Doft B H, Metz D J, Kelsey S F
Retina-Vitreous Consultants, Pittsburgh, PA 15213.
Ophthalmology. 1992 Nov;99(11):1728-34; discussion 1734-5. doi: 10.1016/s0161-6420(92)31739-7.
A study was performed to determine if diabetic subjects who fail to respond to initial panretinal photocoagulation with regression of retinopathy risk factors do better with supplemental panretinal photocoagulation.
Thirty-five patients with 3 or more retinopathy risk factors who failed to respond to panretinal photocoagulation with regression to less than 3 retinopathy risk factors by 3 weeks after initial panretinal photocoagulation were prospectively randomized to augmentation laser panretinal photocoagulation (MORE) or to no additional treatment (NOMORE).
Six months after initial treatment, the MORE group (n = 16) had regressed a mean of -0.94 retinopathy risk factors (with 95% confidence interval [CI] -1.60 to -0.26), compared with -0.21 retinopathy risk factors (95% CI -0.69 to 0.27) in the NOMORE (n = 19) group (P = 0.055). However, by 1 year, there was no statistically significant difference in the amount of regression of retinopathy risk factors with a mean decrease of -1.12 (95% CI -2.0 to -0.24) versus -1.05 retinopathy risk factors (95% CI -1.80 to -0.28) in the 2 groups, respectively. Similarly, for visual acuity, there was no difference in outcome. For all study patients, the persistence of three or more retinopathy risk factors was associated with a poorer visual result than if there was regression to less than three retinopathy risk factors.
This study shows that although augmentation panretinal photocoagulation achieved faster regression of retinopathy risk factors, by 1 year, there was no difference in either mean regression of retinopathy risk factors or visual acuity between eyes treated or not treated with augmentation panretinal photocoagulation. In addition, the study shows that the persistence of 3 or more retinopathy risk factors 1 year after treatment was associated with a poorer visual result. Because sample size limited the power of the study to find small differences between groups, and because in proliferative diabetic retinopathy small differences could be important clinically, the authors do not recommend changes in current clinical practice.
开展一项研究以确定，对于那些初始全视网膜光凝治疗后视网膜病变危险因素未消退的糖尿病患者，补充性全视网膜光凝治疗是否效果更佳。
35例患有3种或更多视网膜病变危险因素的患者，在初始全视网膜光凝治疗后3周，视网膜病变危险因素未消退至少于3种，将这些患者前瞻性随机分为强化激光全视网膜光凝治疗组（MORE）或不进行额外治疗组（NOMORE）。
初始治疗6个月后，MORE组（n = 16）视网膜病变危险因素平均消退-0.94种（95%置信区间[CI]为-1.60至-0.26），相比之下，NOMORE组（n = 19）为-0.21种（95% CI为-0.69至0.27）（P = 0.055）。然而，到1年时，两组视网膜病变危险因素消退量无统计学显著差异，两组平均分别减少-1.12种（95% CI为-2.0至-0.24）和-1.05种（95% CI为-1.80至-0.28）。同样，视力方面的结果也无差异。对于所有研究患者，持续存在3种或更多视网膜病变危险因素与视力结果较差相关，相比视网膜病变危险因素消退至少于3种的情况。
本研究表明，虽然强化全视网膜光凝治疗能使视网膜病变危险因素更快消退，但到1年时，接受或未接受强化全视网膜光凝治疗的眼睛，在视网膜病变危险因素平均消退或视力方面均无差异。此外，研究表明治疗1年后持续存在3种或更多视网膜病变危险因素与视力结果较差相关。由于样本量限制了本研究发现组间微小差异的能力，且因为在增殖性糖尿病视网膜病变中微小差异在临床上可能很重要，作者不建议改变当前临床实践。
