【摘要】  目的：观察白内障人工晶状体植入术后糖尿病视网膜病变(DR) 的氩激光光凝治疗效果及光凝后的远期效果, 探讨光凝治疗的时机及影响光凝的因素。方法:采用Zeiss Visulas 氩离子眼科激光治疗仪对36例58眼的光凝术方法及治疗效果进行回顾性分析。结果:42眼行广泛视网膜光凝术,16眼行局部视网膜光凝术,其中6眼伴有人工晶状体后囊混浊,先期行Nd:YAG激光切开后囊膜。24眼视力提高1～2行,占42%,其中 BDR 16眼,PPDR 8眼；28眼视力无变化,占48%，其中 PPDR 24眼，PDR 4眼；6眼视力下降,占10% ，均为PDR。3mo后行荧光素眼底血管造影( FFA) 检查,新生血管大部萎缩,视网膜水肿消退。结论:适时的白内障摘除联合IOL 植入,合理及时的激光治疗,是控制糖尿病患者眼底病变继续恶化的重要手段。FFA 是进行正确有效激光治疗的重要参考依据,而放置大直径IOL 又是完善眼底激光治疗的先决条件。

【关键词】  白内障摘除联合人工晶状体植入；糖尿病视网膜病变；视网膜光凝术

    Laser treatment of diabetic retinopathy after cataract extraction combined with intraocular lens implantation

    Guo-Pei Li, Gang-Ping Zhao, Min Zhu, Lin-Li Yu, Liao-Yuan Chen

    Department of Ophthalmology, the First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China

     AbstractAIM: To investigate the effect of laser photocoagulation treatment on diabetic retinopathy after cataract extraction combined with intraocular lens implantation, and to discuss the factors which affected the success rate of treatment, and the time of laser photocoagulation treatment.METHODS: Fifty-eight diabetic retinopathy eyes (36 cases) were treated with Zeiss Visulas ophthalmic laser. The method of photocoagulation and result were analyzed retrospectively.
 RESULTS: Forty-two eyes underwent panretinal photocoagulation , 16 eyes underwent local photocoagulation. 6 eyes accompanied with posterior capsular opacity Nd:YAG laser posterior capsulotomy were performed before retina photocoagulation . Visual acuity improved in 24 eyes, remained stable in 36 eyes , decreased in 14 eyes. Three months later , fundus fluorescein angiography (FFA) showed neovascular at rophied and retina edema subsided. CONCLUSION: Timely cataract extraction combined with intraocular lens implantation, rational and timely laser therapy are important methods to control diabetic retinopathy. FFA is an important reference to perform laser photocoagulation. Place big size IOL is a preliminary requirement to perform laser photocoagulation perfectly.

    · KEYWORDS: cataract extraction combined with IOL implantation ; diabetic retinopathy; retina photocoagulation

     0引言

    糖尿病患者致盲的主要原因是白内障和糖尿病视网膜病变(DR) , 白内障术后视力及远期效果除手术因素外, 主要取决于DR的严重轻度及是否对其进行及时有效的治疗。氩激光光凝治疗是阻止及延缓DR 进展的有效方法。现将我院2002-03/2006-03行白内障人工晶状体植入术后伴有DR的患者, 采用氩激光光凝治疗, 对其治疗时机及疗效进行分析。

    1对象和方法

    1.1对象　 DR患者36例58眼,男15例,女21例,年龄32～85岁,糖尿病病史2mo～20a。增生型糖尿病视网膜病变(proliferative diabeticretinopathy ,PDR)10眼,严重非增生型糖尿病视网膜病变（PPDR）32眼,背景型糖尿病视网膜病变(background diabetic retinopathy ,BDR) 16眼。均行超声乳化IOL植入。手术后激光治疗时间1～6mo不等。视力为: 0. 04～0. 8。6眼伴有IOL 后囊混浊,5眼玻璃体有程度不同的出血及混浊,4眼部分虹膜后粘连,3 例白内障患者手术前曾接受局部视网膜激光治疗。

    1.2方法　 我们使用Zeiss Visulas 氩离子眼科激光治疗仪,行视网膜光凝术。术前1wk行荧光素眼底血管造影(furdus fluoresceinangiography, FFA)检查。术眼散瞳后行表面麻醉,仔细观察瞳孔反应和IOL的位置,安置Goldmann三面镜,应特别注意不要对眼球施加压力。对于白内障术后植入IOL眼,由于存在瞳孔不易散大, IOL 光学部与无晶状体部产生像差,加之IOL前后沉积物及后囊混浊等因素,易造成眼底图像不清晰,尤以周边部视网膜更为明显。我们对其中6例合并后囊混浊的患者先期行Nd:YAG激光切开混浊的后囊,1wk后再行眼底激光治疗。鉴于上述情况,在光凝过程中要特别注意术眼的转动配合及随时调整裂隙灯显微镜的角度,注意光凝区域的衔接,以尽可能避免遗漏治疗区域。要根据照射部位和屈光间质的清晰度,选择适当的光斑直径、能量及脉冲时间。本组所用能量为100～360mW ,时间0.1～0.2s ,光斑直径100～300μm ,光斑间隙0.5～1.5个光斑直径。对于新生血管部位则采用较密集的光斑融合光凝。光凝治疗2～4次,光斑点数800～2 500,其中大部分患者激光点数为800～1 600次,仅有1例增生期病变的患者,因周边部广泛无灌注区,后极部密集芽状新生血管,光斑较密集,部分重叠,达到2 500点数。光凝术1mo后复查眼底,部分患者必要时行补充光凝术。3mo后行荧光造影,观察3～24mo。

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