Lövestam-Adrian Monica, Agardh Carl-David, Torffvit Ole, Agardh Elisabet
Department of Ophthalmology, University Hospital, Lund, Sweden.
Acta Ophthalmol Scand. 2003 Jun;81(3):221-5. doi: 10.1034/j.1600-0420.2003.00050.x.
To examine whether panretinal photocoagulation for severe non-proliferative retinopathy in type 1 diabetes patients could halt the progression of retinopathy with subsequent vitreous haemorrhages and visual impairment.
During a 10-year follow-up study period of 344 type 1 diabetes patients, 81 subjects went through panretinal photocoagulation. Forty patients were treated for severe non-proliferative retinopathy (age at onset of diabetes 14 +/- 8 years, diabetes duration 18 + 10 years) and 41 for proliferative retinopathy (age at onset 15 +/- 10 years, diabetes duration 22 + 13 years). One randomly selected eye per patient forms the basis for the study. Metabolic control, systolic and diastolic blood pressure, serum creatinine and urinary albumin levels were measured and analysed yearly during the follow-up period.
A total of 35% (14/40) of eyes treated for severe non-proliferative retinopathy developed neovascularizations during a mean time of 2.9 +/- 1.5 years. Vitreous haemorrhages were more frequent in eyes with proliferative retinopathy at treatment than in eyes with severe non-proliferative retinopathy (12/41 versus 2/40; p = 0.007). The number of vitrectomies due to vitreous haemorrhages in eyes treated for severe non-proliferative retinopathy tended to be lower (1/40 versus 6/41; p = 0.052). Before photocoagulation, visual acuity (VA) was similar in eyes with severe non-proliferative retinopathy and in those with proliferative retinopathy (1.0, 0.4-1.0 versus 1.0, 0.1-1.0; median and range). Visual impairment and blindness tended to develop more often in eyes treated for proliferative retinopathy compared to those treated for severe non-proliferative retinopathy (10/40 versus 4/40; p = 0.056). Eyes with neovascularizations at follow-up were more often visually impaired (VA < 0.5) than eyes without neovascularizations (15/55 versus 1/26; p = 0.016).
In type 1 diabetes, panretinal photocoagulation may be beneficial even at the severe non-proliferative retinopathy stage in terms of preventing vitreous haemorrhage, subsequent vitrectomy and visual impairment.
研究1型糖尿病患者严重非增殖性视网膜病变进行全视网膜光凝是否能阻止视网膜病变进展以及预防随后的玻璃体出血和视力损害。
在对344例1型糖尿病患者进行的为期10年的随访研究中，81例患者接受了全视网膜光凝。40例患者因严重非增殖性视网膜病变接受治疗（糖尿病发病年龄14±8岁，糖尿病病程18±10年），41例因增殖性视网膜病变接受治疗（发病年龄15±10岁，糖尿病病程22±13年）。每位患者随机选取一只眼睛作为研究对象。随访期间每年测量并分析代谢控制情况、收缩压和舒张压、血清肌酐及尿白蛋白水平。
接受严重非增殖性视网膜病变治疗的眼睛中，共有35%（14/40）在平均2.9±1.5年的时间里出现了新生血管。治疗时增殖性视网膜病变的眼睛玻璃体出血比严重非增殖性视网膜病变的眼睛更频繁（12/41对2/40；p = 0.007）。因玻璃体出血而进行玻璃体切割术的次数，接受严重非增殖性视网膜病变治疗的眼睛往往较少（1/40对6/41；p = 0.052）。光凝前，严重非增殖性视网膜病变的眼睛和增殖性视网膜病变的眼睛视力（VA）相似（分别为1.0，0.4 - 1.0和1.0，0.1 - 1.0；中位数和范围）。与接受严重非增殖性视网膜病变治疗的眼睛相比，接受增殖性视网膜病变治疗的眼睛视力损害和失明的发生率往往更高（10/40对4/40；p = 0.056）。随访时出现新生血管的眼睛比未出现新生血管的眼睛更常出现视力损害（VA < 0.5）（15/55对1/26；p = 0.016）。
在1型糖尿病中，即使在严重非增殖性视网膜病变阶段，全视网膜光凝在预防玻璃体出血、随后的玻璃体切割术和视力损害方面可能也是有益的。
