合并全身病的糖尿病视网膜病变患者的激光治疗

The security of panretinal photocoagulation in diabetic retinopathy patients with systemic disease

目的探讨合并全身病的糖尿病视网膜病变(DRP)患者进行激光治疗的适应证和安全性分析。方法对108例(216只眼)合并全身病的重度非增生性DRP患者进行激光治疗的情况进行统计分析,随访观察半年～1年,对激光的安全性和适应证进行讨论。结果91例(182只眼)激光前后均无不良反应和严重并发症;17例(34只眼)激光后出现视网膜出血,其中26只眼需再次补充光凝,2只眼因玻璃体出血而需行玻璃体切割术。术后视力提高2行以上有48例(96只眼),保持不变56例(112只眼),视力下降4例(8只眼)。结论只要严格掌握适应证,合并全身病的DRP患者进行激光治疗是安全的。其适应证有:①血压控制在140/90 mmHg以下;②血糖控制在10 mmol/l以下;③用药物能控制的心律失常和心功能不全;④近期无心绞痛和心肌梗塞发作史;⑤长期服用抗凝药者应酌情短期减量或停药,使出凝血时间正常或接近正常;⑥因尿毒症需做血液透析者,应选择在透析前1d进行激光,且以无肝素透析为宜。

Objective To evaluate the security of panretinal photocoagulation in diabetic retinopathy patients with systemic disease. Methods The authors performed a retrospective study of panretinal photocoagulation in 108 diabetic retinopathy patients with systemic disease. Results 91 cases （ 182eyes）did not have the complications. 17 cases （34 eyes） had the retinal hemorrhage. Among them,26 eyes were treated with the local photocoagulation again and 2 eye had to do the vitreous operation. After follow up for 6 - 12 months ,48cases （ 96 eyes ） had a better visual acuity. 56cases （ 112 eyes ） were equal and 4 cases （ 8 eyes）were lower than before. Conclusion Diabetic retinopathy patients with systemic disease could be safe after necessary preparation during the course of panretinal photocoagulation. The good control included： BP≤140/ 90mmHg, FBG≤10mmol/l,treated the heart disease, stop or reduced the anticoagulant to keep the blood parameter normal,one day before the blood dialysis and use the non-heparinize dialysis.