Chew E Y, Benson W E, Remaley N A, Lindley A A, Burton T C, Csaky K, Williams G A, Ferris F L
Division of Biometry and Epidemiology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892-2510, USA.
Arch Ophthalmol. 1999 Dec;117(12):1600-6. doi: 10.1001/archopht.117.12.1600.
To assess the visual results after surgical lens removal in patients with diabetic retinopathy.
A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy and/or macular edema.
Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, lens surgery was performed on 205 patients (270 eyes) during follow-up that ranged from 4 to 9 years.
Visual acuity, macular edema status, and degree of diabetic retinopathy. In addition, risk factors associated with lens extraction and with poor postoperative visual acuity (worse than 20/100) were assessed.
The risk of lens extraction increased with increasing age, female sex, and baseline proteinuria. Ocular variables associated with increased risk of lens surgery included poor baseline visual acuity and vitrectomy performed during the course of the study. At 1 year after lens surgery, visual acuity improvement of 2 or more lines from preoperative levels occurred in 64.3% of the operated-on eyes assigned to early photocoagulation and 59.3% of eyes assigned to deferral of photocoagulation. In eyes assigned to early photocoagulation, 46% of eyes achieved visual acuity better than 20/40; 73%, better than 20/100; and 8%, 5/200 or worse at 1 year after surgery. Visual acuity results for eyes assigned to deferral of laser photocoagulation at 1 year were not as favorable; 36% achieved visual acuity better than 20/40; 55%, better than 20/100; and 17%, 5/200 or worse at 1 year after surgery. Evaluation of 1-year postoperative visual acuities for all eyes with mild to moderate nonproliferative diabetic retinopathy at the annual visit before lens surgery showed that 53% were better than 20/40; 90%, better than 20/100; and 1%, 5/200 or worse. However, for eyes with severe nonproliferative or worse retinopathy at the annual visit before lens surgery, only 25% were better than 20/40; 42%, better than 20/100; and 22%, 5/200 or worse at 1 year after lens surgery. There was little change in visual acuity between 1 and 2 years postoperatively. Increased severity of retinopathy and poor visual acuity before surgery were associated with visual acuity of worse than 20/100 at 1 year after surgery. Lens surgery was associated with a borderline statistically significant increased risk of progression of diabetic retinopathy in the adjusted analyses (P = .03). No statistically significant long-term increased risk of macular edema was documented after lens surgery.
Visual acuity results after lens surgery in patients in the Early Treatment Diabetic Retinopathy Study were better than published results for similar patients. This may be because of more intensive photocoagulation for lesions of diabetic retinopathy in the Early Treatment Diabetic Retinopathy Study than in previously reported studies. Although patients with severe nonproliferative retinopathy or worse before lens surgery had poorer visual results, visual improvement was seen in 55% of these patients at 1-year follow-up. The main causes of poor visual results in eyes after lens surgery were complications of proliferative retinopathy and/or macular edema.
评估糖尿病视网膜病变患者晶状体摘除术后的视力结果。
一项多中心随机临床试验，旨在评估光凝和阿司匹林对轻至重度非增殖性或早期增殖性糖尿病视网膜病变和/或黄斑水肿患者的疗效。
在糖尿病视网膜病变早期治疗研究中登记的3711例患者中，205例患者（270只眼）在4至9年的随访期间接受了晶状体手术。
视力、黄斑水肿状态和糖尿病视网膜病变程度。此外，还评估了与晶状体摘除及术后视力不佳（低于20/100）相关的危险因素。
晶状体摘除的风险随着年龄增加、女性以及基线蛋白尿而升高。与晶状体手术风险增加相关的眼部变量包括基线视力差以及研究过程中进行的玻璃体切除术。在晶状体手术后1年，分配至早期光凝组的手术眼有64.3%视力较术前提高2行或更多，分配至延迟光凝组的眼有59.3%视力提高。在分配至早期光凝组的眼中，术后1年46%的眼视力优于20/40；73%优于20/100；8%为5/200或更差。分配至延迟激光光凝组的眼在术后1年的视力结果较差；36%的眼视力优于20/40；55%优于20/100；17%为5/200或更差。对晶状体手术前年度随访时所有轻至中度非增殖性糖尿病视网膜病变眼的术后1年视力评估显示，53%优于20/40；90%优于20/100；1%为5/200或更差。然而，对于晶状体手术前年度随访时患有严重非增殖性或更严重视网膜病变的眼，术后1年仅有25%优于20/40；42%优于20/100；22%为5/200或更差。术后1至2年视力变化不大。视网膜病变严重程度增加及术前视力差与术后1年视力低于20/100相关。在调整分析中，晶状体手术与糖尿病视网膜病变进展风险增加具有边缘统计学意义（P = 0.03）。晶状体手术后未记录到黄斑水肿风险有统计学意义的长期增加。
糖尿病视网膜病变早期治疗研究中患者晶状体手术后的视力结果优于类似患者的已发表结果。这可能是因为糖尿病视网膜病变早期治疗研究中对糖尿病视网膜病变病变进行了比先前报道研究更强化的光凝。尽管晶状体手术前患有严重非增殖性视网膜病变或更严重病变的患者视力结果较差，但在1年随访时这些患者中有55%视力得到改善。晶状体手术后视力不佳的主要原因是增殖性视网膜病变和/或黄斑水肿的并发症。
