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目的 观察增生前期或增生期糖尿病视网膜病变 (diabeticretinopathy ,DR)有临床意义黄斑水肿 (clinicalsignificantmacularedema ,CSME)的患者不同光凝顺序治疗后的近期疗效。 方法 门诊由三面镜及荧光素眼底血管造影 (fundusfluorescenceangiography ,FFA)检查确诊的DR有CSME的连续病例 6 3例 10 3只眼 ,分为A、B 2组。A组 (5 4只眼 )先行黄斑局部光凝 (macularlocalphotocoagulation ,MLP) ,1个月后再行全视网膜光凝 (panretinalphotocoagulation ,PRP) ;B组 (49只眼 )先行PRP ,1个月后再行MLP。随访 3～ 13个月 ,观察 2组患者治疗前后视力、中心 5°光敏感度、FFA的变化。 结果 治疗完成后 2个月 ,A组视力恢复明显好于B组 (P <0 .0 1) ,其余各时间段 2组患眼视力变化差异无显著性意义 (P >0 .0 5 )。3～ 4个月时 2组患眼中心 5°光敏感度改变差异亦无显著性意义 (P >0 .0 5 )。 2组患眼中 5 9只眼 (A组 32只眼 ,B组 2 7只眼 )黄斑渗漏得到有效控制。 结论 对于CSME的增生期或增生前期DR患者 ,先行MLP后行PRP比先行PRP后行MLP视力恢复较快 ;不同光凝顺序对中心 5°黄斑光敏感度没有明显影响。
Objective To observe the short-term curative effect of different photocoagulation procedures in patients with pre-proliferative or proliferative diabetic retinopathy (DR) with clinical significance of macular edema (CSME). Methods Outpatients were examined by three-mirror and fundusfluorescence angiography (FFA). Sixty-three cases (103 eyes) of continuous CSME with DR were diagnosed. The patients were divided into groups A and B 2. In group A (54 eyes), macularlocalphotocoagulation (MLP) was performed first, and panretinal photocoagulation (PRP) was performed one month later. In group B (49 eyes), PRP was performed one month later Line MLP. The patients were followed up for 3 to 13 months. The visual acuity, 5 ° light sensitivity and FFA of the two groups were observed before and after treatment. Results At 2 months after the completion of treatment, the visual acuity recovery in group A was significantly better than that in group B (P <0.01). There was no significant difference in visual acuity between the two groups (P> 0.05). At 3 ~ 4 months, there was no significant difference in the change of 5 ° light sensitivity between the two groups (P> 0.05). Macular leakage was effectively controlled in 59 eyes of 2 eyes (32 eyes in group A and 27 eyes in group B). Conclusions For patients with proliferative or premalignant DR at CSME, the PRP after first MLP is faster than PRP after PRP. The different photocoagulation sequences have no significant effect on central 5 ° macular light sensitivity.