糖尿病视网膜病变患者视网膜新生血管形态与激光治疗效果的关系

Impact of morphological type of retinal neovascularization in diabetic retinopathy on retinal photocoagulation

目的探讨糖尿病视网膜病变患者视网膜新生血管形态与激光治疗效果的关系.方法对2009年1月至2012年11月就诊接受激光治疗的糖尿病视网膜病变患者362例587眼,使用ZeissVisucam型眼底造影机采集视网膜新生血管的形态、面积和分布,将视网膜新生血管按形态分为4个类型隐匿型、轻型、中型、重型.隐匿型采用全视网膜激光光凝术,其余采用超全视网膜激光光凝术,记录患者激光治疗参数、激光治疗前后视力、眼压和眼底的动态变化,进行为期9～12个月随访,总结不同类型新生血管对激光治疗的反应和预后.采用SPSS16.0统计软件进行数据处理,临床疗效采用行×列表的χ2检验,以P〈0.05为差异有统计学意义.结果糖尿病视网膜病变患者不同视网膜新生血管类型激光治疗的有效率：视力维持或提高：（1）隐匿型：77.3%;（2）轻型：56.7%;（3）中型：41.0%;（4）重型：17.2%;新生血管消退且无灌注区减少：（1）隐匿型：42.3%;（2）轻型：34.9%;（3）中型：16.9%;（4）重型：5.4%.结论糖尿病视网膜病变患者视网膜激光治疗的预后,与视网膜新生血管的不同类型相关,及时进行视网膜激光治疗是挽救患者视力的关键.

Objective To explore the morphological classification for retinal neovascularization of diabetic retinopathy and the impact on retinal photocoagulation.Methods The total of 587 eyes with retinal photocoagulation in 362 cases with diabetic retinopathy were received from January 2009 to November 201 2 in our hospital.The morphology,area and distribution of the neovascularization were acquired by Zeiss Visucam angiography machine and they were divided into 4 types:occult,mild,medium and severe.The occult cases were received with the treatment of panretinal photocoagulation and other cases were received with the treatment of extra panretinal photocoagulation.The parameters for retinal photocoagulation,visual acuity before and after the treatment,intra ocular pressure and dynamic changes of the fundus were recorded. The follow-up visits were given during 9 ~1 2 months and then the response to retinal photocoagulation and the prognosis of different types of neovascular were summarized.Clinical curative effect was analyzed by chi-square test.Results The effective rate of retinal photocoagulation for different types of neovascular:Maintained or improved visual acuity:(1 )occult:77.3%;(2)mild:56.7%;(3)medium:41 .0%;(4)severe:17.2%.Neovascular regression and decreased non-perfusion areas:(1 )occult:42.3%;(2)mild:34.9%;(3)medium:16.9%;(4)severe:5.4%.Conclusions The prognosis of diabetic retinopathy after retinal photocoagulation is related to different types of neovascular.It′s very important to choose retinal photocoagulation in time for patients with diabetic retinopathy to ensure visual acuity maintainting.