糖尿病视网膜病变光凝术的并发症与处理

The mechanism and treatment of laser complication in diabetic retinopathy

目的探讨糖尿病视网膜病变（DR）光凝术常见与少见严重并发症的发生机制及处理方法。方法对PPDR、早期PDR、高危PDR患者77例132只眼，实施次全、标准及超全视网膜光凝，有临床意义的黄斑水肿则联合局部光凝。观察术中、术后3个月内并发症的发生并给予相应处理。结果（1）55只眼（41．67％）无并发症发生，病情稳定。（2）29只眼（21．97％）刺、胀痛，多可以忍受，未作特殊处理。（3）16只眼（12．12％）中心视力下降，其中9只眼为黄斑水肿加重，5只眼为调节性视力下降，2眼白内障加重。对有临床意义的黄斑水肿先行局部光凝、延长光凝间隔时间及服用一些中药，有利于黄斑水肿消退。（4）10只眼（7．58％）玻璃体出血，其中2只眼行激光追加；6只眼行玻切手术；2只眼放弃治疗；（5）9只眼（6．82％）感幌眼不能视物，20min内恢复。（6）4只眼（3．03％）急性结膜，加强消毒杀菌可杜绝；3眼（2．27％）急性眼压、血压升高并光感消失，对症急救后视力恢复；1眼睫状体脉络膜水肿伴前房消失，后期瞳孔后粘连，继发青光眼；另有1单眼患者等待光凝术时发生低血糖性短暂晕厥，给予低血糖抢救后好转。结论熟练掌握DR光凝术的技术特点，通晓各种并发症的发生机制和处理原则；严格无菌操作；熟悉患者眼前后节及全身病情；准确判定和快速处理有助于减少严重后果的发生。

Objective To discuss the mechanism and treatment of laser complication in diabetic retinopathy （DR）Methods One hundreds and thirty-two eyes of 77 cases suffering from DR were treated with panretinal photocoagulation.If there were clinically significant macular edema, combined the focal/grid macular photocoagulation was performed.The complication in the laser surgery and that of after 3 months was observed.Results There were no complication in 55 eyes （41.67%） ;29 eyes （21.97%） felt pain;Visual acuity were decreased in 16 eyes （12.12%）;vitreous hemorrhage in 10 eyes （7.58%） （2 eyes with further photocoagulation, 6 eyes underwent vitrectomy, 2 eyes gave up treatment） ;9 eyes （6.82%） were dazzled and this disappeared after 20 minutes spontaneously; 4 eyes （3.03%） had acute conjunctivitis, strict surgical asepsis during laser surgery and routinely use antibacterial eye drops were recommend; 3 eyes （2.27%） had acute elevating of intraocular pressure and blood pressure with light perception disappeared.The visual acuity recovered after lowering the intraocular pressure and blood pressure; 1 eye had ciliary body and choroid edema with ante- rior chamber disappeared, pupil adhesion and second glaucoma.One patient had hypoglycemia and became safe after emergency treatment.Conclnsions Master the technical skill ofpaureteinal photocoagulation to DR and thoroughly understand the mechanism and treatment of laser complication is very important to reduce the incidence of complication and avoid the serious consequences.