【摘要】 目的：探讨非超声乳化小切口白内障摘除人工晶状体植入术后糖尿病视网膜病变激光治疗的时机及效果。方法：对41例68眼行非超声乳化小切口白内障摘除人工晶状体植入术后的糖尿病视网膜病变患者在眼底荧光血管造影(FFA)指导下早期予以激光光凝。结果：光凝治疗后41例68眼术后随访均满1a，其中视力提高19眼(28%);视力不变40眼(59%);视力下降9眼(13%)，总有效率为87%。由于先处理已存在的黄斑水肿，未见全视网膜光凝术后黄斑水肿加重。结论：适时的白内障非超声乳化摘除人工晶状体植入术后合理及时的进行激光光凝，能有效的控制糖尿病视网膜病变的进展，稳定视力。FFA 是进行正确有效激光重要参考依据。
【关键词】 非超声乳化小切口白内障;糖尿病视网膜病变;激光
Laser photocoagulation for diabetic retinopathy after small incision nonphacoemulsification extraction
YongYan Fu1, RuiJun Zhang2,YongHua Jin1
1Department of Ophthalmology, Peoples Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China; 2Department of Ophthalmology, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
AbstractAIM: To evaluate the results of laser photocoagulation for diabetic retinopathy after small incision nonphacoemulsification extraction combined with intraocular lens implantation and to determine the time for the laser photocoagulation.METHODS: According to the results of fundus fluorescein angiography( FFA),totally 68 eyes of 41 cases were treated with the laser photocoagulation earlier after nonphacoemulsification extraction combined with intraocular lens implantation.RESULTS: After one years followup,visual acuity was improved in 19 eyes (28%)，remained stable in 40 eyes (59%) and decreased in 9 eyes (13%). The total effective rate was 87%. Because the macular edema was treated first, no one was found bad after photocoagulation.CONCLUSION: Reasonable laser photocoagulation is preferable for diabetic retinopathy patients after nonphacoemulsification extraction. It can control or delay the advance of diabetic retinopathy, and steady the visual acuities in future.FFA is a very important reference for photocoagulation.
KEYWORDS: small incision nonphacoemulsification extraction; diabetic retinopathy;laser photocoagulation
0引言
糖尿病性视网膜病变(diabetic retinopathy, DR)是糖尿病的眼部严重并发症，是一种复杂的进展性的眼底病变。有效和充分地激光治疗是延缓其发展的关键[1]。然而DR的患者又多合并有白内障，从而影响对DR的治疗效果。我们回顾性分析了我院200505/200712行非超声乳化小切口白内障摘除及人工晶状体植入术后行激光治疗的病例，效果良好，现报告如下。
1对象和方法
1.1对象 200505/200712行非超声乳化小切口白内障摘除人工晶状体植入手术后，常规眼底检查及眼底荧光血管造影(FFA)确诊有DR的患者41例68眼，其中男25例，女16例。年龄35～73(平均56)岁。激光治疗时间3mo以内，所有白内障术后患者均在内科医生指导下控制血糖。
1.2方法 采用倍频532nm Nd∶YAG固体激光器行光凝治疗。所有患者均在术后常规检查眼底并于激光前15d内行FFA，根据FFA结果，制订激光治疗方案。其中增殖期糖尿病视网膜病变(PDR)24眼，增殖前期糖尿病视网膜病变(PPDR)44眼。PPDR表现为：视网膜出血较多，见于4个象限，视网膜静脉串珠样改变(见于2个象限)，视网膜内微血管异常至少肯定出现于一个象限或无灌注区>5.00PD;PDR表现为FFA可见新生血管及无灌注区。PPDR,PDP均用全视网膜光凝镜行全视网膜光凝(PRP)。光凝范围：视盘上、下、鼻侧外1.00DD到赤道壶腹部，黄斑侧1.00DD外到赤道壶腹部。激光参数：后极200μm，中周部250～350μm，时间0.2～0.5s，光斑中心须产生明显白色反应的功率。分3～4次完成，每次光斑数300～500点。间隔1wk光凝1次。对 PPDR，PDR如合并黄斑水肿，则加入局部光凝。黄斑局部水肿即采用灶性光凝法，光凝参数：光凝直径50～100μm，时间0.1s，能量100～200mW;黄斑区弥漫性水肿及囊性水肿即行格栅样光凝。光凝参数：时间0.1s，直径100～200μm，能量100～200mW。光凝后继续随访，随诊1a，期间根据FFA对新生血管未退者和尚存较大区域无灌注区进行追加光凝。
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