糖尿病视网膜病变患者全视网膜光凝术后一年随访的视力结果及相关危险因素

Visual outcomes of pan-retinal photocoagulation in diabetic retinopathy at one-year follow-up and associated risk factors.

作者信息

Rema Mohan, Sujatha Purushothaman, Pradeepa Rajendra

机构信息

Madras Diabetes Research Foundation, Dr. Mohans' M. V. Diabetes Specialities Centre, Gopalapuram, Chennai, India.

出版信息

Indian J Ophthalmol. 2005 Jun;53(2):93-9. doi: 10.4103/0301-4738.16171.

DOI:10.4103/0301-4738.16171

PMID:15976463

Abstract

PURPOSE

To assess the visual outcomes at one-year follow-up after pan-retinal photocoagulation (PRP) in type 2 diabetes mellitus subjects with proliferative diabetic retinopathy (PDR) and associated risk factors.

MATERIALS AND METHODS

A retrospective study, using data from medical records of 5000 Type 2 diabetic patients who underwent a retinal examination between 1995 and 1999 at a diabetic centre. Ocular, clinical and biochemical parameters were assessed at baseline and at one-year follow-up after PRP. Diabetic retinopathy (DR) was documented by colour photography and PRP was performed according to the ETDRS criteria.

RESULTS

PRP was done in 413 eyes, of which 261 eyes of 160 subjects were eligible for the study. One hundred and forty eyes (73%) of 191 eyes with good visual acuity (6/9) at baseline maintained the same vision at one-year follow-up. Of the 53 eyes with visual acuity of 6/12-6/36 at baseline, 58.5% (31 eyes) maintained same vision and 18.9% (10 eyes) improved their vision at one-year follow-up. Of the 17 eyes with visual acuity < or =6/60 at baseline, 12 maintained the same vision and the remaining 5 improved their vision. The causes of visual loss included vitreous haemorrhage in 20 subjects (31.7%), progression of cataract in 19 (30%), chronic macular oedema in 15 (23.8%), pre-retinal haemorrhage in the macula in 6 (9.5%) and pre-retinal fibrosis in the macula in 3 (4.7%) subjects. On multiple logistic regression analysis, diastolic blood pressure (P =0.03), duration of diabetes (P =0.006), fasting blood glucose (P =0.02) and nephropathy (P =0.01) were associated with decreased vision after PRP. Glycated haemoglobin (HbA1c) (P < 0.001), serum creatinine (P =0.03), HDL cholesterol (P =0.05), diabetic neuropathy (P < 0.001), hypertension (P =0.01) and diabetic nephropathy (P < 0.001) showed a significant association with PDR.

CONCLUSION

Visual acuity at baseline, the duration of diabetes and proteinuria played a significant role in determining the post-PRP visual acuity.

摘要

目的

评估2型糖尿病伴增殖性糖尿病视网膜病变（PDR）及相关危险因素的患者接受全视网膜光凝（PRP）后1年随访时的视力预后。

材料与方法

一项回顾性研究，使用1995年至1999年在一家糖尿病中心接受视网膜检查的5000例2型糖尿病患者的病历数据。在基线时以及PRP后1年随访时评估眼部、临床和生化参数。通过彩色眼底照相记录糖尿病视网膜病变（DR），并根据ETDRS标准进行PRP。

结果

413只眼接受了PRP，其中160例患者的261只眼符合研究条件。基线时视力良好（6/9）的191只眼中，140只眼（73%）在1年随访时视力维持不变。基线时视力为6/12 - 6/36的53只眼中，58.5%（31只眼）在1年随访时视力维持不变，18.9%（10只眼）视力改善。基线时视力≤6/60的17只眼中，12只眼视力维持不变，其余5只眼视力改善。视力下降的原因包括20例患者（31.7%）发生玻璃体积血、19例（30%）白内障进展、15例（23.8%）慢性黄斑水肿、6例（9.5%）黄斑区视网膜前出血以及3例（4.7%）黄斑区视网膜前纤维化。多因素logistic回归分析显示，舒张压（P = 0.03）、糖尿病病程（P = 0.006）、空腹血糖（P = 0.02）和肾病（P = 0.01）与PRP后视力下降相关。糖化血红蛋白（HbA1c）（P < 0.001）、血清肌酐（P = 0.03）、高密度脂蛋白胆固醇（P = 0.05）、糖尿病神经病变（P < 0.001）、高血压（P = 0.01）和糖尿病肾病（P < 0.001）与PDR显著相关。