离心式全视网膜光凝治疗重度非增生性糖尿病视网膜病变的长期预后分析

Evaluation of long-term prognosis of centrifugalpan-retinal photocoagulation in the treatment of severe non-proliferative diabetic retinopathy

目的比较离心式全视网膜光凝(CPRP)与分次模式完成全视网膜光凝(MSPRP)治疗重度非增生性糖尿病视网膜病变(NPDR)的长期预后情况。方法采用病例系列研究,选择2013年8月~2014年10月于首都医科大学附属北京同仁医院治疗的NPDR患者114例(114只眼),随机分为CPRP组(58例58只眼)和MSPRP组(56例56只眼),随访18个月。观察两组视力预后、激光能量密度、视网膜微动脉瘤消退、硬性渗出和棉絮斑消失、视网膜微血管异常、黄斑中心凹视网膜厚度(CMT)等情况。结果随访观察显示,CPRP组有效控制43只眼,稳定14只眼;MSPRP组有效控制41只眼,稳定14只眼;两组各有1例新增的NP区和视网膜血管微动脉瘤,治疗有效率分别为98.2%及98.2%。两组患者均未出现黄斑水肿或加重,未出现新生血管及无明显无灌注区存在。两组患眼治疗前CMT组值比较,差异无统计学意义(P>0.05),治疗后1周及治疗后18个月,两组CMT值差异有统计学意义(P<0.05)。结论离心式全视网膜光凝治疗重度非增生性糖尿病视网膜病变效果良好。

Objective To compare the long-term efficacy of centrifugal pan-retinal photocoagulation （CPRP） and multiple-step style pan-retinal photocoagulation （MSPRP） for the treatment of non-proliferative diabetic retinopathy （NPDR）. Methods Case series study was adopted. 114 cases （114 eyes） with NPDR treated in Beijing Tongren Hospital, Capital Medical University from August 2013 to October 2014 were selected. Patients were divided into the CPRP group （58：cases, 58 eyes） and the MSPRP group （56 cases, 56 eyes） randomly. All patients were followed for 18 months. The indexes including visual prognosis, power density of laser, regression of retinal microaneurysm, disappearance of hard exudate and cotton-wool patches, intraretinalmicrovascular abnormality, central macular thickness （CMT） were observed. Results During the follow-up, in the CPRP group, the fundus disease in 43 eyes were effectively controlled and kept stable in 14 eyes. In the MSPRP group, the fundus disease in 41 eyes were effectively controlled and kept sta- ble in 14 eyes. There was 1 case in each group with new non-perfusion area and intra^retinal microaneurysm, respec- tively. The effective treatment rates of both groups were 98.2% and 98.2%, respectively. In both groups of patients, none of patients had new or aggravated macular edema or remarkable non-perfusion area, There was no statistically significant difference in CMT at baseline between the two groups （P 〉 0,05）, but after 1 week and 18 months treatment, the differences were statistically significant （P 〈 0.05）. Conclusion The efficacy of long-term prognosis of CPRP for treatment of NPDR is goodi