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目的观察532 nm激光治疗糖尿病视网膜病变的临床疗效。方法糖尿病视网膜病变患者152例208只眼,分为重度非增殖性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)104例144只眼,增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)48例64只眼,均采用532 nm倍频Nd∶YAG激光行标准全视网膜激光光凝或超全视网膜激光光凝,对合并黄斑水肿者行局限光凝或格栅光凝。术后6~24个月随访,无灌注区或新生血管未消退者行补充光凝,观察各组最佳矫正视力、眼底血管造影(fundus fluorescein agiography,FFA)及眼底视网膜病变进展变化。结果重度NPDR组视力提高和不变115只眼(占79.9%),PDR组视力提高和不变47只眼(占73.4%),两组比较差异有显著意义(P<0.05);眼底视网膜改变,重度NPDR组有效率81.9%,PDR组有效率71.9%,两组比较差异有显著意义(P<0.05);39只眼因黄斑水肿行黄斑局限光凝或格栅光凝,24只眼水肿减轻或消退。结论采用激光治疗DR的临床疗效显著,重度NPDR组疗效好于PDR组,选择合适的时机和有效的光凝治疗是稳定视力和延缓眼底病变的关键。
Objective To observe the clinical efficacy of 532 nm laser in the treatment of diabetic retinopathy. Methods One hundred and twenty-eight eyes (152 eyes) with diabetic retinopathy were divided into 144 eyes (104 eyes) with severe nonproliferative diabetic retinopathy (104 eyes), 48 eyes (48 eyes) with proliferative diabetic retinopathy (PDR) , Were used 532 nm double-frequency Nd:YAG laser standard retinal laser photocoagulation or ultra-total retinal laser photocoagulation, macular edema were confined with limited photocoagulation or grid photocoagulation. Follow-up was performed 6 to 24 months after operation. Photocoagulation was performed without perfusion or revascularization. The best corrected visual acuity, fundus fluorescein angiography (FFA) and retinal retinopathy were observed in each group. Results In the severe NPDR group, 115 eyes (79.9%) had visual acuity improvement and no change, and 47 eyes (73.4%) had visual acuity and no change in PDR group (P <0.05). Retinal retinal changes , The effective rate of severe NPDR group was 81.9%, and the effective rate of PDR group was 71.9%, there was significant difference between the two groups (P <0.05); macular edema in 39 eyes was limited by macular dehiscence or grid photocoagulation, and 24 eyes with edema Reduce or dissipate. Conclusion The clinical efficacy of laser treatment of DR is significant, severe NPDR group is better than PDR group, choose the appropriate timing and effective photocoagulation treatment is the key to stabilizing vision and retarding fundus lesions.