倍频532 nm激光治疗糖尿病视网膜病变疗效评价

Evaluation of Multiplier 532 nm Laser Treatment of Diabetic Retinopathy

目的评价倍频532 nm激光视网膜光凝治疗糖尿病视网膜病变(diabetic retinopathy,DR)的疗效。方法DR患者58例95只眼,其中DRⅡ期11只眼,Ⅲ期43只眼,Ⅳ期37只眼,Ⅴ期4只眼;非增殖性21只眼,增殖前期33只眼,增殖性41只眼。Ⅱ期和部分Ⅲ期患者行局限性光凝,多数Ⅲ期和增殖性患者行全视网膜光凝。倍频532 nm激光光凝参数:光斑直径200～350μm,时间0.2～0.5 s,能量0.2～0.8 W,PRP总光斑900～2600点。随访3～14个月,行视力、眼底和FFA检查。结果非增殖性(Ⅱ、Ⅲ期)54只眼视力提高或不变(100.0%),增殖性(Ⅳ、Ⅴ期)41只眼视力提高或不变34只眼(82.9%),总有效率为92.6%。增殖前期和增殖性74只眼,存在不同程度的视网膜新生血管和/或无灌注区,治疗后有效率为85.1%。黄斑水肿55只眼,光凝治疗后有明显减轻或消退,但视力提高较难,大部分维持不变。无光凝并发症。结论倍频532 nm激光治疗DR效果明显且安全,但随病变程度增加疗效降低;提示对DR的激光光凝治疗要把握时机,早期发现,及时治疗。

Objective To evaluate the results of multiplier 532 nm laser photocoagulation for diabetic retinopathy （DR）. Methods Totally 95 eyes of 58 cases with DR were treated, including DR phase Ⅱ 11 eyes, phase Ⅲ 43 eyes, phase Ⅳ 37 eyes, and phase Ⅴ 4 eyes;there were 21 non-proliferating eyes, 33 pre-proliferating eyes and dl proliferating eyes. The localized laser photocoagulation was used for the patients in phase Ⅱ and partly in phase Ⅲ, the panretinal laser photocoagulation was used for the patients mainly in phase Ⅲ and with proliferating eyes by multiplier 532 nm laser with 100-500 μm diameter of spot 0. 2-0. 5 s time, 0. 2-0. 8 W power and panretinal photocoagulation （PRP） totally with 900-2 600 points. The follow-up time was 3-14 months , examining the visual acuity,funds and FFA. Results The eyesight on all of 54 non-proliferating （ Ⅱ ,Ⅲ ） eyes was improved or unchanged, and that of 34 out of 41 eyes proliferating （ Ⅳ, Ⅴ period）, was improved or unchanged, by 82.9%, and the total efficiency of them was 92. 6%. Seventy four cases had different levels of retinal neovascularization with or without reperfusion, with efficiency of 85.1%. Fifty five cases of macular edema, after photocoagulation therapy, had significantly reduced or dissipated, but improvement of eyesight was hard, the most remained unchanged. All of them were with no photocoagulation complications. Conclusions Multiplier 532 nm laser treatment of DR is obviously secure, but the efficacy is lower when the lesions are more serious So we strongly suggest to detect early and treat early.