全视网膜激光光凝治疗高危增生型糖尿病视网膜病变的效果分析  

Panretinal photocoagulation for high-risk proliferative diabetic retinopathy

作　　者：周爱意[1] 陈凌[1] 周陈静[1] 权彦龙[1] 

机构地区：[1]西安交通大学医学院第二附属医院眼科,陕西省西安市710004

出　　处：《眼科新进展》2016年第4期352-355,共4页Recent Advances in Ophthalmology

摘　　要：目的分析全视网膜激光光凝术(panretinal photocoagulation,PRP)治疗高危增生型糖尿病视网膜病变(high-risk proliferative diabetic retinopathy,HR-PDR)临床效果、预后及影响因素。方法回顾性分析2008年7月至2015年7月西安交通大学第二附属医院眼科PRP治疗的糖尿病视网膜病变(diabetic retinopathy,DR)患者85例(150眼)的临床资料,依据我国糖尿病视网膜病变临床诊疗指南,根据眼底荧光血管造影(fundus fluorescein angiography,FFA)检查结果分为两组:严重DR组包括重度非增生型DR(重度NPDR)和增生早期DR(早期PDR)组,共90眼,HR-PDR组包括HR-PDR 60眼。观察两组患者PRP治疗的效果、术后3个月的视力,分析HR-PDR的危险因素。结果严重DR组PRP术后13.3%(12/90)需要补充激光,16.6%(15/90)患眼黄斑水肿加重,2眼发生玻璃出血,1眼发生新生血管性青光眼。HR-PDR组PRP术后55.0%(33/60)需要补充激光,30.0%(18/60)患眼黄斑水肿加重,5眼发生玻璃体出血,3眼发生新生血管性青光眼。PRP术后3个月,严重DR组40.0%(36/90)视力下降,而HR-PDR组65.0%(39/60)视力下降。HR-PDR患者主要的危险因素包括:年龄小于50岁、糖尿病病程长、高糖化血红蛋白、高血脂及颈动脉B超异常。结论 HR-PDR的概念临床意义重大,其病变进展迅速,PRP效果不佳,需要密切随访,及时追加激光或者联合其他治疗方案。Objective To analyze the clinical effects,prognosis and effective factors of panretinal photocoagulation（ PRP） for high-risk proliferative diabetic retinopathy（ HRPDR）. Methods Eighty-five DR patients（ 150 eyes） underwent PRP from July 2008 to July 2015 in the Second Affiliated Hospital of Xi＇an Jiaotong University were retrospectively analyzed. According to the clinical diagnosis and treatment of diabetic retinopathy Guide（ 2014 edition）,the eyes were divided into two groups according to FFA： Severe DR group included severe non-proliferative DR and early PDR patients,a total of 90 eyes; HR-PDR group included 60 eyes with HR-PDR. PRP treatment effects and postoperative complications were observed in two group,the visual acuity of 3 months after operation was recorded,and the risk factors for HR-PDR were analyzed. Results After PRP,13. 3 %（ 12 /90） of eyes in the severe DR group required supplemental PRP laser,worse macular edema were observed in 16. 6 %（ 15 /90） eyes,the vitreous hemorrhage occurred in 2 eyes,and the neovascular glaucoma happened in 1 eye. After PRP,55. 0 %（ 33 /60） of eyes in the HR-PDR group needed to add laser,there were 30 %（ 18 /60） of eyes with worse macular edema,5 eyes of vitreous hemorrhage,and 3 eyes of neovascular glaucoma. At 3 months after PRP,the visual acuity in 40 %（ 36 /90） eyes of severe DR group decreased,and 65 %（ 39 /60） eyes of HR-PDR group decreased. The main risk factors for HR-PDR included the age younger than 50 years old,longer duration of diabetes,high glycated hemoglobin,high cholesterol and abnormal carotid in B-ultrasound. Conclusion The concept of HR-PDR has important clinical significance,these patients need close follow-up after PRP,because the retinopathy progresses rapidly. The timely additional laser or a combination of other treatment options must be paid more attention.

关 键 词：全视网膜激光光凝 糖尿病视网膜病变 影响因素 

分 类 号：R774.1[医药卫生—眼科]