糖尿病性视网膜病变不同分期光凝治疗的疗效评价
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摘要
目的：观察糖尿病视网膜病变(diabetic retinopathy，DR)不同分期的患者视网膜激光治疗分析，探讨激光术后视力的变化。方法：根据糖尿病性视网膜病变视网膜光凝研究组(Diabetic Retinopathy photocoagulation Study Group，DRPS)治疗技术规定，对148例241只眼分别为非增殖期糖尿病性视网膜病变(nonproliferative diabetic retinopathy，NPDR)、增殖前期糖尿病视网膜病变(prepro liferative diabetic retinopathy，PPDR)、增殖期糖尿病视网膜病变(prepro liferative diabeticretinopathy，PDR)的患者行视网膜激光光凝治疗，术后3～6个月对眼底作直接检眼镜和(或)三面镜检查及眼底荧光照影(fundus fluorescence angiography，FFA)，验证荧光素渗漏、毛细血管无灌注区，微血管瘤等有无消退，酌情补充光凝。随访6～24个月。结果：经过激光光凝治疗后NPDR期视力提高和不变占97.22％，PPDR期视力提高和不变占92.42％，PDR期视力提高和不变占72.66％。黄斑水肿完全消退者占71.64％，部分消退占19.40％，仍存在者占8.96％。3～6月后复查FFA眼底改善情况NPDR期有效占97.22％；PPDR期有效占81.82％；PDR期有效占61.87％。结论：DR的不同分期行视网膜激光光凝治疗后预后不同，因此选择合适的时机和合理的激光参数对不同分期DR进行视网膜激光光凝治疗是挽救DR患者视功能的关键。
Objective: To assess clinical therapeutic effect of diabetic retinopathy in different periods.
Methods: Based on Diabetic Retinopathy photocoagulation StudyGroup, 148cases, 241eyes of nonproliferative diabetic retinopathy (NPDR)、prepro liferative diabetic retinopathy (PPDR)、prepro life- rative diabeticretinopathy (PDR)were divided into Laser photocoagu-ation, after three to six months, color photograph and fundus fluores- cence angiography (FFA) .Those cases needing to supplement were complemented with further photocoagulation.
Results : After treatment of 6to24 months, the total effective rateof NPDR was 97.22%, PPDR was 92.42%, PDR was 72.66%.Macular Edema cured was 71.64% , improved was 19.40%,no effected was 8.96%. After 3～6 months FFA NPDR was 97.22%; PPDR was 81.82%; PDR Was 61.87%.
Conclusion :The prognosis of diabetic retinopathy of different staging is different after PRP. Therefore, the appropriate time should be chosen to carry on PRP to treat DR for the improvement of prognostic visual function of patients.
Objective: To assess clinical therapeutic effect of diabetic retinopathy in different periods.
Methods: Based on Diabetic Retinopathy photocoagulation StudyGroup, 148cases, 241eyes of nonproliferative diabetic retinopathy (NPDR)、prepro liferative diabetic retinopathy (PPDR)、prepro life- rative diabeticretinopathy (PDR)were divided into Laser photocoagu-ation, after three to six months, color photograph and fundus fluores- cence angiography (FFA) .Those cases needing to supplement were complemented with further photocoagulation.
Results : After treatment of 6to24 months, the total effective rateof NPDR was 97.22%, PPDR was 92.42%, PDR was 72.66%.Macular Edema cured was 71.64% , improved was 19.40%,no effected was 8.96%. After 3～6 months FFA NPDR was 97.22%; PPDR was 81.82%; PDR Was 61.87%.
Conclusion :The prognosis of diabetic retinopathy of different staging is different after PRP. Therefore, the appropriate time should be chosen to carry on PRP to treat DR for the improvement of prognostic visual function of patients.
