CAJ | 학술논문

目的：评价格栅状光凝（macular laser grid photocoagulation，MLGP）联合全视网膜激光光凝（panretinal photocoagulation，PRP）治疗增殖性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）患者视网膜新生血管纤维膜的效果。方法选取 PDR 患者87例138眼。依据眼底荧光血管造影（fundus fluorescein angiography，FFA）评估结果将患者分为2组，A 组为视网膜新生血管纤维膜不伴有周围血管牵引扭曲组，B 组为伴有周围血管牵引扭曲组。每组再分2个亚组，Ⅰ组（新生血管纤维膜形成范围＜2PD）和Ⅱ组（范围＞2PD）。对眼底病情较轻的 A 组先行黄斑部 MLGP，1周后给予 PRP。对病情较重的 B 组，先期治疗同 A 组，然后根据视力恢复及眼底 FFA 结果，适时、个体化地追加 PRP 治疗。另外，对纤维膜形成范围较小的Ⅰ组患者行纤维增殖膜覆盖光凝，视网膜新生血管纤维膜形成范围＞2PD 的Ⅱ组行纤维增殖膜周围环绕光凝（不覆盖光凝）。结果视力总有效率 AⅠ组为92．86％，AⅡ组为94．87％，BⅠ组为91．30％，BⅡ组为85．29％，组间比较差异无统计学意义（P ＞0．05）。治疗视野缺损的总有效率 AⅠ组为92．96％，AⅡ组为84．62％，BⅠ组为91．30％，BⅡ组为73．53％，组间比较差异无统计学意义（P ＞0．05）。各组患者经视网膜激光光凝治疗后视网膜水肿、渗出、出血吸收加快，AⅠ组总有效率为95．23％，AⅡ组为84．62％，BⅠ组为95．65％，BⅡ组为79．41％，组间比较差异无统计学意义（P ＞0．05）。结论针对 PDR 患者眼底不同新生血管及纤维增殖膜形成的形态及大小采用不同光凝处理方法是稳定视力和阻止糖尿病视网膜病变患者眼底病变进展的关键。
목적：평개격책상광응（macular laser grid photocoagulation，MLGP）연합전시망막격광광응（panretinal photocoagulation，PRP）치료증식성당뇨병시망막병변（proliferative diabetic retinopathy，PDR）환자시망막신생혈관섬유막적효과。방법선취 PDR 환자87례138안。의거안저형광혈관조영（fundus fluorescein angiography，FFA）평고결과장환자분위2조，A 조위시망막신생혈관섬유막불반유주위혈관견인뉴곡조，B 조위반유주위혈관견인뉴곡조。매조재분2개아조，Ⅰ조（신생혈관섬유막형성범위＜2PD）화Ⅱ조（범위＞2PD）。대안저병정교경적 A 조선행황반부 MLGP，1주후급여 PRP。대병정교중적 B 조，선기치료동 A 조，연후근거시력회복급안저 FFA 결과，괄시、개체화지추가 PRP 치료。령외，대섬유막형성범위교소적Ⅰ조환자행섬유증식막복개광응，시망막신생혈관섬유막형성범위＞2PD 적Ⅱ조행섬유증식막주위배요광응（불복개광응）。결과시력총유효솔 AⅠ조위92．86％，AⅡ조위94．87％，BⅠ조위91．30％，BⅡ조위85．29％，조간비교차이무통계학의의（P ＞0．05）。치료시야결손적총유효솔 AⅠ조위92．96％，AⅡ조위84．62％，BⅠ조위91．30％，BⅡ조위73．53％，조간비교차이무통계학의의（P ＞0．05）。각조환자경시망막격광광응치료후시망막수종、삼출、출혈흡수가쾌，AⅠ조총유효솔위95．23％，AⅡ조위84．62％，BⅠ조위95．65％，BⅡ조위79．41％，조간비교차이무통계학의의（P ＞0．05）。결론침대 PDR 환자안저불동신생혈관급섬유증식막형성적형태급대소채용불동광응처리방법시은정시력화조지당뇨병시망막병변환자안저병변진전적관건。
ABSTRACT:Objective To evaluate the effects of grid photocoagulation combined with panretinal laser photocoagulation treatment for fiber membrane of retinal neovascularization in proliferative diabetic retinopathy (PDR)patients.Methods A total of 138 eyes of 87 patients, who were diagnosed as PDR,were enrolled in this study.All patients were evaluated by fundus fluorescein angiography (FFA ) examination.According FFA examination,87 patients were separated into two groups:retinal neovascularization fiber membrane formation not associated with peripheral vascular traction distorted group (group A)and retinal neovascularization fiber membrane formation associated with peripheral vascular traction distorted group (group B).Each group was again divided into two subgroups:group Ⅰ (retinal neovascularization fiber membrane formation range less than the 2PD)and group Ⅱ (the formation of retinal neovascularization fiber membrane greater than 2PD).The patients of group A were treated with macular laser grid photocoagulation first,and one week later treated with panretinal laser photocoagulation.The patients of group B were treated the same with group A firstly,and then according with the FFA and visual acuity to formulate timely and individual panretinal laser photocoagulation treatment. The best corrected visual acuity,fundus changes,and FFA examination were recorded before the laser surgery and laser treatment at least six months.Results The total effective rate in visual acuity of group AⅠ accounted for 92.86%,and that of group A Ⅱ 94.87%;group BⅠ91.30%, group B Ⅱ 85.29% .The treatment efficiency showed no significant difference between the four groups(P >0.05).The treatment efficiency of DR retinal lesions was total 92.96% in group AⅠ, 84.62%in group A Ⅱ ,91.30% in group BⅠ,73.53% in group B Ⅱ.The treatment efficiency showed no statistic difference between the four groups (P > 0.05 ).The absorption of retinal edema,exudation and bleeding were sped up after the treatment with laser photocoagulation.The effect was 95.23% in group AⅠ,84.62% in group A Ⅱ ,95.65% in group BⅠ,79.41% in group B Ⅱ.And the treatment efficiency did not have significant difference between the four groups (P > 0.05 ).Conclusion The prognosis of different staging PDR with retinal laser photocoagulation treatment is different,right time of photocoagulation treatment is important for the stability of visual acuity and retinopathy.