中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2009年
4期
275-278
,共4页
王玉%范传峰%夏信昌%舒相汶%张华%盛艳娟%程朝晖%吴昌龙%谭瑞礼%张同河
王玉%範傳峰%夏信昌%舒相汶%張華%盛豔娟%程朝暉%吳昌龍%譚瑞禮%張同河
왕옥%범전봉%하신창%서상문%장화%성염연%정조휘%오창룡%담서례%장동하
糖尿病视网膜病变/治疗%激光凝固术/方法%治疗效果
糖尿病視網膜病變/治療%激光凝固術/方法%治療效果
당뇨병시망막병변/치료%격광응고술/방법%치료효과
Diabetic retinopathy/therapy%Laser coagulation/methods%Treatment outcome
目的 观察视网膜激光光凝治疗不同分期糖尿病视网膜病变(DR)患者的疗效.方法 经国际标准视力表检查视力、直接或间接检眼镜眼底检查和荧光素眼底血管造影(FFA)检查确诊的DR患者304例534只眼纳入研究.其中,非增生期(NPDR)组92只眼,平均视力0.52±0.32;增生前期(PPDR)组108只眼,平均视力0.49±0.23;早期增生期(早期PDR)组196只眼,平均视力0.20±0.31;高危增生期(高危PDR)组138只眼.平均视力0.17±0.22.参照ETDRS的规定,采用氩激光对NPDR期行次全视网膜激光光凝、PPDR期和早期PDR期行标准全视网膜激光光凝、高危PDR期行超全视网膜激光光凝.视网膜激光光凝治疗后,每隔3个月采用与治疗前相同的检查设备和方法复查视力、眼底、FFA.新生血管未消退和无灌注区残留补充激光光凝.随访观察10～18个月,平均随访时间11.6个月,以最后一次随访时的观察指标进行疗效评价.以视力提高≥2行为视力提高.视力变化2行以内为视力稳定,视力下降≥2行为视力下降,视力稳定或提高判定为有效.原有视网膜水肿消退,出血渗出吸收,微动脉瘤消失或减少;原有新生血管完全消退或部分减退,无灌注区消失或缩小,无新的新生血管或无灌注区出现判定为视网膜病变激光光凝治疗有效.结果 NPDR组、PPDR组、早期PDR组激光光凝治疗后平均视力分别为0.55士0.28、0.47±0.33、0.16±O.33.视力有效率分别为79.3%、76.9%、74.5%,三组间视力有效率比较,差异无统计学意义(χ2=0.180,0.811,0.209;P>0.05);高危PDR组平均视力为0.13±0.21,视力有效率为63.0%,与NPDR组、PPDR组、早期PDR期组视力有效率比较,差异有统计学意义(χ2=6.182,4.783,4.502;P<0.05).视网膜病变激光光凝治疗有效率NPDR组、PPDR组、早期PDR组分别为89.1%、85.2%、82.7%.三组治疗有效率比较,差异无统计学意义(χ2=0.684,2.030,0.325;P>0.05);高危PDR组治疗有效率为55.1%,与NPDR组、PPDR组、早期PDR组的治疗有效率比较.差异有统计学意义(χ2=28.212,23.999,28.746;P<0.05).结论 不同分期的DR视网膜激光光凝治疗后预后不同,早期、及时而有效的激光光凝治疗是稳定病变,降低致盲率的关键.
目的 觀察視網膜激光光凝治療不同分期糖尿病視網膜病變(DR)患者的療效.方法 經國際標準視力錶檢查視力、直接或間接檢眼鏡眼底檢查和熒光素眼底血管造影(FFA)檢查確診的DR患者304例534隻眼納入研究.其中,非增生期(NPDR)組92隻眼,平均視力0.52±0.32;增生前期(PPDR)組108隻眼,平均視力0.49±0.23;早期增生期(早期PDR)組196隻眼,平均視力0.20±0.31;高危增生期(高危PDR)組138隻眼.平均視力0.17±0.22.參照ETDRS的規定,採用氬激光對NPDR期行次全視網膜激光光凝、PPDR期和早期PDR期行標準全視網膜激光光凝、高危PDR期行超全視網膜激光光凝.視網膜激光光凝治療後,每隔3箇月採用與治療前相同的檢查設備和方法複查視力、眼底、FFA.新生血管未消退和無灌註區殘留補充激光光凝.隨訪觀察10～18箇月,平均隨訪時間11.6箇月,以最後一次隨訪時的觀察指標進行療效評價.以視力提高≥2行為視力提高.視力變化2行以內為視力穩定,視力下降≥2行為視力下降,視力穩定或提高判定為有效.原有視網膜水腫消退,齣血滲齣吸收,微動脈瘤消失或減少;原有新生血管完全消退或部分減退,無灌註區消失或縮小,無新的新生血管或無灌註區齣現判定為視網膜病變激光光凝治療有效.結果 NPDR組、PPDR組、早期PDR組激光光凝治療後平均視力分彆為0.55士0.28、0.47±0.33、0.16±O.33.視力有效率分彆為79.3%、76.9%、74.5%,三組間視力有效率比較,差異無統計學意義(χ2=0.180,0.811,0.209;P>0.05);高危PDR組平均視力為0.13±0.21,視力有效率為63.0%,與NPDR組、PPDR組、早期PDR期組視力有效率比較,差異有統計學意義(χ2=6.182,4.783,4.502;P<0.05).視網膜病變激光光凝治療有效率NPDR組、PPDR組、早期PDR組分彆為89.1%、85.2%、82.7%.三組治療有效率比較,差異無統計學意義(χ2=0.684,2.030,0.325;P>0.05);高危PDR組治療有效率為55.1%,與NPDR組、PPDR組、早期PDR組的治療有效率比較.差異有統計學意義(χ2=28.212,23.999,28.746;P<0.05).結論 不同分期的DR視網膜激光光凝治療後預後不同,早期、及時而有效的激光光凝治療是穩定病變,降低緻盲率的關鍵.
