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目的:比较两种不同光凝方案治疗高危糖尿病视网膜病变,为临床选择获得更好疗效的光凝参数提供参考。方法:高危增殖性糖尿病视网膜病变患者共36例(60只眼),17例(30只眼)应用方案A全视网膜光凝,19例(30只眼)应用方案B全视网膜光凝,方案B与方案A相比,光斑较大、光凝反应较强及光凝范围较广泛。光凝治疗后3个月及6个月后复查眼底荧光血管造影,并酌情追加光凝。随访时间平均8.3个月。结果:抑制新生血管方面,两种治疗方案均有显著的疗效,方案B组较方案A组对新生血管具有更强的抑制作用(P<0.01)。全视网膜光凝术后,两组视网膜前出血或少量玻璃体出血的发生率均有下降,方案B组比方案A组对视网膜前出血及玻璃体出血具有更强的治疗作用(P<0.05)。结论:对严重致盲性疾病高危增殖性糖尿病视网膜病变,及时恰当的全视网膜光凝治疗是抑制新生血管及玻璃体大出血的极重要手段,而采用较大的光凝斑、适当的光凝反应和较广泛的光凝范围可能获得更好的治疗效果。
OBJECTIVE: To compare two different photocoagulation regimens for the treatment of high-risk diabetic retinopathy and to provide a reference for the clinical choice of photocoagulation parameters for better curative effect. Methods: Thirty-six patients (60 eyes) with high-risk proliferative diabetic retinopathy were enrolled in this study. Total retinal photocoagulation was performed in 17 eyes (30 eyes) and total retinal photocoagulation in 19 eyes (30 eyes). B Compared with the solution A, the spot size is larger, the photocoagulation reaction is stronger and the photocoagulation range is broader. Photocoagulation 3 months after treatment and 6 months after fundus fluorescein angiography, and additional photocoagulation, as appropriate. The average follow-up time was 8.3 months. Results: In the aspect of inhibiting the neovascularization, both of the two treatment regimens had significant curative effect. In the B group, the neovascularization was more inhibited than that of the A group (P <0.01). After panretinal photocoagulation, the incidence of pre-retinal hemorrhage or a small amount of vitreous hemorrhage decreased in both groups, and group B had a stronger therapeutic effect on pre-retinal hemorrhage and vitreous hemorrhage than group A (P <0.05). Conclusion: It is very important to inhibit the neovascularization and vitreous hemorrhage in the treatment of high-risk proliferative diabetic retinopathy with severe blinding disease and timely and appropriate panretinal photocoagulation. However, the larger photocoagulation spot, appropriate photocoagulation and A broader range of photocoagulation may achieve better therapeutic results.