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目的观察对非增殖性糖尿病视网膜病变进行轻型播散性光凝的治疗效果。设计回顾性病例系列。研究对象背景型糖尿病视网膜病变(BDR)III期,且病变未进入增殖前期(PPDR)的病例100例(178眼),其中合并黄斑水肿者156眼。方法对BDR-III期患者100例(178眼)进行规定治疗标准的轻型播散性光凝,其中合并黄斑水肿的156眼同时进行局部光凝治疗。随诊观察至光凝治疗后2年,对光凝治疗前后的视力、视网膜病变进展程度(通过荧光素眼底血管造影和眼底照相)进行评价。主要指标视力,糖尿病视网膜病变进展程度。结果本组病例在接受早期光凝治疗后2年内,视力变化差异有统计学意义(P=0.017),以光凝后2年的视力变化最为显著。但视力>0.3者的比例变化不大,在光凝前为53.9%,光凝后1年、2年分别为55.1%、52.8%。黄斑水肿通过局部光凝治疗2年内视力稳定或改善的病例达到70.5%。早期光凝术后1年、2年视网膜病变稳定者分别占91.0%、80.9%。结论对于BDRIII期,且病变未进入PPDR的病例行早期轻型播散性光凝治疗,对合并黄斑水肿的病例同时进行黄斑局部光凝,可使多数患者达到稳定视网膜病变进展的作用。
Objective To observe the therapeutic effect of light disseminated photocoagulation on non-proliferative diabetic retinopathy. Design retrospective case series. The study included 100 patients (178 eyes) with stage III diabetic retinopathy (BDR) who did not enter the pre-proliferative phase (PPDR), 156 of whom had macular edema. Methods A total of 100 patients (178 eyes) with BDR-III were treated by light disseminated photocoagulation, of which 156 eyes with macular edema were treated with local photocoagulation. Follow-up observation until 2 years after photocoagulation, the visual acuity before and after photocoagulation treatment, retinal lesion progression (by fluorescein fundus angiography and fundus photography) were evaluated. Main indicators of visual acuity, diabetic retinopathy progression. Results The change of visual acuity was statistically significant (P = 0.017) within 2 years after receiving the early photocoagulation treatment in this group of patients, and the visual acuity was the most significant after 2 years of photocoagulation. However, the ratio of visual acuity> 0.3 did not change much, 53.9% before photocoagulation, 1 year after photocoagulation, 2 years were 55.1%, 52.8% respectively. Macular edema achieved 70.5% of stable or improved visual acuity within 2 years by local photocoagulation. One year after the early photocoagulation, 2 years of stable retinal lesions accounted for 91.0%, 80.9%. Conclusions In the early stage of BDRIII and the patients with no pathological changes in PPDR, early stage light disseminated photocoagulation is performed. In the case of macular edema, macular local photocoagulation can be performed in most patients to stabilize the progression of retinopathy.