목적 관찰시망막격광광응치료불동분기당뇨병시망막병변(DR)환자적료효.방법 경국제표준시력표검사시력、직접혹간접검안경안저검사화형광소안저혈관조영(FFA)검사학진적DR환자304례534지안납입연구.기중,비증생기(NPDR)조92지안,평균시력0.52±0.32;증생전기(PPDR)조108지안,평균시력0.49±0.23;조기증생기(조기PDR)조196지안,평균시력0.20±0.31;고위증생기(고위PDR)조138지안.평균시력0.17±0.22.삼조ETDRS적규정,채용아격광대NPDR기행차전시망막격광광응、PPDR기화조기PDR기행표준전시망막격광광응、고위PDR기행초전시망막격광광응.시망막격광광응치료후,매격3개월채용여치료전상동적검사설비화방법복사시력、안저、FFA.신생혈관미소퇴화무관주구잔류보충격광광응.수방관찰10～18개월,평균수방시간11.6개월,이최후일차수방시적관찰지표진행료효평개.이시력제고≥2행위시력제고.시력변화2행이내위시력은정,시력하강≥2행위시력하강,시력은정혹제고판정위유효.원유시망막수종소퇴,출혈삼출흡수,미동맥류소실혹감소;원유신생혈관완전소퇴혹부분감퇴,무관주구소실혹축소,무신적신생혈관혹무관주구출현판정위시망막병변격광광응치료유효.결과 NPDR조、PPDR조、조기PDR조격광광응치료후평균시력분별위0.55사0.28、0.47±0.33、0.16±O.33.시력유효솔분별위79.3%、76.9%、74.5%,삼조간시력유효솔비교,차이무통계학의의(χ2=0.180,0.811,0.209;P>0.05);고위PDR조평균시력위0.13±0.21,시력유효솔위63.0%,여NPDR조、PPDR조、조기PDR기조시력유효솔비교,차이유통계학의의(χ2=6.182,4.783,4.502;P<0.05).시망막병변격광광응치료유효솔NPDR조、PPDR조、조기PDR조분별위89.1%、85.2%、82.7%.삼조치료유효솔비교,차이무통계학의의(χ2=0.684,2.030,0.325;P>0.05);고위PDR조치료유효솔위55.1%,여NPDR조、PPDR조、조기PDR조적치료유효솔비교.차이유통계학의의(χ2=28.212,23.999,28.746;P<0.05).결론 불동분기적DR시망막격광광응치료후예후불동,조기、급시이유효적격광광응치료시은정병변,강저치맹솔적관건.
Objective To observe the therapeutic effect of laser photocoagulation on diabetic retinopathy (DR)at different stages.Methods A total of 534 eyes of 304 patients with DR diagnosed by fundus fluorescein angiography (FFA) were enrolled in this study.In the 534 eyes,92 with nonproliferative DR (NPDR) had the best-corrected visual acuity(BCVA) of 0.52±0.32,108 with preproliferative DR (PPDR) had the BCVA of 0.49±0.23,196 with early PDR had the BCVA of 0.20±0.31,and 138 with high-risk PDR had the BCVA of 0.17±0.22.According to the rules of ETDRS,retinal photocoagulation,pan-retinal photocoagulation or extra-panretinal photoeoagulation were performed on the paitents with NPDR,PPDR,and high-risk PDR,respectively.The patients were followed up for 10-18 months after the operations and the results of the examinations at the last time were regarded as the criteria for judgement.The examination of BCVA and ocular fundus and FFA were performed with the time interval of 3 months.The judgement for BCVA was (1)improved:improved ≥ 2 lines;(2) kept still:changed within 2 lines;(3)decreased:decreased ≥2 lines.And the effect on BCVA was positve when it was improved or kept still.The judgement for the therapeutic effect on DR was:retinal edeama was alleviated,leakage of hemorrhage was obsorbed,microaneurysm disappeared or decreased,neovascularization (NV) was relieved completely or partly,non-perfusion area disappeared or narrowed,and no new NV or non-perfusion area came into being.Results After the operations,BCVA in NPDR,PPDR and early PDR groups was improved or kept still in 73 (79.3%),83 (76.9%),and 146 eyes (74.5%),respectively,without any statistical difference among these three groups(P>0.05).BCVA in high-risk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P<0.05).The positive rate of therapeutic effect on DR was 89.1% 、85.2%.82.7% in NPDR,PPDR,and early PDR groups,respectively without any statistical difference among the groups(P>0.05).The positive rate of therapeutic effect on DR in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P<0.05).Conclusion The prognosis of DR at different stages after laser photocoagulation is different;timely and effective laser photocoagulation is important to prevent the development of the disease and decrease the blindness rate.
