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糖尿病视网膜病变玻璃体积血玻璃体切割手术时机探讨

Visual acuity of patients of proliferative diabetic retinopathy after vitreoretinal surgery

Objective　To observe the visual acuity of different stages of proliferative diabetic retinopathy (PDR) eyes after vitrectomy and analyze the risk factors of blindness.Methods　A total of 384 eyes of 300 patients underwent vitrectomy for PDR were followed up. All cases were divided into three groups according to different stage of PDR (stage Ⅳ, stageⅤ and stage Ⅵ), the effect of vitrectomy were compared among these groups．Results　The final visual acuity increased in 271 eyes (70.6%), among them there were 171 eyes (85.5%) in stage Ⅳ-Ⅴ, and 100 eyes (54.3%) in stage Ⅵ, and there was statistical difference between these two groups（chi;2=44.78，P＜0.05）. 82.8% of early-treated and 64.6% of middle/late-treated stage Ⅵ patients had postoperative visual acuity above 0.05 (chi;2=4.861，P＜0.05). 39.5% (131 eyes) of 332 eyes with diabetic blindness was still blind after surgery. Conclusion　Visual acuity can be improved in the majority of PDR eyes after vitrectomy, early prevention and early treatment are the keys to avoid diabetic blindness.

Therapeutic effect of laser photocoagulation on diabetic retinopathy at different stages

bjective　To observe the therapeutic effect of laser photocoagulation on diabetic retinopathy (DR)at different stages.Methods　A total of 534 eyes of 304 patients with DR diagnosed by fundus fluorescein angiography (FFA) were enrolled in this study. In the 534 eyes, 92 with nonproliferative DR (NPDR) had the bestcorrected visual acuity(BCVA) of 0.52plusmn;0.32,108 with preproliferative DR (PPDR) had the BCVA of 0.49plusmn;0.23,196 with early PDR had the BCVA of 0.20plusmn;0.31,and 138 with highrisk PDR had the BCVA of 0.17plusmn;0.22． According to the rules of ETDRS, retinal photocoagu1ation,pan retinal photocoagu1ation or extrapanretinal photocoagu1ation were performed on the paitents with NPDR,PPDR,and highrisk PDR,respectivelyThe patients were followed up for 10-18 months after the operations and the results of the examinations at the last time were regarded as the criteria for judgement. The examination of BCVA and ocular fundus and FFA were performed with the time interval of 3 months．The judgement for BCVA was(1)improved:improved ge;2 lines;(2) kept still: changed within 2 lines;(3)decreased:decreased ge;2 lines.And the effect on BCVA was positve when it was improved or kept still.The judgement for the therapeutic effect on DR was:retinal edeama was alleviated,leakage of hemorrhage was obsorbed,microaneurysm disappeared or decreased, neovascularization (NV) was relieved completely or partly,nonperfusion area disappeared or narrowed, and no new NV or nonperfusion area came into being. Results After the operations, BCVA in NPDR,PPDR and early PDR groups was improved or kept still in 73(79.3%),83(76.9%)，and 146 eyes (74.5%), respectively,without any statistical difference among these three groups（P＞0.05）.BCVA in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P＜0.05). The positive rate of therapeutic effect on DR was 89.1%,85.2%,82.7% in NPDR,PPDR,and early PDR groups, respectively without any statistical difference among the groups(P＞0.05). The positive rate of therapeutic effect on DR in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups(P＜0.05). Conclusion　The prognosis of DR at different stages after laser photocoagulation is different;timely and effective laser photocoagulation is important to prevent the development of the disease and decrease the blindness rate.