引文
[1] 李凤鸣．眼科全书[M]．北京：人民卫生出版社，1996：2320—2329
[2] 刘家琦，李凤鸣．实用眼科学[M]．第2版．北京：人民卫生出版社，1999：418
[3] 张承芬主编．眼底病学[M]．北京：人民卫生出版社，1998：701
[4] 胡琦，徐锦堂，崔浩．氩激光光凝治疗糖尿病视网膜病变疗效观察[J]．中国实用眼科杂志，2002，20(2)：95
[5] 赵志刚，马书平，张菱，等．Ⅱ型糖尿病初诊时视网膜病变的调查分析及中日比较[J]．眼科研究，2000，18(5)：451-453
[6] 聂爱光主编．现代黄斑疾病诊断治疗学[M]．北京：北京医科大学，中国协和医科大学联合出版社，1997：264
[7] The Diabetic Retinopathy Study Research Group. Preliminary report on effects of photocoagulation therapy [J].Am J Ophthalmol, 1976,81:393-396
[8] Early Treatment Diabetic Retinopathy Study ResearchGroup. Report NO Ⅲ: techniques of scatter and localphotocoagulation treatment of diabetic retinopathy[J]. IntOphthalmol Chil, 1987,4:265-272
[9] 徐凤芹．糖尿病视网膜病变的激光治疗[J]．医学综述，2005，11(9)：823-824．
[10] 张承芬，张惠蓉主编．糖尿病的眼部并发症及治疗[M]．北京：人民卫生出版社，2003：62
[11] 郭庆，刘风华，奚冉冉，等．倍频Nd：YAG激光治疗糖尿病黄斑水肿[J]．中国实用眼科杂志，2000，18(6)：362—363
[12] 王玉，田杰，张绍光，等．氪红激光光凝治疗非增殖性糖尿病视网膜病变黄斑水肿[J]．中华眼底病杂志，1997，13(4)：199—200
[13] 周炜，郭希让主编．眼科激光治疗学[M]．郑州：河南医科大学出版社，1998：298
[14] Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation fordiabetic macularedema:treatm ent techniques and clinicalguidelines for photocoagulation of diabetic macularedema. Early treatment diabetic retinopathy study reportnum ber2[J].Arch Ophthalmol, 1987,94:654.
[15] Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macularedema: early treatmrntdiabetic retinopathy study reportnum berl[J].Arch Ophthalmol, 1985,103:1796-809.
[1] 徐凤芹．糖尿病视网膜病变的激光治疗[J]．医学综述，2005，11(9)：823-824
[2] 张承芬，董方田，叶俊杰，等．增殖前期与增殖期糖尿病性视网膜病变的激光治疗[J]．中华眼科杂志，1989，25(6)：329-331
[3] 何剑峰．激光治疗糖尿病视网膜病变[J]．右江民族医学院学报，1997，4：639-641
[4] 周炜，郭希让主编．眼科激光治疗[M]．郑州：河南医科大学出版社，1998：279-299
[5] 孙心栓，王燕琪．激光全视网膜光凝术[J]．中国实用眼科杂志，1998，16(9)：514-516
[6] 周平．糖尿病视网膜的激光治疗[J]．医学文选，2001，20(6)：882-884
[7] 李瑞峰主编．眼科激光治疗学概要[M]．北京：人民卫生出版社，1998．117-118
[8] 朱豫主编．眼科诊疗新技术[M]．北京：北京科学出版社，2001：116-117
[9] Striph GG, Stark WJ, Kratz RP, et al. Preliminary report on effect of photocoagulation therapy[J].Ophthalmology, 1988,95:1673
[10] RJ. Jalkh AE, Kraff MC, et al. Argon green(514nm)versus krypton red(647nm)modified grid laser photocoagulation for diffuse diabetic macular edema[J]. Ophthalmology, 1990,97:1101
[11] Lee CM,Watzke RC, Suger HS, et al. Argon laser treatment of proliferative diabetic retinopathy[J].Ophthalmology, 1991,98:1594
[12] 孙心铨，王燕琪．眼底病激光光凝技术浅谈[J]．中国实用眼科杂志，1991，9(1)：3-4
[13] 郑玉祥，李瑞峰．糖尿病视网膜病变光凝治疗的指征和方法[J]．中国实用眼科志，1999，17(1)：6-10
[14] 注栗．糖尿病性黄斑水肿[J]．国外医学·眼科学分册，1995，15：87-91
[15] 孙瑞雪(综述)，李素芬(审校)．糖尿病性黄斑水肿的激光治疗[J]．河北医科大学学2005，26(3)：239-241
[16] R. Joseph Olk. Modified grid argon(blue2gree)laser photocoagulation for diffuse diabetic macular edema[J].Ophthalmology, 1986,93:938-949
[17] 张惠蓉主编．视网膜病临床和基础研究[M]．太原：山西科学技术出版社，1995：89
[18] 张承芬．糖尿病视网膜的激光治疗[J]．中国糖尿粕杂志，1994，2(3)：163-167
