：R774.1[医药卫生—眼科]