[2] 刘家琦，李凤鸣．实用眼科学[M]．第2版．北京：人民卫生出版社，1999：418
[3] 张承芬主编．眼底病学[M]．北京：人民卫生出版社，1998：701
[4] 胡琦，徐锦堂，崔浩．氩激光光凝治疗糖尿病视网膜病变疗效观察[J]．中国实用眼科杂志，2002，20(2)：95
[5] 赵志刚，马书平，张菱，等．Ⅱ型糖尿病初诊时视网膜病变的调查分析及中日比较[J]．眼科研究，2000，18(5)：451-453
[6] 聂爱光主编．现代黄斑疾病诊断治疗学[M]．北京：北京医科大学，中国协和医科大学联合出版社，1997：264
[7] The Diabetic Retinopathy Study Research Group. Preliminary report on effects of photocoagulation therapy [J].Am J Ophthalmol, 1976,81:393-396
[8] Early Treatment Diabetic Retinopathy Study ResearchGroup. Report NO Ⅲ: techniques of scatter and localphotocoagulation treatment of diabetic retinopathy[J]. IntOphthalmol Chil, 1987,4:265-272
[9] 徐凤芹．糖尿病视网膜病变的激光治疗[J]．医学综述，2005，11(9)：823-824．
[10] 张承芬，张惠蓉主编．糖尿病的眼部并发症及治疗[M]．北京：人民卫生出版社，2003：62
[11] 郭庆，刘风华，奚冉冉，等．倍频Nd：YAG激光治疗糖尿病黄斑水肿[J]．中国实用眼科杂志，2000，18(6)：362—363
[12] 王玉，田杰，张绍光，等．氪红激光光凝治疗非增殖性糖尿病视网膜病变黄斑水肿[J]．中华眼底病杂志，1997，13(4)：199—200
[13] 周炜，郭希让主编．眼科激光治疗学[M]．郑州：河南医科大学出版社，1998：298
[14] Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation fordiabetic macularedema:treatm ent techniques and clinicalguidelines for photocoagulation of diabetic macularedema. Early treatment diabetic retinopathy study reportnum ber2[J].Arch Ophthalmol, 1987,94:654.
[15] Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macularedema: early treatmrntdiabetic retinopathy study reportnum berl[J].Arch Ophthalmol, 1985,103:1796-809.
[1] 徐凤芹．糖尿病视网膜病变的激光治疗[J]．医学综述，2005，11(9)：823-824
[2] 张承芬，董方田，叶俊杰，等．增殖前期与增殖期糖尿病性视网膜病变的激光治疗[J]．中华眼科杂志，1989，25(6)：329-331
[3] 何剑峰．激光治疗糖尿病视网膜病变[J]．右江民族医学院学报，1997，4：639-641
[4] 周炜，郭希让主编．眼科激光治疗[M]．郑州：河南医科大学出版社，1998：279-299
[5] 孙心栓，王燕琪．激光全视网膜光凝术[J]．中国实用眼科杂志，1998，16(9)：514-516
[6] 周平．糖尿病视网膜的激光治疗[J]．医学文选，2001，20(6)：882-884
[7] 李瑞峰主编．眼科激光治疗学概要[M]．北京：人民卫生出版社，1998．117-118
[8] 朱豫主编．眼科诊疗新技术[M]．北京：北京科学出版社，2001：116-117
[9] Striph GG, Stark WJ, Kratz RP, et al. Preliminary report on effect of photocoagulation therapy[J].Ophthalmology, 1988,95:1673
[10] RJ. Jalkh AE, Kraff MC, et al. Argon green(514nm)versus krypton red(647nm)modified grid laser photocoagulation for diffuse diabetic macular edema[J]. Ophthalmology, 1990,97:1101
[11] Lee CM,Watzke RC, Suger HS, et al. Argon laser treatment of proliferative diabetic retinopathy[J].Ophthalmology, 1991,98:1594
[12] 孙心铨，王燕琪．眼底病激光光凝技术浅谈[J]．中国实用眼科杂志，1991，9(1)：3-4
[13] 郑玉祥，李瑞峰．糖尿病视网膜病变光凝治疗的指征和方法[J]．中国实用眼科志，1999，17(1)：6-10
[14] 注栗．糖尿病性黄斑水肿[J]．国外医学·眼科学分册，1995，15：87-91
[15] 孙瑞雪(综述)，李素芬(审校)．糖尿病性黄斑水肿的激光治疗[J]．河北医科大学学2005，26(3)：239-241
[16] R. Joseph Olk. Modified grid argon(blue2gree)laser photocoagulation for diffuse diabetic macular edema[J].Ophthalmology, 1986,93:938-949
[17] 张惠蓉主编．视网膜病临床和基础研究[M]．太原：山西科学技术出版社，1995：89
[18] 张承芬．糖尿病视网膜的激光治疗[J]．中国糖尿粕杂志，1994，2(3)：163-167